What do you need to document for the exam? According to the Documentation Guidelines, exam findings must be documented. It is not sufficient to … [Read more...]
Using Time to Select a Code | Dermatology
Some Evaluation and Management codes, and some other codes are defined by the amount of time of the service. When a CPT code is defined by time, … [Read more...]
E/M in 2019: A look ahead
Now that the dust has settled from the release of the Physician Fee Schedule Final Rule, maybe it’s time for a re-cap. This article will also discuss … [Read more...]
E/M for Dermatology | History, Exam, MDM
Accurately documenting and coding E/M services is critical to reducing compliance risk and maximizing revenue for the evaluation and management … [Read more...]
E/M services for Hospitalists | Cheatsheet
This quick coding cheatsheet is a must have when coding E/M services for hospitalists. It covers office visits, consults, initial and subsequent … [Read more...]
Coding for Dermatology E/M | Cheatsheet
This dermatology specific E/M cheat sheet includes 1997 single specialty skin exam and medical decision making examples relevant to your … [Read more...]
Modifier 25 for Dermatology
Modifier 25 Significant, separately identifiable E /M service by the same physician on the same day of the procedure or other service Use to … [Read more...]
Remote Physiologic Monitoring Treatment Management Services
2019 brings us three new CPT codes and a revised existing code for remote monitoring and treatment. Here are the four active codes. Two of them have … [Read more...]
CMS E/M proposal: when will we hear?
Checking my crystal ball, my guess is Friday, November 2. Late afternoon. CMS releases its final rule about 60 days before it goes into effect, and … [Read more...]
Exam and time in a visit | Documentation requirements in E/M services
Question: For an established patient, if I don’t document a physical exam, am I required to say that the visit was a counseling visit and document … [Read more...]
Billing Guide – How Physician Services are Paid
Table of Contents CPT HCPCS Modifiers NCCI Multiple procedures Fee calculation Global surgical payment Diagnosis coding A … [Read more...]
CMS Proposed Changes in the 2019 Physician Fee Schedule Rule | Webinar
Recorded August 16, 2018 Some Fee Schedule rules are almost boring, but not this year! CMS is proposing significant changes to the payment … [Read more...]
CMS proposes significant changes to E/M requirements
By now, you’ve read the headlines that CMS is proposing major changes to both the documentation requirements for new and established patient visits … [Read more...]
Not all emergency surgery should be coded at the highest level | E/M Services and MDM
Surgeons sometimes think that the E/M service on the date of every emergency surgery is the highest level E/M. 99205 or 99285 or 99223. When I … [Read more...]
Coding home visits | Cheat Sheet
Use this reference guide to select a level of service for new and established patient home visits, based on the key components or time. Relevant … [Read more...]
Are changes coming to the E/M documentation guidelines?
Do you remember that CMS is talking about changing the documentation requirements for E/M services? If it slipped your mind in the course of your … [Read more...]
What does the decision to perform a minor procedure really mean?
I received this question recently and want to share it with you. “Since the decision to perform a minor procedure is included in the payment for the … [Read more...]
Let’s go to the source! Should this visit be downcoded?
A physician asked me this question: “As an interventionalist, a good part of my visit is spent not only explaining patients conditions to them but … [Read more...]
Determining new patient vs. established patient | CPT Rules
Question: A physician wrote: “We have a cosmetic treatment center that is separate from our surgical clinic. I have seen a patient in the cosmetic … [Read more...]
To Credit or Not to Credit: Auditing E/M Services
Recorded September 21, 2017 When it comes to auditing E/M services, there’s black, white and a whole lot of gray. Reasonable auditors can disagree. … [Read more...]