In Billing
May 1st, 2017
Without a thorough understanding of the guidelines, calculating time may land you in hot water. When time is the controlling factor in a patient’s visit, be sure to capture the appropriate time-based service code. Per CPT®, unless there are code or code-range-specific guidelines, parenthetical instructions, or code descriptors to the contrary, the following standards apply ...
NGS is making certain exam requirements clearer. Under the current 1995 Documentation Guidelines for Evaluation and Management (E/M) Services, 2-7 body parts and/or organ systems are examined for both the expanded problem-focused visit and detailed physical exam visit. This contradictory guidance for determining level of service has frustrated many a provider and coder from day ...
These familiar terms have new meaning in ICD-10-CM. Fracture coding can be a challenge for both physicians and coders, but its effect on hierarchical condition code (HCC) funding in Medicare Advantage, as well as health plan Star ratings, leaves little room for speculation. Knowing how ICD-10 delineates initial and subsequent visits is key. Initial Means ...
UPDATE! Read the article “New Guidance Is Good News for E/M Service Coding” on page 54 of the May issue for new guidance that may help to make exam requirements clearer. They were problematic 20 years ago and are even more so with today’s technology. There are two sets of evaluation and management (E/M) services guidelines ...
Ambiguities in the 1995 documentation guidelines create uncertainty. Editor’s Note: After this article was written, a Medicare administrative contractor announced new definitions for “detailed” and “expanded poblem-focused.” See the May issue of Healthcare Business Monthly to learn more. Within the Centers for Medicare & Medicaid Services’ (CMS) 1995 Documentation Guidelines for Evaluation and ...