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E/M Coding Alert

Make Sure Your E/M Claims Aren't Part of the 14.6 Percent Error Rate
NPP claims are part of the problem. Evaluation and management coding and “&ldqu... Read more
Hospital Policy:
Ensure You're Ready For New NOTICE Requirements
Good news: You may already be doing what you need to do. As you learned in “Look... Read more
Reader Question:
Easily Identify E/M vs. Eye Codes
Question: I just started at an ophthalmology practice and am having trouble figurin... Read more
Reader Question:
Consult NCDs and LCDs Both
Question: Can you help me understand the difference between NCDs and LCDS? Do we ha... Read more
Reader Question:
Focus on the Final Diagnosis
Question: A 14-year-old established patient presented with severe throat pain that ... Read more
Reader Question:
Injury Change Warrants Second E/M
Question: An established patient with a history of left knee injuries reported to o... Read more
Reader Question:
Contact Your WC Payers Before Billing ICD-10
Question: I have heard I won’t use ICD-10 for workers’ compensation rel... Read more
You Be the Coder:
What Qualifies as ER POS?
Question: My physician was performing rounds at the hospital. He got a page that an... Read more
Check 5 Key Diagnosis Code Changes To Perfect Your ICD-10 Claims
Hint: Skip the V codes. Oct. 1, 2015 has come and gone, and you have started  usi... Read more
ICD-10 Spotlight:
Primary Care: Pinpoint Infectious vs. Noninfectious Gastroenteritis
The tests ordered can help guide you in the right direction. When your provider docume... Read more
Revisit the ICD-10 Manual to Make Your Job Easier
Just because the book is thicker, doesn’t mean it is harder to use. Flipping th... Read more
Review the Changes to Your Most Common Diagnoses
Make sure your provider’s documentation will lead you to the right code. Hopeful... Read more
Reader Question:
Don't Count CMS Software a Pass
Question: I have heard that Medicare has created free billing software that will le... Read more
Reader Question:
Avoid ICD-9 and ICD-10 on 1 CMS-1500 Form
Question: Our physician admitted a patient in September and didn’t discharge ... Read more
Reader Question:
Not Enough Documentation? Turn to 'Unspecified'
Question: If I find that a common ICD-9 code that I use doesn’t have a direct... Read more
You Be the Coder:
Coding 'Rule Out' Diagnoses
Question: My ED physician saw a patient for anterior wall chest pain. After he chec... Read more
CPT® 2016:
Get the Scoop on 2 New Prolonged Services Codes You Can Use Next Year
You’ll now be able to report more than just physician time. ‘Tis the seas... Read more
Reimbursement News:
Look Beyond Code Changes to Billing and Policy Updates
CMS pulls back on some proposed changes. With ICD-10 and CPT® code changes on the... Read more
Look Beyond Oct. 1, 2015 in Your ICD-10 Training Plan
Focus on provider + coder cooperation to ensure success. The implementation date for ... Read more
Amidst Anxiety Over Implementation, Focus on the Positives ICD-10 Will Bring
Combat ICD-10 stress with expert advice. Stress levels in your office — includin... Read more
Reader Question:
Learn 2 New POS Codes for 2016
Question: I heard a rumor that we’ll have new place of service codes for hosp... Read more
Reader Question:
Try 25 for E/M + Urinalysis
Question: Our practice performs urinalysis (81003) for some patients and we are hav... Read more
Reader Question:
Don't Assume ICU Means Critical Care
Question: My physician often rounds on patients in the intensive care unit (ICU). H... Read more
You Be the Coder:
I&D + E/M = 2 Codes
Question: Our physician reviewed a 56-year-old male patient with complaints of pain... Read more
Clear Up Consultation Coding Conundrums, Regardless of the Payer
Not all payers follow Medicare rules. For the past several years, you haven’t be... Read more
Identify 'New Problem' Before Billing NPP Services
For established problems, consider billing incident-to the physician. If your practice... Read more
Dig Into the Details of CMS's ICD-10 Announcement
Watch out: Other payers may not have a grace period. If you are confused by the July 6... Read more
Reader Questions:
Stop Submitting Opt-Out Authorization Every Year
Question: Our practice has chosen to opt out of Medicare. I heard that there’... Read more
Reader Questions:
Separately Report Counseling That Prompts Vaccination
Question: An established 19-year-old patient reported to our family physician for c... Read more
Reader Questions:
Obey the 60-day Max for Locum Tenens
Question: We will employ a substitute physician to fill in for one of our physician... Read more
You Be the Coder:
Flu Shot + E/M
Question: When patients come in for a flu shot, our nurse sees the patient first. She do... Read more
Primary Care E/M:
Tackle Camp, School, and Sports Physical Challenges with Preventive Medicine Codes -- Sometimes
Consider collecting from the patient when you can’t bill the payer. Summer and e... Read more
Focus Your ED ICD-10 Prep on These Top-9 Codes, Part 2
Get to know five more common ED diagnoses and their ICD-10 updates. According to the l... Read more
ICD-10 News You Can Use
There is good news on the diagnosis coding front. According to a recent CMS guidance doc... Read more
Unlock Observation Pay By Getting to Know the Timing Rules
Check the clock before you code. With multiple code sets for different types of observ... Read more
Reader Question:
Compare Treatment and Transfer of Care
Question: Is it true that I cannot bill a consultation if the consulting physician takes... Read more
You Be the Coder:
Same-Day E/M and Critical Care
Question: We had a patient with a history of angina report to the emergency departm... Read more
E/M Compliance:
Ensure Medical Necessity Before Leveling Your E/M Services
Key: MDM and medical necessity are not the same. If you are reporting high level E/M c... Read more
Focus Your ED ICD-10 Prep on These Top-9 Codes, Part 1
Set yourself up for diagnosis success this fall. Without the correct diagnosis codes t... Read more
Self Audits:
Analyze E/M Trends to See Where Your Practice Fits
Comparing your coding to the curve can focus your provider education. These days, it i... Read more
Reader Questions:
Check the Dates Before Adding 57
Question: A patient had an office visit (99213) with a 185 diagnosis on Feb. 17. The nex... Read more
Reader Questions:
Skipping PFSH Can Cost You
Question: I have a claim in front of me that is giving me pause because I cannot decide ... Read more
You Be the Coder:
Specialty Designation Matters in New vs. Established
Question:If a patient is referred to our practice for otitis media in 2014 from Dr. Smit... Read more
Emergency Department E/M:
Don't Let Lack of Official Guidelines Waylay Your Facility Coding Compliance
Keep medical necessity at the forefront of your facility’s guidelines. Because C... Read more
Get Specific with Allergic Rhinitis Diagnoses This Fall
Cause will affect your coding. ‘Tis the season for allergies, which means your p... Read more
Specialty Focus - Psychiatry:
Test Your E/M vs. Psych Eval Coding Know-How with 3 FAQs
Don’t interchange E/M and 90792. If you code for a practice that provides mental... Read more
Office Security:
Avoid PHI Breaches With Mobile Technology
Secure passwords are just the beginning. Chances are good that at least one provider i... Read more
Reader Questions:
Think 99395-99397 for a Periodic E/M
Question: A patient presents for her yearly examination, and the ob-gyn decides to ... Read more
Reader Questions:
Point Out Mandated Services With 32
Question: A 40-year-old male came into our office with a work-related back injury. ... Read more
You Be the Coder:
Screening Colonoscopy H&P + Problem-Oriented Service
Question: A high-risk patient came in for a screening colonoscopy to our gastroente... Read more
Inpatient E/M:
5 Steps Walk You Through Top-Notch Inpatient Consultation Coding
Know when to apply modifier AI for proper payment. When your physician provides consul... Read more
News You Can Use:
Stop Worrying About Double-Digit Pay Cuts
Move forward with ICD-10 plans for this fall, too.  Things looked bleak as April ... Read more
Payer Pointers:
Get the Scoop on E/M Myths Direct From NGS
MDM and face-to-face requirements fall in the top-six questions. Whether your practice... Read more
Reader Questions:
Don't Rely on 'Other' ICD-10 Codes
Question: Though there are many crosswalks between ICD-9 to ICD-10, there are many ... Read more
You Be the Coder:
Unravel Intensive and Critical Codes for Neonate on Same Day
Question: My doctor saw a neonate early in the morning. Later that day her conditio... Read more
Case Study:
Improve Your Prolonged Service Coding by Reviewing 3 Coding Examples
Precise reasons in the note for extra time spent on a service are key to getting pa... Read more
Be Ready for 2 GERD K Codes in October
Rely on the note to get information you need to choose either K21.0 or K21.9.Rely on the... Read more
Emergency Codes:
Report More Than 1 ED E/M Code to Pay Multiple Professionals
Don’t try to get paid for a nurse’s work in the ED when the patient doesn&rs... Read more
CPT® 2015:
Adopt New Advance Care Codes for End of Life Discussions
CMS isn’t paying for these services this year, but maybe your payer has a payment ... Read more
Reader Questions:
Ask Your Payer if They Use the 4 x 4 Rule
Question: I have heard of the 4 x 4 rule, but I don’t understand what that really ... Read more
Reader Question:
Save 99318 for Annual Assessments
Question:Our physician met a patient in a nursing facility in March and then saw the pat... Read more
Reader Question:
Don't Report a 99499 Without an E/M
Question: Can I use 99499 to report writing a prescription? Rhode Island Subscriber ... Read more
Reader Question:
Think Again When Reporting Same Date Admission and 99217
Question: A 69-year-old male patient came into our office this week with a mild acu... Read more
Reader Question:
Couple the HPV Vaccine with 99402
Question: An established patient came into our ob-gyn office wanting to talk about ... Read more
Reader Question:
Check for Another F2F in Past 3 Years
Question: We’ve been getting a denial for new patient code 99204. The only se... Read more
You Be the Coder:
Prepare for Denial When 2 Physicians Claim Consult on Same Day
Question: We are a large group with all the physicians billing under the same tax ID. On... Read more
Case Study:
3 Scenarios Help Refine Your Smoking Cessation Coding
Consider using G0436 or G0437 when making your coding decision. Coding smoking and tob... Read more
Breathe Easy: Fourth Digit of Emphysema Codes Provides More Specificity
Two ICD-9 emphysema codes have a direct match to ICD-10 codes. If your providers perfo... Read more
Preventive Care:
Separate Problem-Oriented From Preventive Visit
You can report a problem with preventive but you need to support it in documentation. ... Read more
Quick Quiz:
Push Yourself to Answer 3 E/M Questions
Test and grade yourself to see if you need to take a refresher course. Many topics fal... Read more
Quick Quiz Answers:
Grade Yourself with Our Answers
Test and grade yourself to see if you need to take a refresher course. Answer 1: CMS n... Read more
Reader Question:
Watch Your 99218-99220 Observation Coding
Question: How should I code for a 55-year-old patient with mild chronic bronchitis ... Read more
Reader Question:
Make Use of Specific Codes for Home Visits
Question: We have a patient who had been in the neonatal intensive care unit since ... Read more
Reader Question:
Look to April 1 for Another CF Reduction
Question: Has the new conversion factor been updated since it was released in error... Read more
Reader Question:
Link an FBR to an E/M
Question: A mother brings her child into the office complaining that the child&rsqu... Read more
You Be the Coder:
Meet the Challenge of More Than One Problem Per Day
Question: I work in a practice that has multiple specialties such as orthopedic, ps... Read more
Key Elements:
Differentiate 99213, 99214 to Get the Pay That You Deserve
Knowing what to look for in documentation is the key to deciding outpatient visit leveli... Read more
Look Forward to Diabetes Coding Being More Specific
Instead of both types of diabetes having the same base number, they’ll each have t... Read more
Chiropractic Spotlight:
Overcome the Challenge of E/M Coding with CMT Services
One call to your payer may be your ticket to bringing in chiropractic E/M payments. So... Read more
Reader Question:
Try 99455 If No Other Plan Pays
Question: What code should I use to submit a claim for a disability exam that our p... Read more
Reader Question:
Choose 99211 When an NPP Performs a Service
Question: A pediatrician in my practice ordered a mother to return with her child f... Read more
Reader Question:
Code Interoperative Consult as Inpatient
Question: Doctor A from our office was asked to provide an interoperative consultat... Read more
Reader Question:
Apply 99354 When Over Threshold
Question: Our doctor saw a new 10-year-old patient who was recently diagnosed with ... Read more
You Be the Coder:
Coding a Team Conference With Family Present
Question: A mid-level provider (MLP) in our office met with a patient’s family mem... Read more
Key Elements:
Secure an MDM for an Accurate E/M Level
Take time to break down the complexity of a diagnosis to get proper reimbursements. Wi... Read more
Preview Hypertension Coding to Hit the Ground Running
The organ-related categories with ICD-10 should look familiar. There’s less than... Read more
Key Elements:
Practice the Marshfield System for Figuring MDM
Rely on the records to make choices for each MDM component. Figuring out the medica... Read more
Critical Care:
Don't Overlook Same-Day Critical Care and E/M
Errors in notes can cost you one service. If you’re coding for both an E/M visit... Read more
Reader Question:
Rely On 99462 for Subsequent Care of Newborn
Question: One of our pediatric physicians saw a newborn at the hospital with no med... Read more
Reader Question:
Add Online Consults in Claim
Question: A doctor securely emailed patient information to another physician for he... Read more
You Be the Coder:
Rely on Note for Reason for Partial History
Question: When we have an established patient that comes into our office that needs... Read more