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E/M Coding

E/M Coding

G2211

5 Compliance Considerations for Practices Reporting G2211

Ever since the beginning of 2024, practices have been able to report G2211 to collect extra cash for longitudinal care performed with E/​M visits. Since not every patient qualifies for this service and not every insurer will pay it, you must heed some guidelines before you bill this add-on code. Check out five compliance considerations […]
Published Date: September 23, 2024
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99443

Collect Top Dollar for 99443 When Performing Telehealth

When your provider talks to patient on the phone, you may worry that your payer won’t reimburse you appropriately for the visit, even though it takes just as much medical decision-making as an in-person visit. The good news is that Medicare pays over $128 for non-facility telephone visits if you report and document 99443 correctly. […]
Published Date: August 26, 2024
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G2211 reimbursement

Some UHC Plans to Stop Reimbursing G2211: Will It Affect You?

Even though G2211 has only been payable since the beginning of the year, many practices have gotten accustomed to the additional $16.05 in G2211 reimbursement with certain E/​M services. Unfortunately, one payer wants to limit practices from collecting for this service in some circumstances. Read on to get the lowdown on how a new decision […]
Published Date: July 22, 2024
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99211

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. […]
Published Date: July 15, 2024
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99211

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. […]
Published Date: June 17, 2024
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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 […]
Published Date: April 15, 2024
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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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