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E/M Coding Alert

Compliance:
Nab ABN, Forget Worries About Uncovered Services
Experts: ABN will build patient trust. Occasionally, a patient will present to the pra... Read more
Modifiers:
Use G Modifiers to Represent ABN Situation
Medicare uses G modifiers to specify why practice issues ABN. Patients that report to ... Read more
ED E/Ms:
Use This Advice to Decipher ED E/M Questions
Experts: If an ED E/M is prolonged, check for other hospital codes. When you are filli... Read more
Reader Question:
Careful When Coding Oximetry Separately From E/M
Question: We are coding an office E/M code for a patient along with a single-readin... Read more
Reader Question:
Use This E/M Risk Category For Coumadin
Question: In the E/M Table of Risk, where does prescription drug management of Coum... Read more
Reader Question:
Use This Advice to Navigate 'Negative' E/M Notes
Question: Our physician always marks “all others negative” in the elect... Read more
You Be the Coder:
Coding E/Ms That End in Nursing Care
Question: An 86-year-old established patient with worsening dementia due to early-o... Read more
Modifiers:
Go Global to Find Proper E/M Modifier
Trouble deciding between modifiers 57 and 25? Here are the answers you need. When your... Read more
E/M Components:
Count HPI Carefully to Maximize Claim Values
Confusing brief, extended HPI could mean money lost. It’s important that you cho... Read more
Clip and Save:
Use This Template to Get HPI Info
Asking pointed questions will help you sort through HPI. During the history of present... Read more
Reader Question:
Obey Stark Law to Stay Out of Medicare Crosshairs
Question: I overheard one of our nurse practitioners (NPs) say that someone at the ... Read more
Reader Question:
Check for Physician Involvement Before Coding Cast Removal
Question: A 60-year-old presents to the emergency department (ED) and is found to h... Read more
Reader Question:
Go By the Book on Critical Care Claims
Question: CPT® states that a patient must be “critically ill or injured&r... Read more
You Be the Coder:
Choosing an ICD-10 Code for Zika
Question: Have there been any changes in how you should report an ICD-10 code for t... Read more
Hospital Coding:
Note These Rules to Make Proper Observation Code Choice
Experts: Check with third-party payers on longer one-day stays. When your physician pe... Read more
Hospital Coding:
Count Days Before Using Subsequent Observation Codes
If observation stretches into second full day without admit, use these codes. On occa... Read more
Ask An Expert:
Take This Advice When Coding for APNs
Can you code incident-to for acute issues? Read on to find out. We’ve gotten a n... Read more
ICD-10:
Provide Deep Dx Detail With 7th Character, X Placeholder Smarts
Longer Dx codes might require this ‘placeholder’ character. If you’r... Read more
Reader Question:
No Physical Exam? Established E/M Possible
Question: I have newly joined family medicine coding. Recently, when reporting an E... Read more
Reader Question:
Validate Provider Signatures Before Filing Claims
Question: What are the specifics regarding provider signatures on claims? Is it eve... Read more
Reader Question:
Get ABN If Medicare Might Not Pay
Question: I am new to coding and I heard a fellow coder recently mention “get... Read more
You Be the Coder:
E/M and Earwax Removal
Question: I have been researching new cerumen removal code 69209 (Removal impacted ... Read more
Mythbusters:
Get to Know ED E/Ms, Avoid Coding Emergencies
Here’s why it doesn’t really matter how long an ED E/M lasts. Coders who f... Read more
Dual-Provider Coding:
Learn These 3 Keys to Separate Incident-To, Split Visits
POS can be vital when making the coding decision. When a physician and a nonphysician ... Read more
Case Study:
Use This Advice to Check Your Shared/Split Visit Claims
Make sure physicians understand documentation guidelines. When you are considering co... Read more
Reader Question:
Use These Details to Decide Patient Status
Question: An intensive care physician asked my pediatrician to see a premature newb... Read more
Reader Question:
Use This Advice to Master Telemedicine Coding
Question: Can we code for telemedicine services our physician or qualified nonphysi... Read more
Reader Question:
Focus On Insurer With HPI Counts
Question: Could you explain the basics of history of present illness (HPI) coding? ... Read more
Reader Question:
Educate Physicians on 'Automatic' E/M Coding
Question: I am having an issue with one of our physicians who wants to report almos... Read more
You Be the Coder:
Reporting Ear Wick Insertion
Question: Our general practitioner (GP) recently saw a patient with an infection of... Read more
Time-Based Coding:
Use Counseling Exception Where Allowed to Prevent Underpayments
When time dominates the E/M encounter, the exception might apply. If you’re not ... Read more
Time-Based Coding:
The Record Matters When Coding Counseling Exception E/Ms
Pay attention to notes or risk missing counseling exception opportunities. You’d... Read more
Hospital Coding:
Use These Reimbursement Tips, Max Out E/M Visits for Hospital Patients
Learn from these five case scenarios on core inpatient coding. When you perform E/M vi... Read more
Reader Question:
Careful, That Open Wound Care Might Be an E/M
Question: What is the difference between an open and closed wound, and does open wo... Read more
Reader Question:
Feel the Burn: Coding for Sunburned Patients
Question: When patients report for sunburn treatment, how do we code for the servic... Read more
You Be the Coder:
Deciding Between FBR Code, E/M
Question: A patient reports to the physician’s office with a jagged piece of ... Read more
Dual-Provider Coding:
Remember, Concurrent Care Cannot Address the Same Concern
Here’s the difference between ‘concurrent,’ ‘duplicative.’... Read more
Critical Care Q&A:
Answer These 3 Questions to Solidify Critical Care Coding
If the ‘critical care’ doesn’t last 30 minutes, we’ve got the co... Read more
Case studies:
Check Your 99291 Smarts Against These Scenarios
Can you get all the codes right on these 2 cases? Deciphering encounter notes to find... Read more
Quick Dx Tips:
Reduce Coding Headaches by Knowing Chronic Migraine Symptoms
Experts: You have to know which migraines qualify as chronic to code correctly. Any me... Read more
Reader Question:
Observe 8-Hour Rule on 1-Day Observations
Question: One of our physicians performed an observation service for a patient that... Read more
Reader Question:
Check for Physician Involvement on Cast Removals
Question: A 10-year-old male patient presents to the emergency department (ED) for ... Read more
Reader Question:
Check Payers' Policies on Modifier SA
Question: We employ a nurse practitioner (NP) at our office. When she provides supe... Read more
You Be the Coder:
Coding Late-Occurring and Private Payer IPPEs
Question: I know how to code initial preventive physical exams (IPPEs) for most of ... Read more
CCI 22.1:
CCI Bundles Up INR, Anticoagulation With Hospital Codes
Expert: Stop reporting 99363, 99364, G0250 with these inpatient E/Ms. The latest Corre... Read more
Medicare:
Incorrect Incident-to Billing Could Cut Into $$
Keep your bottom line strong with incident-to coding smarts. Coders who don’t kn... Read more
Modifiers:
Follow 32's Rules When Coding Mandated Services
Expert: Second opinion requests often lead to modifier 32 situations. When a provider ... Read more
Reader Question:
Coding O2 Therapy, E/M Together Will Deflate Claim
Question: During an E/M service, our provider ordered oxygen therapy for a 65-yeear... Read more
Reader Question:
Learn Split/Shared Visit Rules to Avoid Pay Cuts
Question: I’ve heard nurse practitioners (NPs) and other providers talk about... Read more
Reader Question:
Don't Get Paranoid Over a Paronychia Procedure with an E/M Code
Question: I have a question regarding whether to apply both the E/M code and the pr... Read more
You Be the Coder:
Nosebleeds, E/Ms and Potential Procedure Codes
Question: I have a rather involved claim that I need help with. A 22 year-old estab... Read more
Modifiers:
Split E/M from Typical Postop Care With 24
Modifier will make unrelated E/Ms during surgical globals fly. Most E/M services for p... Read more
ICD-10 Coding:
Hone in on Proper Migraine Diagnoses With 4th-Character Smarts
Here’s why character No. 4 is the major player for migraines. Getting a bead on... Read more
Clip N Save:
Consider Critical Care When You Spot These Interventions
Don’t be fooled by interventions that are separately reportable from 99291/99292. ... Read more
Reader Question:
Consider Modifier CR When Disaster Occurs
Question: I’ve been reading through the latest CPT® book, and I happened ... Read more
Reader Question:
Remember the Excludes1 Note on CTS ICD-10 Codes
Question: Could you explain how to report ICD-10 codes for carpal tunnel syndrome (... Read more
Reader Question:
Think Before Coding E/M with Every Surgery
Question: Can I charge for a 99213 and a 17250 on the same day at the same visit if... Read more
Reader Question:
Remember Modifier, Dx Pairs for ED E/M, Thoracentesis
Question: A patient with shortness of breath reports to the emergency department (E... Read more
You Be the Coder:
Put Locum Tenens Rules to Work for You Using These Tips
Question: Our practice recently hired a locum tenens (LT) physician to fill in for ... Read more
Critical Care:
Max Out Pay by Separating Certain Services from Critical Care
Experts: You’ll often see these separately reportable services on 99291 claims. ... Read more
E/M Elements:
Keep Accurate ROS Count to Make Correct E/M Decision
Spot complete ROS and you might be able to code a high-level E/M. When you’re co... Read more
Modifier Basics:
Make Modifier 25 Your Constant Companion When Considering Multi-Code Claims
Documentation is the key to claims with separate E/Ms. Coders that hope to report E/M ... Read more
Reader Question:
Remember, One Size Doesn't Fit All When Coding Physicals
Question: I work at a family practice that performs a lot of physicals for kids &md... Read more
Reader Question:
Code E/M for Most 'Buddy Taping' Services
Question: I work in an emergency department (ED), and I have a question about fract... Read more
You Be the Coder:
Choosing Acute or Chronic Dx
Question: For diagnosis coding purposes, what is the difference between acute and c... Read more
Coding Compliance:
Find Your E/M Coding Flaws with Self-Audits
Spot E/M issues before the payers do, and prevent future headaches. Any medical practi... Read more
E/M Self-Audits:
Remember Modifier 25 When Conducting Self-Audits
You need to prove significant, separately identifiable service before employing the modi... Read more
Case Study:
Get Elemental to Gain Knowledge on HPI Levels
Remember, Medicare, and CPT® differ on duration element. Each coder in the office... Read more
Medicare News:
Medicare Payer Reports Problems with 99215 Use
Jump any high-level claim hurdles you might encounter with this advice. NGS Medicare r... Read more
Medicare News:
NGS Reports Worse Error Rates for Hospital E/M Codes
Solidify hospital coding by using pre-payment audit results. NGS Medicare’s rece... Read more
Reader Question:
Coding Same Level E/M for Follow-up Visits
Question: Our internal medicine specialist recently saw a patient who was suffering... Read more
Reader Question:
Remember, Critical Care Needn't Be Continuous
Question: A 68-year-old woman with cirrhosis presents to the emergency department (... Read more
Reader Question:
Calendar, Not Clock, Drives Observation Code Choice
Question: If we admit a patient to observation at 11 p.m. on Thursday and then rele... Read more
You Be the Coder:
Using Time to Choose E/M Level
Question: I have an encounter note in front of me that I cannot decipher. Notes ind... Read more
News You Can Use:
Keep an Eye on Your 2016 Prolonged Services, Home Visits
The OIG will be. Every year, the Office of the Inspector General (OIG) puts together ... Read more
Inpatient:
Prove Medical Necessity and You Can Skip the Two-Midnight Rule
But don’t overlook it completely, CMS says. While CMS won’t give in fully ... Read more
Clip and Save:
Protect Your Practice From Nursing Facility Snafus With a Contract
Using a sample agreement like this can ensure you get proper payment. If you are one o... Read more
Reader Question:
Capture NP Counseling with New Code: 99415
Question: A 25-year-old new patient reports to the gastroenterologist complaining o... Read more
Reader Question:
Take Note of New 'Excludes1' Guidance
Question: I heard that there were changes to the Exclude notes in ICD-10, but they ... Read more
Reader Question:
Base Coding on HEM, Not Visit Type
Question: I have a provider that saw a patient on Monday and coded a 99214. He then... Read more
Reader Question:
POS Won't Eliminate Global Period
Question: Does the global period of a surgical procedure, such as 11642, apply when... Read more
You Be the Coder:
Sort Out DSMT Code Options
Question: What CPT® and ICD-10 codes should we be using for diabetes education ... Read more
Follow 3 Tips to Successfully Report Pre-op Clearance Encounters
Note the pre-op clearance is different from an H&P. Many providers, both primary c... Read more
RAC Audits:
Shore Up Your SNF Coding Before Auditors Come Knocking
1 RAC points you toward problem areas you can fix now. If your physicians perform E/M... Read more
Advance Care Planning:
Your Chances of Getting Paid for End-of-Life Services Just Got Better
But you may see a small reimbursement dip due to conversion factor changes. Since Janu... Read more
Reader Question:
Update Your Deductible Collections
Question: Can you tell us what the Medicare deductible will be for next year? Ken... Read more
Reader Question:
No Hospice Employment Relationship? Use GV
Question: A patient at a local hospice care facility with terminal lung cancer was ... Read more
Reader Question:
Identify Separate Service Before Charging an E/M with Allergy Shots
Question: My physicians have just started seeing patients for allergy shots. They w... Read more
Reader Question:
Routine 99211s Will Land You in Hot Water
Question: My doctor heard we can report 99211 with 85610 for prothrombin time check... Read more
You Be the Coder:
Is 81001 POS Dependent?
Question: Is 99214 payable if coded with 81001 when the place of service is 22? Is ... Read more