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E/M Coding

E/M Coding

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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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 […]
Published Date: April 7, 2021
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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 […]
Published Date: March 11, 2021
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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 […]
Published Date: December 14, 2020
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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 […]
Published Date: December 2, 2020
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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 […]
Published Date: October 1, 2020
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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 […]
Published Date: August 26, 2020
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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 […]
Published Date: February 7, 2020
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