Tick-Tock: Understand Why Time Matters for E/M Coding

Mon, Apr 22, 2019


understand time for E/M coding success

For E/M, there has been a lot of attention on how the role of time will change in 2021. But what about right now? After this skill sharpener on time in the AMA CPT® E/M guidelines, you’ll have a better understanding of time’s current role in E/M coding.

Where to Find AMA CPT® E/M Guidelines

The CPT® code set includes a set of E/M Services Guidelines that give you important information about applying the codes in the E/M section.

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Your Secret Decoder for ICD-10-CM Notes Has Arrived!

Thu, Apr 18, 2019


I’ve been working with ICD-10-CM notes recently, like Excludes1 and “code first.” One thing coders have to know about those notes is that they come with qualifiers. Let’s look at some of the not-so-obvious meanings of these ICD-10-CM notes.

Excludes1 Means “NOT CODED HERE!” Unless …

ICD-10-CM Excludes1 notes originally came with the explanation that you should never report the excluded code at the same time as the code above the note. The idea was that the two conditions in the two codes could never occur together. But life and coding aren’t always that simple.

In practice, coders found that in some cases when an …

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Before You Pick a Pain Code, You Need to Know These Official Guidelines

Mon, Apr 15, 2019


ICD-10-CM is picky about pain coding, and it’s no wonder considering all the possible variations. Fortunately you can turn to the 2019 ICD-10-CM Official Guidelines for Coding and Reporting (OGs) to keep your coding skills sharp. Today we’ll take a look at some of these pain pointers.

Walk a Fine Line for Pain Related to Psychological Factors

Pain related to psychological factors has one code. Pain exclusively related to psychological factors has another …

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Coding Snapshot: 4 Answers to Ace Major Joint Arthrocentesis

Thu, Apr 11, 2019


coding for arthrocentesis

Time for an arthrocentesis refresher! Today we’re digging into the details of 20610 and 20611 with four questions and answers.

1. What Are the Major Components of These Codes?

Let’s start by working our way through the code descriptors:

  • 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance)
  • 20611 (… with ultrasound guidance, with permanent recording and reporting).

Both descriptors start by stating the codes represent arthrocentesis, which is puncture and aspiration of a joint, according to Dorland’s Illustrated Medical Dictionary. …

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$325 Million in Office Visit Underpayments! How Much Is Yours?

Mon, Apr 8, 2019


Don't lose reimbursement to downcoding.

Audit discussions often focus on the fear of upcoding and having to hope that repaying the extra amount is the worst of the consequences. But downcoding is another problem area affecting your payments and more. Here’s why you should never purposely downcode your services.

Start With a CERT Story

Wondering about the $325 million in the headline? CMS measures improper payment rates through the Comprehensive Error Rate Testing (CERT) program. The 2018 Medicare Fee-for-Service Supplemental Improper Payment Data report includes Table F5: Top 20 Types of Services with Downcoding Errors.

The top data row of the table shows that established office visits had …

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No More 99201? What’s Coming in 2021 for E/M

Thu, Apr 4, 2019


E/M coding changes

There’s been a lot of buzz about what Medicare has planned for E/M in 2021. One question all that raises is how it will mesh with AMA CPT® coding rules. Here are some hints from the February 2019 CPT® Editorial Summary of Panel Actions about what is in store for the code descriptors and guidelines.

Do You Review Panel Action Summaries? You Should!

First a note about the source. Each Editorial Summary of Panel Actions gives a glimpse into (…

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How Well Do You Know ICD-10-CM Vax Codes? Quiz Time!

Thu, Mar 28, 2019

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ICD-10-CM coding for immunization

Complete knowledge of ICD-10-CM coding for immunizations means knowing how to code both when an immunization occurs and when it does not. Ready to see if you’ve mastered the ICD-10-CM codes for these encounters? Let’s go!

Choose Your Answers to These ICD-10-CM Questions

Q1. What does the code-level note with Z23 (Encounter for immunization) in the ICD-10-CM tabular list instruct you to “Code first”?

Q2. Which reason for not carrying out an immunization is NOT covered under Z28.0-?


  • A. acute illness
  • B. immune compromised state
  • C. …
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Simplify Cystocele Coding With These ICD-10-CM and CPT® Pointers

Mon, Mar 25, 2019


coding for urogynecology encounters

Urogynecology brings together urology and gynecology, specifically focusing on treating pelvic floor disorders. One diagnosis urogynecology coders need to be familiar with is cystocele, our topic for today.

Tie Your Diagnosis to These ICD-10-CM Codes

A cystocele occurs when the wall between the bladder and vagina weakens, causing a protrusion. You should report this condition using ICD-10-CM subcategory N81.1- (Cystocele). You have three codes to choose from in this subcategory:

  • N81.10 (Cystocele, unspecified)
    • Use this code when the only information you have is cystocele, prolapse of vaginal …
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Make the CCI Manual Your Go-To Guide for Shoulder Arthroscopy With Debridement

Thu, Mar 21, 2019


coding shoulder arthroscopy

Before you code debridement with shoulder arthroscopy, make sure you know what the Medicare Correct Coding Initiative (CCI) manual has to say. You’ll find the highlights here to help you get started.

Where to look: You’ll find these instructions in chapter IV, section E, of the Medicare CCI manual.

Same Shoulder? Stick to the Basic CCI Rule

In chapter IV, section E.4, the CCI manual states that “CMS considers the shoulder to be a single anatomic structure,” and so CMS does not …

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Watch April MPFS Update for NGACO Code Changes With a January Twist

Mon, Mar 18, 2019


NGACO home visit HCPCS code updates

Ready for some retroactive MPFS changes? The next Medicare Physician Fee Schedule update may have an April 1, 2019, implementation date, but the effective date is Jan. 1, 2019. The theme for the HCPCS codes involved is Next Generation Accountable Care Organization (NGACO) Model Post Discharge Home Visits.

Remember: “MACs will not search their files to retract payment for claims already paid or to retroactively pay claims. However, MACs will adjust claims that you bring to their attention,” MLN Matters

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