Tag: E/M Codes


Cigna Updates Modifier 25 Reimbursement Policy

Find out what you must do to get significant, separately identifiable E/M services paid. The Cigna Group recently updated its reimbursement policy for modifier 25. Effective May 25, if you are billing this health insurance company for an evaluation and management (E/M) service and a minor procedure, you may need to do more than append […]
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The 2023 Telehealth Service Codes Physicians Need to Know

Medicare Telehealth Services for 2023, Centers for Medicare and Medicaid Services (CMS) is adding new Healthcare Common Procedure Coding System (HCPCS) codes to the list of Medicare telehealth services, specifically the following HCPCS codes. Prolonged Service Codes G0316: Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary […]
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AMA Releases More 2023 CPT® Errata

E/M, Gastro, and Lab Coders, take note. The American Medical Association (AMA) announced some last-minute corrections to the CPT® code set effective Jan. 1, 2023. Add these to your code book, along with the previously released corrections, to ensure you start the year off right with accurate codes and guidelines. Evaluation and Management (E/M) In […]
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Take the Complexity Out of Behavioral Health Coding

The secret to ensuring both proper payment and compliance is in the details. Why is mental health coding so complex? Laurie Bouzarelos, MHA, CPC, asked and answered that question in her presentation “Coding and Billing for Psychiatry and Outpatient Mental Health Providers” at AAPC’s virtual HEALTHCON 2022, March 27-30. Bouzarelos manages to take much of […]
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Social determinants of health and medical coding: What to know

Recognition of the impact that social determinants of health (SDOH) have on patients’ outcomes is growing, as is the desire to incorporate SDOH factors into patient-care plans. But awareness of an existing data infrastructure that could help physician practices do so is limited. “The clinical care we provide only accounts for about 50% of the […]
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Are You Using Modifier 25 Correctly?

Oftentimes a patient’s “Oh, by the way …” comment turns an encounter that was scheduled as a preventive medicine visit or a minor office surgery into something more involved. When the provider goes above and beyond the physician work normally associated with a billable service or procedure, you may be able to report the separate […]
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CMS Updates HCPCS Level II for Q2

Coding highlights and other insight. The HCPCS Level II code set used to report medical services and supplies will include 37 new codes effective April 1, 2022. Also in the second quarter update, five codes will be deleted and one modifier’s description will be revised. Lay Terms for New Codes Among the new codes being […]
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Medical decision making and coding

MDM elements during a preventive visit Q: Is it appropriate to count laboratory tests and other tests ordered during a preventive medicine service (99381-99397) visit in medical decision making (MDM) selection? No, because the 2021 revisions to the E/M office or other outpatient MDM do not apply to codes 99381-99397 (preventive services). These codes are […]
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Coding audits 101: How physicians can prepare

You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything, you under code! You provide excellent care for your patients and achieve great outcomes. No […]
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