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E/M Coding Alert

Nab ABN, Forget Worries About Uncovered Services
Experts: ABN will build patient trust. Occasionally, a patient will present to the pra... Read more
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
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
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
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
Incorrect Incident-to Billing Could Cut Into $$
Keep your bottom line strong with incident-to coding smarts. Coders who don’t kn... Read more
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
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
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