decisionhealth Newsletters, Coder Pink Sheets - 2023 Issue 2 (February)
E/M update includes review warning for time, no help for split/shared billing
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Article Overview
This article reviews a CMS change request that updates Medicare guidance for evaluation and management services in hospital and nursing facility settings, including prolonged services and split/shared visits. It is relevant to coders, billers, compliance staff, and clinicians who document and report E/M services under Medicare rules. The discussion focuses on documentation expectations, implementation timing, and areas where Medicare’s guidance remains limited or unclear.
Why This Topic Matters
The update affects how providers document and report common E/M visits under Medicare, making it important for accurate claims, compliance review, and audit readiness. It also highlights where guidance has been clarified and where uncertainty remains for split/shared billing.
Article Sections
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CMS change request and manual update
Introduces the Medicare change request, the related manual chapter update, and the general scope of the revised E/M guidance. It also notes the release timing and implementation timing discussed in the article.
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Time-based visit documentation
Covers the article’s discussion of documentation expectations when time is used to support E/M reporting. The section addresses the broader recordkeeping emphasis described in the update.
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Split/shared visit guidance
Summarizes the article’s discussion of split/shared billing and the areas where Medicare’s guidance remains limited. It also notes the article’s focus on unresolved documentation expectations.
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Resources
Lists the referenced CMS materials and source documents that accompany the article.
What You Will Learn
- What Medicare guidance was updated for E/M visit reporting
- What the article says about documentation when time supports an E/M service
- What remains unclear about split/shared visit billing guidance
- What implementation timing is noted for the Medicare update
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Revenue cycle professionals
- Physician practices
- Hospital coding teams
Codes Discussed
Code Ranges Discussed
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