E/M Coding Alert - 2007 Issue 33
REIMBURSEMENT: Don't Treat A Second-Hand Problem Like A New Development
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Article Overview
This reimbursement-focused article compiles Medicare contractor FAQ guidance that affects how providers interpret established versus new problems, select diagnoses for certain services, document risk in emergency department settings, understand probe review types, and handle services Medicare does not cover. It is relevant for billers, coders, compliance staff, and clinicians who work with Medicare Part B and related facility guidance. The piece is organized as a practical roundup of payer clarification topics from multiple Medicare contractors.
Why This Topic Matters
The article helps readers recognize when payer guidance may affect claim support, documentation, and billing decisions across common outpatient and facility scenarios. It is especially useful for teams that need to stay aligned with Medicare contractor interpretations without relying on assumptions drawn from clinical familiarity alone.
Article Sections
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Don’t bill Medicare for routine pre-operative chest X-ray
Introduces the article’s reimbursement context and frames the discussion around Medicare contractor FAQ guidance. It sets up the broader topics covered in the roundup.
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Other recent FAQ answers from the carrier Web sites:
Presents a series of payer clarification topics from multiple Medicare contractors. The section covers documentation, diagnosis selection, inpatient rehabilitation participation, emergency department risk, probe review types, and non-covered services.
What You Will Learn
- How Medicare contractor FAQs address common reimbursement and documentation questions
- How payer guidance distinguishes new problems for payment purposes
- How Medicare-related guidance discusses diagnosis selection and coverage support
- How contractor FAQs address participation in inpatient rehabilitation team activities
- How payer guidance may affect documentation of risk in emergency department care
- How probe review types are differentiated at a high level
- How routine non-covered services may be handled in the billing process
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Revenue cycle teams
- Clinicians documenting services for Medicare claims
Modifiers Discussed
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