ED Coding & Reimbursement Alert - 2014 Issue 10
E/M Coding: This MAC Reveals The Top Prolonged Service Errors
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Article Overview
This article explains common problem areas that can cause prolonged service claims to be denied or flagged in Part B billing. It summarizes guidance from National Government Services (NGS) on documentation completeness, timing, face-to-face service requirements, and the need to pair prolonged service reporting with an appropriate E/M service. The piece is aimed at coders, billers, and provider offices that submit evaluation and management claims.
Why This Topic Matters
Prolonged service reporting is highly dependent on complete documentation and correct pairing with an E/M service. Understanding the common errors discussed here can help practices reduce claim problems and improve compliance.
Article Sections
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Top prolonged service claim errors
An overview of the most common documentation and reporting problems identified by the MAC. The section introduces the main issue areas discussed in the article.
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Documentation and timing requirements
Guidance on the types of recordkeeping needed to support prolonged service reporting. The section focuses on signatures, beneficiary information, total visit time, and related documentation elements.
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Face-to-face service and companion E/M requirements
Discussion of the service setting and visit structure that must be present for prolonged service reporting. The section also addresses the need for an accompanying evaluation and management service on the same date.
What You Will Learn
- Why documentation completeness matters for prolonged service claims
- What kinds of recordkeeping elements are reviewed in prolonged service reporting
- How face-to-face service structure affects prolonged service claim eligibility
- Why an E/M service must accompany prolonged service reporting
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Physician office staff
- Evaluation and management coding professionals
Codes Discussed
Code Ranges Discussed
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