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E/M Coding

E/M Coding

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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Does Medicare Fee Schedule Include E/M Changes for 2020?

QUESTION: I’m pretty nervous about the significant changes to the Evaluation and Management (E/​M) codes being made soon. The 2020 CMS Physician Fee Schedule goes into effect January 1, 2020, Does it contain the changes? ANSWER: The 2020 Medicare Physician Fee Schedule Final Rule confirms that the E/​M code changes completely take effect in 2021. […]
Published Date: December 31, 2019
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CPT coding 99201 99215 Office Visits

Don’t Lose $64 Per CPT 99201 – 99215 Office Visits for New and Established Patients

Determining whether a patient is new or established shouldn’t be complicated — but coding CPT 99201-99215 office visits is oftentimes not so clear. Miscoding these E/​M visits, however, can cost you thousands of dollars each year in lost revenue. In fact, selecting an established patient when you should have billed a new patient office visit […]
Published Date: December 23, 2019
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2020 Medicare Physician Fee Schedule: TCM Expands, E/M Confirmed

If you don’t have time to comb through the 2020 Medicare Physician Fee Schedule Final Rule, you’re not alone. Most physicians and staff are simply too pressed for time to figure out exactly what parts of the rule are relevant to their practice and specialty. If that’s the case — don’t worry. We’ve sussed out […]
Published Date: November 8, 2019
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Ask an Expert: What CPT Code Applies for a Blood Pressure Check by a Nurse?

QUESTION:  Can you bill CPT Code 99211 for a blood pressure check by the nurse? The patient did not see the doctor. – Anonymous, Salt Lake City, UT ANSWER: You may bill CPT code 99211 for a blood pressure evaluation for an established patient whose physician requested a follow-up visit to check blood pressure. CPT […]
Published Date: October 12, 2019
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Infusion Administration

Recognize Infusion Administration Types to Ensure Proper Payment

Coding infusions is far from run-of-the-mill, and if you don’t get it right, you’ll likely see reduced — if not denied — claims. One of the key concepts when reporting this service is understanding the type of infusion you’re providing. Get it right, and your claim sails through, but get it wrong, and you’ll be […]
Published Date: July 18, 2017
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Medicare Overpays

Medicare Overpays Billions on E/M Claims

According to a May 2014 report based on 2010 data, HHS is claiming Medicare overpaid $6.7 billion in E/​M payments to providers. The Inspector General’s report, released on May 29, 2014 estimates that 21% of the $32.3 billion spent on E/​M services in 2010 are overpayments.  This data is based on 657 Medicare claims. Although […]
Published Date: July 21, 2016
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