Tag: E/M Services


349 Ways CPT Codes Set is Revolutionizing Medical Practice for Physicians in 2024

The user-friendly descriptions associated with the over 11,000 Current Procedural Terminology (CPT®) codes are integrated into various medical documents, insurance forms, price lists, and patient portals. They serve as crucial references for numerous hospitals, health plans, and medical offices. To address language barriers, the recently released 2024 CPT code set now incorporates these descriptors in […]
Learn More

CMS Corrects Time Thresholds for Prolonged Services

What a difference 15 minutes can make when billing E/M services. The Centers for Medicare & Medicaid Services (CMS) issued a notice March 14 correcting several errors in the 2023 Medicare Physician Fee Schedule (MPFS) final rule. Most notably, CMS is correcting technical errors in the calculations of the time thresholds for reporting evaluation and […]
Learn More

Medicare, Beneficiaries Saw Higher Prices at Provider-Based Facilities

The Medicare program and Medicare beneficiaries could have saved a combined $1.6 billion if provider-based facilities charged the same payment rate as freestanding facilities, OIG found. Medicare and its beneficiaries paid significantly higher prices at provider-based facilities than they would have paid to freestanding facilities for the same services, according to a report from the […]
Learn More

Professional, Hospital E/M Charge Index Continued to Grow in 2021

In addition to the hospital E/M charge index rising, prices for professional evaluation and management, surgery, medicine, and radiology services increased last year. The median charge index for hospital evaluation and management (E/M) visits increased by 7 percent during the COVID-19 pandemic, according to a white paper from FAIR Health. The FH Medical Price Index […]
Learn More

Append Modifier FT for Unrelated Critical Care Services

On Jan. 14, coders and billers gained insight into proper use of novel HCPCS Level II modifier FT Unrelated evaluation and management (e/m) visit during a postoperative period, or on the same day as a procedure or another e/m visit. (report when an e/m visit is furnished within the global period but is unrelated, or […]
Learn More

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 […]
Learn More

Understand Critical Care Before You Code

A solid understanding of guidelines and COVID-19-related complexities will limit claim denials and audits. Deciphering documentation to determine what qualifies as critical care services can be challenging for medical coders and auditors. With limited critical care codes available for assignment, reporting may appear relatively straightforward at first glance. However, there are many considerations that coders […]
Learn More

Telehealth: Key Takeaways from The CY2022 PFS Final Rule

In November 2021, the Centers for Medicare and Medicaid Services (“CMS”) issued the Physician Fee Schedule Final Rule (“Final Rule”) which includes several telehealth policy updates that will go into effect in calendar year 2022.1  As a result of the COVID-19 public health emergency (“PHE”),  CMS expanded the availability of telehealth through the use of […]
Learn More