decisionhealth Newsletters, Part B News - 2020 Issue 7 (July)
Generous MUEs for office visits haven’t changed the rules for same-day visits
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Article Overview
This article reviews Medicare guidance on same-day evaluation and management billing and explains how CMS temporarily adjusted medically unlikely edits during the COVID-19 public health emergency. It is relevant to physicians, group practices, and coders who need to understand how office visit billing intersects with CMS manual guidance, NCCI updates, and telehealth-related policy changes.
Why This Topic Matters
It helps billing and coding staff recognize that broader edit allowances do not remove other Medicare rules governing same-day visits, group practice billing, and medically necessary service reporting.
Article Sections
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Question
Introduces a billing scenario involving same-day office visits and asks about the impact of medically unlikely edits on evaluation and management services.
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Answer
Summarizes Medicare guidance on same-day visits, describes the temporary CMS edit changes tied to the public health emergency, and notes the relationship to telehealth and NCCI updates.
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Resources
Lists source references and CMS webpages related to manual guidance and correct coding initiative updates.
What You Will Learn
- How CMS guidance relates to same-day office evaluation and management billing
- Why temporary edit changes do not eliminate other Medicare coding requirements
- What broad types of CMS policy updates affected telehealth-era coding edits
- Where to find the referenced CMS and NCCI resources
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance staff
- Practice managers
Codes Discussed
Code Ranges Discussed
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