Utilization of hospital resources related to separate and distinct E/M encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier -27 (Multiple outpatient hospital E/M encounters on the same date) to each appropriate level outpatient and/or ED E/M code(s). This modifier provides a means of reporting circumstances involving E/M services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (e.g., hospital ED, clinic). Use this flowchart to determine when use of this modifier is appropriate.
This guide explains the four programs of Medicare, various fee-for-service models such as the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS), and key steps in determining payment rates for IPPS and OPPS, accompanied with a resource list.
This clinical scenario for transurethral resection of prostate is designed to simulate real-life coding processes for training and assessing new coders or keeping skills sharp for experienced staff. After reviewing the case, coders should report the most applicable ICD-10-CM diagnosis codes and all relevant CPT procedural codes. The answer key is included with the correct codes to report for this case. This scenario was originally published in JustCoding’s Clinical Scenario Workbook.
This clinical scenario for deep vein thrombosis is designed to simulate real-life coding processes for training and assessing new coders or keeping skills sharp for experienced staff. After reviewing the case, coders should report the most applicable ICD-10-CM diagnosis codes and all relevant CPT procedural codes. The answer key is included with the correct codes to report for this case. This scenario was originally published in JustCoding’s Clinical Scenario Workbook.
Auditing and monitoring, Health information management, Hospital inpatient
Coders can use these reference sheets for understanding the importance of quality metrics and the implications of them for all coding professionals. This resource was taken from the HCPro webinar “Managing the Maze: The Impact of Public Quality Metrics on Coding Best Practices”, presented by Kim Conner, BSN, CCDS, CCDS-O, a senior CDI consultant and denials program manager for Enjoin.
Use modifier -74 to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started due to extenuating circumstances or those that threatened the well-being of the patient. This case study illustrates a scenario where it is appropriate to report this modifier.
Modifier -XE (Separate encounter, a service that is distinct because it occurred during a separate encounter) is used to indicate a separate surgical operative session on the same date of service or a distinct encounter after the patient has left the hospital or changed status/locations within the facility. Use this flowchart to determine when use of this modifier is appropriate.
Clinical documentation, Hospital inpatient, Training
This exercise is designed to help coders practice reading and interpreting operative reports related to the female reproductive system. As you review the operative information, your task is to assign the correct ICD-10-CM and ICD-10-PCS codes. Pay close attention to the specific terminology used in the report, including diagnoses, procedures, and any relevant anatomical references, and remember to reference coding guidelines. Once you have filled in your codes, you may scroll further down to reveal the answers.
Reading over the rules and consulting the medical decision-making (MDM) table is one way to get acquainted with the evaluation and management (E/M) office visit guidelines. But to really learn the E/M office visit guidelines, there is nothing better than seeing how they are used in real life. This code scenario will help you to do just that. In it, you’ll find a rationale so you can see the decision-making process that went into selection of each MDM element.
