Prolonged service codes give practices the opportunity to earn additional revenue when the treating clinician spends extra time on a patient’s care. Evaluation and management (E/M) office visit codes include prolonged service code for exclusive use with office E/M services. Learn some quick facts about prolonged service codes and E/M visits.
Physicians and other qualified healthcare professionals have the flexibility to select an evaluation and management level based on either the complexity of medical decision-making or the total time spent on the date of the encounter. This article covers documenting E/M services based on time.
Level-based evaluation and management services may be coded based on medical decision-making (MDM). To reach a code based on MDM, the documentation must support at least two out of the three elements. This article covers the first element: number and complexity of problems addressed at the encounter.
Physicians and other qualified healthcare professionals have the flexibility to select an evaluation and management level based on either the complexity of medical decision-making or the total time spent on the date of the encounter. This article covers documenting E/M services based on time. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The major revisions to the coding guidelines for office/other outpatient evaluation and management visits are almost four years old. And yet, practices continue to face challenges when they document and report these services. This article outlines four actions to avoid and four challenges that practices face when they report these high-value, high-volume services.
Coders should use particular care when selecting diagnosis codes, always selecting the most specific code possible, based on the clinician’s documentation. This article covers diagnosis coding guidelines to help avoid using vague or non-specific diagnosis codes that will likely result in denials. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Enhanced care management codes for advanced primary care management services in the physician fee schedule proposed rule have been cleared. This article discusses the terms billing providers and their teams must meet when providing these services.
CMS finalized its proposal to relax restrictions on complexity of care add-on HCPCS code G2211. The changes come in response to stakeholder concerns that the current CMS policy is disruptive to the way providers normally treat patients. This article covers how to prepare for this update.
The changes proposed in the final rule for Medicare’s burgeoning behavioral health category have been finalized, expanding its purview beyond previous therapeutic models and even into digital care engaged by the patients themselves. Review those changes in this article.
Selecting a level of evaluation and management (E/M) service can be based on either the complexity of medical decision-making or the total time spent on the date of the encounter. Providers need to decide which to use. This article covers the pros and cons of both methods.
CMS implemented modifier -FS (Split [or shared] E/M visit) as part of a major revision to its rules for split/shared services on January 1, 2022. This article provides tips for using modifier -FS from top reporters as it approaches its third year of active status. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With CMS publishing annual updated versions of its Medicare National Correct Coding Initiative (NCCI) Policy Manual, as well as quarterly updates to the individual NCCI edit files, it is often hard for facilities to keep up with the changes. This article details the latest updates, as well as provides insights on implementing NCCI-associated modifiers and tips for preventing and overriding common edits.
Take in the details of the 16 new telemedicine codes for real-time encounters in the CPT 2025 manual while you wait to see whether private payers adopt the services or CMS sways from proposed non-coverage of the codes.
In January 2024, CMS released guidance for the implementation of the office and outpatient evaluation and management visit complexity HCPCS add-on code G2211. Courtney Crozier provides a breakdown of the code, including documentation requirements and appropriate and inappropriate billing scenarios.
Protect your practice by understanding the code level selection risks that could impact E/M office visit claims. Incorporate the guidance in this article into your compliance plan to make sure they stay on your risk radar. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS may have major changes in store for outpatient hospital reimbursement and compliance, according to the 2025 Outpatient Prospective Payment System proposed rule. The proposed rule, released in July, includes potential changes to payment, coding, and billing for hospital outpatient services.
CMS recently announced updates to the January 2025 Integrated Outpatient Code Editor, including new HCPCS codes and changes to a handful of status indicators.
In January 2024, CMS released guidance for the implementation of the office and outpatient evaluation and management visit complexity HCPCS add-on code G2211. Courtney Crozier provides a breakdown of the code, including documentation requirements and appropriate and inappropriate billing scenarios.
