E/M Coding

E/M Coding

2021 prolonged service changes

2021 Changes: Get $20 More for New Prolonged Service Codes

Update Notice: 2021 prolonged service changes. Important: This information was updated for accuracy on April 28th, 2021. The guidelines for counting total time for code 99417 were revised to bring clarity around what can be included regarding patient education during a patient visit. You’ll find this update in the “Add Direct Plus Certain Indirect Minutes” […]
AMA E/M Updates

2021 E/M Guidelines: AMA Releases Errata and Technical Corrections

You are not alone when it comes to the challenge of correctly implementing the massive changes implemented this year related to the 2021 E&M coding changes. It’s no surprise that the American Medical Association’s (AMA) CPT Editorial Panel has received numerous questions and requests for clarification on these new 2021 E&M coding changes. As a […]
Using modifier 25

Key to Using Modifier 25? Separate History and Exam

With the new 2021 E/​M guidelines in effect, payers and auditors have made it clear that they’ll be closely scrutinizing E/​M claims more than usual—this includes the modifiers appended to them as well. One of the murkiest modifiers continues to be 25 (a significant, separately identifiable evaluation and management service by the same physician or […]
2021 E/M MDM Guidelines Data

2021 E/M MDM Guidelines: Justify Data Score, Correctly Credit Tests

You can get more credit towards higher levels of medical decision making (MDM) using 2021 E/​M data guidelines that allow you to give more points for tests that your provider orders and/​or reviews. The money is just waiting for you to take it. Getting paid accurately for your office visits in 2021 hinges on your […]
2021 E/M Guidelines for medical decision making

Avoid Pay Loss from 2021 E/M Guidelines for Medical Decision Making

The new 2021 E/​M coding guidelines give you the option of using either time or medical decision making (MDM) to choose the proper code level for office visits. And while time-based coding may be simpler, it’s not always the best choice. Solely follow the clock, and you could cheat yourself out of valuable reimbursement. Three […]
CPT EM 2021 Medical Decision Making

New 2021 Medical Decision-Making Factor

QUESTION: Our clinic is seeing more and more people who lack adequate food and housing. Sometimes this impacts the physician’s plan and assessments. The physicians are concerned that there is high risk for the patient not being able to carry out the needed health requirements. Is there any way for us to give the physicians […]
2021 EM Coding Changes

CMS Rule: Prepare for Huge 2021 E/M Code Changes

You’ve been anticipating the CPT 2021 E/​M coding changes and holding your breath on whether your payers will follow suit. Now with the 2021 proposed Medicare Physician Fee Schedule you can count on at least your MAC to align its coding and payment rules with AMA’s rehauled guidelines. The updates will shake up your E/​M […]
1995 and 1997 EM Guidelines

Avoid 1995 and 1997 E/M Guidelines Misuse – or Face 2021 Overpayments

When documenting medical records, CMS has two sets of established evaluation management (E/​M) documentation guidelines that will be replaced in 2020. You’ve got to understand the key foundations of the current guidelines to be able to learn and understand the upcoming replacement rules – or risk facing thousands in overpayments. E/​M codes will change for […]

Does Medicare Fee Schedule Include E/M Changes for 2020?

QUESTION: I’m pretty nervous about the significant changes to the Evaluation and Management (E/​M) codes being made soon. The 2020 CMS Physician Fee Schedule goes into effect January 1, 2020, Does it contain the changes? ANSWER: The 2020 Medicare Physician Fee Schedule Final Rule confirms that the E/​M code changes completely take effect in 2021. […]
CPT coding 99201 99215 Office Visits

Don’t Lose $64 Per CPT 99201-99215 Office Visits for New and Established Patients

Determining whether a patient is new or established shouldn’t be complicated — but coding CPT 99201-99215 office visits is oftentimes not so clear. Miscoding these E/​M visits, however, can cost you thousands of dollars each year in lost revenue. In fact, selecting an established patient when you should have billed a new patient office visit […]
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