Category: Medical Coding

How To Code EM Levels with Confidence

How To Code E/M Levels with Confidence

How many times has a provider asked you, “What do I need to document to get a 99215?” All too often, medical coders feel they should help their providers understand what elements of documentation are needed to warrant the higher level evaluation and management (E/M) service. Do not do it! If It Isn’t Documented, It […]
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The Coding Conundrum Vaping-Related Lung Injury

The Coding Conundrum: Vaping-Related Lung Injury

Confusion persists for the coding of vaping. The Centers for Disease Control and Prevention (CDC) is currently investigating vaping-related illnesses that have recently been reported. There are 450 confirmed or suspected cases in 33 states. The first death was reported on Aug. 23, 2019, in Illinois. The concern has escalated to the point that the […]
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Hospitals to Assume Risk in Value-Based Care Models

Verma Presses Hospitals to Assume Risk in Value-Based Care Models

Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower reimbursement rates under Medicare for All. “Our choices are […]
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What Happens When EM Guidelines Change

What Happens When E/M Guidelines Change?

Medical coders, billers, auditors, and other healthcare business professionals started Day 2 of AAPC’s Regional Conference in New York City getting the scoop on the proposed changes to evaluation and management (E/M) services coding and E/M guidelines. E/M Guidelines Changes Are About Time Conference attendees were eager to hear Raemarie Jimenez, CPC, CDEO, CIC, CPB, CPMA, […]
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ICD-10-PCS Changes

ICD-10-PCS Changes: 20 Codes Deleted For FY 2020

CMS has provided ICD-10-PCS updates for fiscal year 2020 that include 2,056 deletions. Here are 20 of the deleted codes: 0370046 – Dilation of right internal mammary artery, bifurcation, with drug-eluting intraluminal device, open approach 0372046 – Dilation of innominate artery, bifurcation, with drug-eluting intraluminal device, open approach 0374056 – Dilation of left subclavian artery, bifurcation, with […]
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Understanding Why 99201 Will be Deleted

Understanding Why 99201 Will be Deleted

An overview of the proposed Medicare Physician Fee Schedule: The proposed Medicare Physician Fee Schedule (MPFS) rule for 2020 was officially released on Aug. 14, 2019, encompassing various elements. Among these are proposals such as adjusting the PFS conversion factor to $36.09, introducing new HCPCS codes for bundled episode-of-care treatment for opioid use disorders, revising […]
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Evaluation and Management Codes

Evaluation and Management Codes…Why Bother?

Denials and how to not get discouraged with evaluation and management codes, and how to appeal There Is Little More Frustrating To Chiropractors And Billers Than Evaluation And Management Codes: While the service is required both clinically and documentation-wise, it is being bundled more and more often by third-party payers. If both the chiropractic manipulative […]
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CMS Proposes Payment Changes to Endoscopic Sinus Codes

CMS Proposes Payment Changes to Endoscopic Sinus Codes

The Centers for Medicare & Medicaid Services (CMS) has proposed changes to the payment structure for sinus endoscopy services in the 2020 Physician Fee Schedule (PFS) proposed rule (page 53). Specifically, CMS intends to apply multiple endoscopy rules, similar to those used for colonoscopies, to sinus endoscopy reimbursements. This approach is detailed in MLN Matters […]
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4 Strategies For Accurate Medical Coding & Denial Prevention

4 Strategies For Accurate Medical Coding & Denial Prevention

4 Strategies For Accurate Medical Coding and Denial Prevention Payers typically deny evaluation and management codes (E/M code) on the back end of the billing process, which can cause costly reimbursement recoupments, according to Medical Economics. Four tips to avoid denials caused by inaccurate E/M levels: Make sure the E/M code supports the specific patient encounter. […]
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