E/M Coding

E/M Coding

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 […]
Published Date: March 11, 2024
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G2211

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 […]
Published Date: March 3, 2024
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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 […]
Published Date: November 28, 2023
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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, […]
Published Date: August 16, 2023
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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 […]
Published Date: July 10, 2023
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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 […]
Published Date: June 20, 2023
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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 […]
Published Date: May 31, 2023
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Split/shared billing rules

Master 2023 Split/Shared Billing Rules With Key Tips & Examples

When a split/​shared visit takes place, both the physician and the nonphysician provider (NPP) perform part of an E/​M visit in the facility setting. The tricky part comes in when determining which provider should actually report the claim for the service. Check out a few tips so you can ensure your practice is following the […]
Published Date: April 11, 2023
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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 […]
Published Date: February 21, 2023
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Evaluation and management codes

See How Coding for 2 E/M Visits on 1 Day Dramatically Changed

It’s a question that has confounded coders and practice managers for years: What do you do if you see a patient in your office, then admit them to the hospital because the condition requires more acute attention? Reporting two evaluation and management codes representing the different sites of service has not been an option in […]
Published Date: December 30, 2022
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