- Codes
- Info
-
Tools
- Topics
- Community
- See Product Video
- Free Demo
- Pricing
- Sign In
News and Important InformationChronic Care Management Services Let's Talk High-Risk E/M Services Take the Stress Out of Leveling Using Our E/M Calculator Code SetsE/M CPT CodesEvaluation and Management Services Find-A-Code's Tools & ResourcesE/M CalculatorUse this tool to calculate an E/M (Evaluation & Management) CPT™ code based on components or time. E/M WebinarsE/M Coding and AuditingEvaluation and Management Coding and Auditing Coding and Auditing Inpatient E/MCoding-Auditing Inpatient E/M - A Hands-On Experience E/M Calculator ToolUsing Find-A-Code's New E/M Calculator Tool Four Part E/M TrainingPart 1E/M Self Audit for Beginners - Part 1 Fundamentals Part 2E/M Self Audit for Beginners - Part 2 History Part 3E/M Self Audit for Beginners - Part 3 Examination Part 4E/M Self Audit for Beginners - Part 4 MDM Additional Links and ResourcesNoridian: E/M ResourcesNoridian JE Part B E/M Resources E/M Documentation Auditor’s InstructionsE/M Documentation Auditor’s Instructions Select the title to see a summary and a link to the full article. October 10th, 2019 Eliminating Consultation Codes?| Published October 10th, 2019 There are a few payers that have joined with CMS in discontinuing payment for consultation codes. Most recently, Cigna stated that, as of October 19, 2019, they will implement a new policy to deny the following consultation codes: 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254 and 99255.
United Healthcare announced they ... September 30th, 2019 Q/A: How Do I Bill a House Call?| Published September 30th, 2019 Question
If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form? A modifier, or something else?
Answer
Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ... September 16th, 2019 E-Health is a Big Deal in 2020| Published September 16th, 2019 The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ... August 13th, 2019 How to Properly Report Prolonged Evaluation and Management Services| Published August 13th, 2019 Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement?
Prolonged Service codes were created just for that reason but you must carefully follow the documentation ... August 6th, 2019 CMS Proposes to Reverse E/M Stance to Align with AMA Revisions| Published August 6th, 2019 On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ... June 14th, 2019 A United Approach| Published June 14th, 2019 - Last Review/Update June 18th, 2019 A United Approach
As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ... June 13th, 2019 What Medical Necessity Tools Does Find-A-Code Offer?| Published June 13th, 2019 Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ... May 29th, 2019 Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?| Published May 29th, 2019 - Last Review/Update June 4th, 2019 Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today? May 24th, 2019 What to Look for When Auditing Smoking Cessation Services| Published May 24th, 2019 - Last Review/Update June 19th, 2019 What to Look for When Auditing Smoking Cessation Services April 23rd, 2019 Let's Talk High Risk E/M Services| Published April 23rd, 2019 Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.
Both the American Medical Association and Medicare-published E/M Guidelines agree that a ... April 23rd, 2019 CPT Announces 2021 E/M Changes| Published April 23rd, 2019 In 2018, Medicare announced their plans for revamping the Evaluation and Management coding structure and was met with a rapid response from the medical community, including the AMA and many other organizations. As a result, the Medicare changes implemented in 2019 were mostly documentation-related changes that generally benefited providers but were not ... April 23rd, 2019 What is Medical Necessity and How Does Documentation Support It?| Published April 23rd, 2019 We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ... March 21st, 2019 The Impact of Medical Necessity on High Level E/M Services| Published March 21st, 2019 I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"
The quick answer is, "it depends."
Code 99233 has the following minimal component requirement:
Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ... January 17th, 2019 Take the Stress out of Leveling Using our E/M Calculator| Published January 17th, 2019 Our E/M Calculator takes the stress out of leveling Evaluation and Management codes. This tool can be used by auditors, as well as coders and students learning E/M coding. Calculate based on Time or Components. The exam portion lets you chose either 95, 97 Guidelines or both.
Included with our Professional and Facility Subscription!
... January 14th, 2019 AMA Issues new CMT Information| Published January 14th, 2019 As many of you may already be keenly aware, there have been ongoing problems with many payers (e.g., BCBS of Ohio) regarding the appropriateness of reporting an E/M visit on the same day as CMT (CLICK HERE to read article). The AMA recently released an FAQ which renders their opinion ... November 7th, 2018 Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?| Published November 7th, 2018 The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ... October 5th, 2018 Prolonged Services Its Not Just About Time| Published October 5th, 2018 - Last Review/Update October 17th, 2018
Time, as it applies to E/M codes, has often been viewed as an "if/then" proposition. "If" the documentation shows that a majority of the encounter was based on counseling and/or coordination of care, "then" we choose the highest level of service based on the total time of the encounter.
However, a ... September 26th, 2018 The Potential Impacts of a Flat Rate EM Reimbursement on our Industry| Published September 26th, 2018 - Last Review/Update October 17th, 2018 The proposed E&M changes by CMS would decrease provider administrative work burden by, per CMS, 51 hours a year; however, how will reducing documentation requirements truly affect the professionals of the healthcare industry? First, let’s discuss the 30,000-foot overview of the most impactful E&M changes—which is the change to the... August 15th, 2018 BREAKING NEWS: CMS Proposes to Change E&M Coding| Published August 15th, 2018 On July 16th 2018, anyone subscribed to the CMS Quality Payment Program received an e-mail containing a letter to doctors from Seem Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS). There are some widespread changes proposed in this letter of which you need to be aware.
Where ... July 25th, 2018 CMS Proposes Changes to Evaluation & Management Requirements| Published July 25th, 2018 It is no secret that providers have long argued that E/M coding is burdensome and does not truly reflect the services provided. This fact is acknowledged by CMS with the following statement "Prior attempts to revise the E/M guidelines were unsuccessful or resulted in additional complexity due to lack of ... July 16th, 2018 CMS Proposed New E/M Codes for Podiatry| Published July 16th, 2018 - Last Review/Update July 17th, 2018 According to CMS changes are coming for E/M codes. A recent proposal from CMS stated: "The E/M visit code set is outdated and needs to be revised and revalued." Since podiatry tends to furnish a lower level of E/M visits, CMS is proposing new G-codes to report E/M office/outpatient visits. The proposed ... June 4th, 2018 Auditing Therapy Evaluation Codes - Not So Quick!| Published June 4th, 2018 New evaluation codes for physical therapy (PT) and occupational therapy (OT) codes were made effective 1/1/2017. Three new physical therapy evaluation codes replaced 97001, and three new occupational evaluation codes replaced 97003. Chart 1 - Short Code Descriptors The PT and OT reevaluation codes remain the same but were... May 30th, 2018 EM Code Changes in CPT 2018| Published May 30th, 2018 - Last Review/Update June 4th, 2018 It is that time of year again! The time to throw out the old and bring in the new. With the release of the CPT 2018 updates, we will see major changes in coding throughout the E/M section. May 1st, 2018 Webinar: Basic E&M Avoiding Common Errors| Published May 1st, 2018 Join us for AAPC CEU approved Education and Outreach with Noridian BASIC E AND M AVOIDING COMMON ERRORS Start Date: 5/15/18 Duration: 11:00 AM – 12:00 PM - Pacific Daylight Time Type: Web-based Workshop Register Now: https://attendee.gotowebinar.com/register/7977003427311130113 Abstract: This presentation is designed to provide basic information on the billing and... March 26th, 2018 Documentation for Evaluation and Management (E/M) Services| Published March 26th, 2018 According to WPS, when billing or coding for E/M services you should follow a few guidelines.
Documentation must support the level of service billed and the medical necessity for the level billed. Below are additional tips for services which commonly incur CERT error findings for insufficient documentation.
Critical Care Visits
Clear indication of patient ... March 21st, 2018 Q/A: Why is Code 99080 Being Denied when Billed with an E/M Service?| Published March 21st, 2018 - Last Review/Update January 30th, 2019 In order to understand and answer the question, "Why code 99080 is being denied when billed with an E/M Service, it is important to first review the requriements of selecting the appropriate level of Evaluation and Management service and how that relates to reporting a 99080 special report service. Continue reading for better understanding. March 13th, 2018 CPT Code for DOT exams| Published March 13th, 2018 - Last Review/Update January 31st, 2019 Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204? February 20th, 2018 Consultation Codes Q/A| Published February 20th, 2018 - Last Review/Update February 4th, 2019 Question
Are there consultation codes that can be used for new and existing patients when a review of systems and detailed history is performed but no examination due to the patient's reluctance to make a decision to continue with the visit but has taken up 30-45 minutes of the doctors time? February 2nd, 2018 Scoring & Reporting Your Audit Findings| Published February 2nd, 2018 - Last Review/Update February 7th, 2018 This week we had a great question posted to our online forum, and I thought it would be a nice thought- provoking question for our auditing and compliance tip of the week. January 18th, 2018 What's the definition of an Office Visit and Can I Bill it With a Chiropractic Treatment?| Published January 18th, 2018 - Last Review/Update February 4th, 2019 What is the definition of Office Visit? Can It be billed with a Chiropractic Treatment? What about using code 99123 E&M code for office visits? Can we bill of office visits even though we are giving chiropractic care? There are more articles. View all articles... View articles for the current subject by subtopic: Select the webinar title to view a summary and link to the webinar video. January 14th, 2019 March 5th, 2019: Evaluation and Management CodingThe Evaluation and Management service is an important part of an episode of care.
It is the initiation of care and determines the scope and severity of the patient’s
condition. Dr. Ron Short will review the levels of Evaluation and Management
codes and which are appropriate in the chiropractor’s office. In this webinar you
will learn:
What constitutes a new patient
Which Evaluation and Management codes should not be used
When to use the consultation code
What changes are coming to Evaluation and Management coding February 28th, 2019 E/M and the Organ Systems Part 2 of 2E/M and the Organ Systems Part 2 of 2 February 21st, 2019 E-M and the Organ Systems (Part 1)E-M and the Organ Systems (Part 1) June 20th, 2019 Coding Auditing Evaluation and Management and 2019Coding Auditing Evaluation and Management and 2019 January 14th, 2019 Evaluation and Management Coding and AuditingAre you responsible for selecting or reviewing Evaluation and Management service levels? Do you wonder how well you know the rules and how to apply them? Join Aimee in this webinar to review and then applly the rules of E/M coding. She will also do a live demonstration of the new Find-A-Code E/M Calculator Tool to assess the level of E/M service for two office visits, one new (99201-99205) and the other established (99212-99215). January 15th, 2019 Coding Auditing Inpatient Evaluation and Management — A Hands-On ExperienceDo your providers perform and report Evaluation and Management (E/M) services in the inpatient setting? Does the documentation match with the services being billed, or does it fall short? Join Aimee for a hands-on audit of an inpatient E/M service and get an idea of the information and documentation needed to correctly code inpatient E/M services. January 15th, 2019 The Proper Way to Report ModifiersModifier 25 has long been a coding conundrum and an auditor's gold mine. Don't risk take-backs, penalties, or accusations of fraud and abuse. Join Aimee in this webinar on how to properly report modifier 25 and have confidence in your code reporting. January 15th, 2019 Using Find-A-Code's New Evaluation and Management Calculator ToolUsing Find-A-Code's New Evaluation and Management Calculator Tool There are more webinars. View all webinars... View webinars for the current subject by subtopic: 1995 E/M Guidelines1997 E/M Guidelines2019 CPT E/M and Prolonged Services Code and Guideline ChangesBehavioral Health Provider TypesCMS-Novitas Solutions: E/M Documentation Auditor's InstructionsE/M Audit Card for ChiropracticE/M Training Video for ChiropracticNoridian E/M ResourcesNovitas - Specialty Exam Score SheetsQualified Healthcare Professionals |
If you know of a resource that should be included here (links, data, etc.) please contact us.
Calculators
Documentation
Education & Training