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G0316: CMS Corrects Time Threshold Errors in 2023 Final Rule

Everybody makes mistakes, but when it’s CMS creating the error, it can create ripple effects through your practice. Hopefully, the agency’s latest mistake provides your practice with a benefit rather than a headache. At issue is the time threshold that must be met to report code G0316, which represents prolonged inpatient/​observation care for Medicare patients. […]

1 Myth and 3 Truths About When to Use CPT Code 99211

You may think you know everything possible about CPT code 99211—or maybe you’re one of the people who thinks there isn’t much to know about this code. After all, some practices simply assign it to every service the nurse provides and move on. This strategy can backfire as audits of 99211 ramp up and payers […]
E&M coding

3 Case Studies Help You Choose the Correct Inpatient Code

Now that your practice has been applying the new inpatient E&M (99221-99233) coding rules for nearly two months, you may have questions about how to apply them. After all, utilizing codes in real-world scenarios can be vastly different than simply reading descriptors in code books. That’s why we’re sharing three examples that can help every […]
Same day admit and discharge

Let These Examples Guide Your Same-Day Admit/Discharges

When CPT eliminated observation care designations from its coding lineup earlier this year, some coders were puzzled about how to report same-day admissions and discharges. Despite the coding rules being overhauled, that didn’t change the fact that patients may be admitted to observation (or inpatient status) and discharged on the same date of service, and […]
Social determinants of health

Z59: Prepare for New SDOH ICD-10-CM Codes Before April 1

Your practice is finally getting the 2023 ICD-10-CM codes committed to memory and you’re settling into the latest CPT code updates—but hot on the heels of those changes comes a whole new crop of diagnosis codes, set to debut on April 1, 2023. Among the latest additions to ICD-10-CM are more than a dozen new […]
E/M codes

CMS: E/M Codes Linked to Over $1 Billion in Improper Payments

Every coder knows that although most providers perform evaluation and management (E/​M) services nearly every day, coding these visits aren’t necessarily straightforward. That fact is backed up by data in the latest CMS report, which notes that E/​M codes 99202-99215 were responsible for more than $1 billion in improper payments during the most recent 12-month […]
Chronic pain management

G3002: Make the Chronic Pain Management Codes Work for You

Medical practices have become accustomed to hearing about cuts to Medicare pay every year, so it’s always good news when Medicare begins covering a new service. Such is the case this year, now that CMS has introduced two new Medicare-specific codes covering chronic pain management. Before you can start collecting for the newly-released chronic pain […]
Advance care planning

Avoid These Advance Care Planning Errors to Keep Pay Flowing

Is your practice reporting advance care planning (ACP) properly? If you’re like the majority of practices that the OIG recently audited, you’re probably documenting these incorrectly, which could mean you’ll need to pay money back to Medicare. Here’s why: A recent OIG audit revealed that out of 691 ACP services they reviewed, 466 didn’t comply […]
CPT code 99211

Check These Four Documentation Rules for Reporting 99211

Your nurses are vital to your office’s operations, and the income they generate is vital as well. But if you don’t ensure that they document their visits properly, you could be throwing thousands of dollars out the window. That’s because payers and government auditors are reviewing documentation for nurse-visit CPT code 99211, and if they […]
risk adjustment

Risk Adjustment: Are You Self-Auditing ICD-10-CM Codes?

Medical practices can get paid more for Medical Advantage claims by accurately reporting patient risk—but the main way insurers evaluate risk is through your diagnosis codes. And if your practice isn’t performing ICD-10-CM self-audits, you could be underrepresenting your risk and shorting your practice significant income without even knowing it. Background: Risk adjustment is a […]