Tag: E/M code

Medical-Necessity-Denials-Image

How to avoid medical necessity denials

How to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is normally addressed during an AWV. How to avoid it:“I often tell doctors to […]
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Surgical Procedure

How to code global surgery modifiers 54, 55, and 56

To understand these modifiers, we first need to review the surgery global period. All medical procedures that include a global period are made up of three parts, explained in more detail later in the article: Pre-operative services Intra-operative services, and Post-operative care. If a physician does not perform all three parts of the service, compliant […]
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3 Ways to Prepare For The 2021 Physician Fee Schedule

Spiking COVID-19 cases and the presidential election may have diverted attention away from the 2021 Physician Fee Schedule, but that doesn’t mean that revenue cycle leaders can afford to drop the ball as they wait for CMS to release its final rule. And even though CMS was late to release the proposed rule—which in turn pushed […]
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New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
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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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