Tag Archive | "E/M"

5 Fast Facts About 1 Payer’s 50 Percent Fee Reduction for Modifier 25

Monday, November 6, 2017

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A payer’s big modifier 25 payment reduction has been getting a lot of attention, both from providers affected and those concerned other payers will adopt the policy. Don’t miss this overview of what the policy is all about. 1. Which Payer Implemented the Policy? Independence Blue Cross, which primarily serves Philadelphia and southeastern Pennsylvania, updated […]

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Ups and Downs, MACRA Modifiers, and E/M DGs in MPFS 2018 Proposed Rule

Tuesday, July 25, 2017

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Part 3 of our proposed rule extravaganza is about the Medicare Physician Fee Schedule (MPFS) 2018 proposed rule. (Part 1 was QPP and Part 2 was OPPS). Let’s get down to business, checking out some highlights explained in recent issues of Medicare Compliance and Reimbursement. Plusses and Minuses The proposed 2018 conversion factor is 35.99, […]

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Don’t Let EHR Tempt You to Upcode E/M Services

Tuesday, June 27, 2017

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EHRs can assist with many aspects of E/M coding (like tracking for coding based on time), but the problem of reporting higher-level E/M codes without medical necessity is still around. A recent article in Ophthalmology Coding Alert discussed the example of a doctor who billed almost all level-four and level-five E/M codes for established patients. […]

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Secrets to Subsequent Hospital E/M Coding Success

Tuesday, May 2, 2017

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Curious how your use of subsequent hospital visit codes compares to reporting by other practices? Palmetto was curious, too. The Part B MAC took part in developing a Comparative Billing Report (CBR) looking at 99231-99233 billing and payment patterns in 2015 for internal medicine providers. Motivation? Those codes see about a billion dollars in improper […]

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Welcome Spring With 3 Laceration Coding Scenarios

Monday, April 10, 2017

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The weather is getting warm enough for bare feet, knees, and elbows, and that leaves them more vulnerable to lacerations. Check out these three scenarios to help you choose correct codes for those cuts, powering up your laceration coding skills for spring. Case 1: Don’t Overcode for Bandaging Skinned Knee Suppose an established patient presents […]

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Tighten Up Your Documentation for Coding E/M Based on Time

Monday, November 21, 2016

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If you almost always choose your E/M codes based on history, exam, and medical decision making (HEM), you may be hesitant to code based on time. But ignoring this opportunity could be leading you to report lower level E/M codes that reimburse at a lower rate than you deserve. Take your time-based coding confidence up […]

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16000 or E/M? Recognize Signs to Simplify Sunburn Coding

Friday, July 22, 2016

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The weather forecast for my hometown this weekend is 98 degrees Fahrenheit and sunny. That heat means anyone outside is likely to have lots of skin exposed to the sun, and that’s a recipe for sunburn. Some patients can find even a first degree sunburn so uncomfortable that they decide a visit to the doctor […]

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