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E/M Coding

E/M Coding

Incident to

Three Providers Who Were Charged With Incident to Fraud

You’re familiar with billing fraud, egregious upcoding behavior and missing documentation — but are you aware of incident to fraud? Well, it happens more often than you’d think, and can get you into huge trouble. Check out three recent cases of practices who were accused of committing incident to fraud so you can avoid their […]
Published Date: February 24, 2025
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Incident to

3 Incident To Scenarios to Keep You Compliant With 2025 Rules

When it comes to incident to billing, annual updates have become a “blink and you’ll miss it” ordeal. While it’s easy to keep up with some of the changes, others are hard to catch. One such change happened at the end of 2024, and it’s in effect right now. CMS now allows you to bill […]
Published Date: February 9, 2025
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G2211

Check These Telehealth Scenarios When G2211 Applies

Ever since G2211 went into effect last year, practices have been using it to collect more from Medicare when seeing patients for longitudinal care. You can bring in an extra $15 or more from MACs for this service, and it may even be applicable for telehealth visits. To straighten out when you can use G2211 […]
Published Date: February 2, 2025
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G0439

Can You Report Both G0439 and 99495 on the Same Date?

It happens from time to time: Your provider performs an annual wellness visit (AWV) and also handles transitional care management (TCM) at the same visit. In these instances, can you submit a claim to Medicare with both G0439 and 99495 on it? In most cases, the answer is yes, but not always. Read on to […]
Published Date: January 20, 2025
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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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