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E/M Coding

E/M Coding

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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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 […]
Published Date: February 2, 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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99211

99211 Q&A: Get Paid More for Your Nonphysician Staff Services

You can get paid for the additional services provided by your medical assistants and registered nurses provide. The amount depends on the number of non-physician staff you employ. For a small practice, this can equal as much as $20K more per year. To access this additional reimbursement, you must correctly utilize CPT code 99211 for […]
Published Date: June 3, 2022
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2021 prolonged service changes

CPT Code 99417 Reimbursement Update: Get $20 for New 2021 Prolonged Service Changes

Update Notice: 2021 prolonged service changes. Important: This information was updated for accuracy on April 28th, 2021. The guidelines for counting total time for CPT 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 […]
Published Date: April 28, 2021
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