Jun 1st, 2013
Proper documentation is a must for reimbursement of 99241–99245, 99251–99255. By G.J. Verhovshek, MA, CPC Medicare payers haven’t accepted claims for either outpatient (99241-99245) or inpatient (99251-99255) consultations since Jan. 1, 2010. Private payers, however, may still pay for consultation services as long as those services are supported by the “three Rs” of consult documentation: ...
Aug 1st, 2012
By Nancy Clark, CPC, CPC-I Modifiers are crucial in telling the story of the claim by identifying procedures that have been altered in some way without changing the core meaning of the code(s) submitted. Let’s look at the modifiers that can be appended to evaluation and management (E/M) codes used within the global period. The ...
Jun 1st, 2009
Part 2 By G. John Verhovshek, MA, CPC Part 1 of this feature (“Consult or Not? Here’s How to Know for Sure,” May 2009 Coding Edge) discussed how to differentiate a consultation service from other E/M services. This month, we conclude with an explanation of how to apply consultation codes in inpatient and outpatient settings. ...
Mar 1st, 2009
Five steps is all you need for modifier 25 claim success. By G. John Verhovshek, MA, CPC Misuse of modifier 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service is among the most common coding mistakes, costing medical practices millions each year ...
Mar 1st, 2009
Use sign, symptom, or condition to prevent confusion with Preventive Medicine Counseling codes (99401-99404). By William P. Galvin, CPC A patient’s status—new, established, or consultation—isn’t the only element you should consider when coding an evaluation and management (E/M) office or other outpatient service. You also need to match the usual time associated with the E/M ...