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E/M Coding

E/M Coding


Nail Down Physician Supervision Levels Before Reporting 99211

If you’ve ever submitted claims for 99211 — also referred to by many practices as the nurse E/​M visit — then you know it requires physician supervision if a registered nurse is billing it. What may be confusing to some medical teams is what type of supervision is necessary, since Medicare maintains multiple supervision levels. […]

99211 Documentation Checklist to Back Up Every Nurse Visit

Auditors routinely agree that when they review E/​M notes, they tend to find that documentation for nurse visits (99211) is too brief. Even though these visits may actually be short and uncomplicated, your documentation must always demonstrate medical necessity for what was done. Consider these documentation guidelines for your nurse visits when you report 99211. […]
Critical care codes

3 Important Facts About Billing Critical Care Codes 99291-99292

Reporting the critical care codes (99291-99292) can lead to mass confusion for many coders and billers. After all, these services are considered both inpatient care and E/​M services — but they follow slightly different rules than most other inpatient E/​M codes. To get a handle on how to report the critical care codes at your […]
Same-day admit/discharge

Let These Examples Guide Your Same-Day Admit/Discharges

When CPT eliminated observation care designations from its coding lineup in 2023, some coders were puzzled about how to report same day admit and discharge situations, and the rules have only become more confusing as the calendar turned to 2024. After all, there are always going to be situations when patients are admitted to observation […]

New G2211 Facts Help Guide Your E/M Reimbursement Strategy

Sometimes it may feel like you’re navigating the G2211 coding and payment rules without much guidance, since CMS updates about how to report this E/​M add-on have been sparse. Fortunately, one Part B MAC has come out with nearly a dozen FAQs that untangle several issues that coders have encountered since this code became payable […]
Modifier 25

3 Modifier 25 Best Practices to Keep Your E/M Pay Flowing

Every minor procedure your providers perform includes an inherent evaluation and management (E/​M) portion factored into the reimbursement for it. But when you go beyond that cursory E/​M work, you should be able to collect for the extra time your provider spends — and that’s where modifier 25 comes in. Although modifier 25 represents a […]
Time-based coding

9 Things You Can Count Toward E/M Time (and 4 You Can’t)

When the office-based E/​M coding guidelines changed in 2021, coders faced a huge learning curve. It involved transitioning from selecting the right code based on history, exam and medical decision making (MDM) to choosing the most appropriate code based on either time spent or MDM only. And while coders have weathered the change by now, […]
Split/shared billing rules

3 Ways to Prepare for the Split/Shared Changes Coming Soon

As many practices are aware, the split/​shared billing rules changed earlier this year, and are in for an even bigger overhaul starting January 1st. If your practice is trying to get ahead of the curve, now is a great time to get a handle on what will change in 2024 and what you’ll need to […]
Prolonged services

RACs Add Prolonged Services to Audit List: Find out Why

When your E/​M visit lasts longer than expected and you want to account for your provider’s additional time, you might reach for a prolonged service code. Just be sure to double-check which code pairs you report together, because the recovery audit contractors (RACs) are watching. Background: Earlier this year, Part B RAC Cotiviti added a […]
Evaluation and management

Report Reveals Whether E/M Changes Freed up Provider Time

When the CPT rules changed in 2021 and the evaluation and management (E/​M) coding requirements were overhauled, one of CMS’ goals was to cut back on the documentation burden that providers faced. By choosing E/​M codes based on time or medical decision making (MDM) for outpatient visits, the idea was that providers would have more […]