Medicare Compliance & Reimbursement - 2021 Issue 4
Reader Questions: Report This Second E/M at Your Peril
Subscribe or sign in to view the full article.
Article Overview
This reader Q&A explains a coding scenario involving a shoulder pain follow-up visit, an in-office joint injection, and questions about whether a separate office/outpatient E/M service may be reported. It is relevant to coders, billers, and clinical staff who review encounter sequencing and documentation for outpatient procedural visits. The article discusses the general relationship between prior assessment, treatment planning, and the later procedure encounter.
Why This Topic Matters
Understanding how the encounter is structured helps prevent inappropriate separate reporting of an office/outpatient E/M service when the later visit is limited to a procedure already contemplated at a prior visit. This is important for accurate claim submission, compliance, and documentation review.
What You Will Learn
- How a follow-up procedural encounter is distinguished from an earlier assessment and treatment-planning visit.
- What general considerations affect whether a separate office/outpatient E/M service is reported with an in-office injection encounter.
- Why documentation and encounter sequencing matter in outpatient coding scenarios.
- How procedural visits are evaluated in relation to the work already performed at a prior visit.
Who Should Read This
- Medical coders
- Billing specialists
- Compliance staff
- Physician practice administrators
- Clinicians who document outpatient encounters
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com