e&m

  1. B

    Question E&M coverage for private insurance vs Medicaid

    Hello. I live in AZ and we have state Medicaid (AHCCCS). I have a question regarding dual (or more) insurances and billing E&M codes. I have patients that have private insurance (i.e. BCBS/UHC/Cigna) as primary and Medicaid as secondary. Do I use the E&M code (i.e. G0108) that I know the...
  2. S

    detailed exam?

    I am still getting my feet wet on E/M coding/auditing. I am stuck on the following encounter. I feel it is a 99213 for established problem not responding/worsening, only one point for data review (DAT results), and a Moderate MDM with prescription drug management. However, the history...
  3. G

    Can the elements in the diabetes management exam be used as elements for the exam portion for e&m level?

    Diabetes Management Exam: Foot Exam (with socks and/or shoes not present): Inspection: MSK/Extremities? Left foot: normal Right foot: normal Nails: Left foot: normal Right foot: normal Sensory-Pinprick/Light touch: Neuro? Left...
  4. K

    Question Woman's Wellness guidelines

    Hello all, We all know how hard E&M coding can be so I want to clarify what we can or cannot bill. I work in a public health clinic where we see women for their yearly woman's wellness exam. According to our nurses, we have patients who come in for their yearly physical exam. During this exam...
  5. C

    Rx management in the ED/ EM Risk Table

    OK...there seems to be some disagreement within my office on Rx Drug Management. The case is: An emergency room provider orders 1 Norco for a patient while he is being assessed in the ED but does not prescribe any long term pain meds on discharge. Some are saying simply ordering the 1 dose is...
  6. N

    In Urgent Care setting, Can a Physcian Assistant bill a new pt using his/her own NPI?

    Hi coder family:) I guess my question is can P.A's see new patients in Urgent Care? I am auditing our P.A.'s who see patients Monday-Sunday in Ortho Urgent Care. My question is, if a new patient comes in to be seen and a P.A. see's them for the first time. Would the P.A. be able to bill...
  7. N

    E&M coding w/o diagnosis

    My physician documented in the assessment part of his note and billed a diagnosis of shoulder pain, however he also diagnosed osteoarthritis in his x-ray results. Since there is a definitive diagnosis, I know this should be replacing shoulder pain. If the note gets audited, will the pain dx be...
  8. N

    CRNA and E&M

    We are getting denials from PA's Medicare for CRNAs when billing 99201 for cancelled procedures. Denial when performed/billed by this type of provider. One claim rep said the service is covered under a CRNA but another rep said this was an error. Is anyone getting payment from MC for these? I...
  9. A

    Med Management without the Member Present?

    Hello, Can a psychiatrist bill for a med management visit (99214) for a child, when the psychiatrist only met with the parent? The child was not present at the visit. Are there Medicare guidelines that state that the identified patient must be present? Thanks, Abby
  10. D

    Straightforward E/M Leveling lookup table

    If anyone's interested, I've created a simplified lookup table that let's you know exactly which CPT code to use for any E/M subcategory whose codes are based on History, Exam and Medical Decision Making. If you're taking the CPT exam, you can transcribe the table into your book, and I'm sure...
  11. S

    Dental claims-Medicare & E&Ms

    I have a oral surgeon specialist, can they bill E&Ms to Medicare when a covered or non-covered procedure is being done?
  12. K

    Evaluation and Management services

    Hello, Im having trouble understanding E/M services. Can someone explain how to code an e/m if the time the physician spent with the patient doesn't match the history and/or medical decision making? Do i code what can be proven with the history noted? or a higher level of E/M due to the...
  13. T

    E&M Hematology Oncology

    I am a new Auditor for E&M charges with Hematology Oncology practice. I am looking for any education sites or cheat sheets that anyone finds helpful. My email is tracy_mcpherson@aol.com. Thank you
  14. L

    E/M Dermatology 99212, 99213

    We have had some difference of opinon on how to bill out the E&M lately with new drs on staff vs drs that have been here for years. Generally patient comes in here for a Full Skin exam which may or may not result in some biopsies but mostly the only other things notes are SK's and maybe Acne or...
  15. C

    Surgeon Sees Patient in ER

    Patient had tonsillectomy one day prior to ER Visit. Surgeon met patient in Emergency Room due to N/V with blood. Fluids given and bleeding controlled prior to patient leaving the ER. Since this is within the global period for the surgeon, does this mean that a ED Professional Level can not...
  16. J

    Nurse Visits 99211 Help

    Hi all, I've been hired as a coder after the clinic I work at updated to a new EMR system, and I've come across issues with coding for nurse visits. We've established that when patients come in for injections/vaccinations, we code for the injections/vaccinations and the correct admin codes...
  17. L

    Multidisciplinary Clinic Coding

    Hi, If I have docs from 3-4 different specialities under the same tax ID performing E&M services on the same patient on the same DOS as part of a multispeciality clinic, do I bill each visit as a separate applicable E&M code? Or something else? Thanks!
  18. J

    E&M coding follow up visit vs post op

    I have a physician who saw a patient in the ER for cholecystitis and removed the patients gallbladder due to the cholecystitis. The patient came in for her post op visit and the pathology revealed she actually had gallbladder consult and he is now treating her for the cancer. Do I still bill...
  19. Y

    Annual PE with E&M, Please HELP!!!!

    We did an annual physical on a gentleman, and also addressed his diabetes as not being very compliant. We billed commercial insurance for 99396 with dx z00.00 and 99213 modifier 25 with E11.9 Insurance allowed both charges, paid for the physical and the E&M was applied to his deductible. My...
  20. L

    correcting documentation before claim submitted

    I code hospital billing and I have a provider who has an intern following him, recently he has allowed the student to document handwritten progress notes and he signs over them correcting/adding/ inputting his own MDM, however the note doesn't have anywhere documented that the intern wrote it...
  21. L

    Two practitioners, one visit

    A patient came in with shoulder pain to see our NP, who did all of the charting for the E&M(99213), then Our physician came in and gave her a trigger point injection(20610) of Kenalog(J3301) How is this coded?
  22. K

    Level 5 E&M with Oral Challenge

    Good Afternoon, I am looking for confirmation of my assumption regarding this scenario more than I am an answer to the question. Is it appropriate to bill a level 5 E&M in addition to the code for an Oral Challenge if the patient does not require physician intervention for anaphylaxis or...
  23. S

    E&M and Procedure

    I would like your opinion on this, please. Pt. walks into the clinic with a laceration due to a fall. Pt. is seen by the doctor for a laceration repair. Doctor also discusses past medical history, patient's current medication--is something off with meds that led to the fall, how is the...
  24. D

    Network with Neurology Expert/Scheduled EEG's

    Looking to network with a neurology coding expert! Needing written documentation guidance on billing scheduled EEG's. If the reason for the visit is a scheduled EEG unless separate identifiable E&M is documented the E&M is not billable. Correct? If anyone has any other billing guidance I...
  25. 1

    What is considered beyond the usual preop care of 20610

    I am struggling to define exactly what all needs to be done in order to bill an EM with 20610. Modifier 25 is a (Significant, separately identifiable E&M service by the same physician on the same day of the procedure), indicates that the patient’s condition required a significant, separately...
  26. A

    No exam done, can E&M be billed???

    If my physician is seeing an established patient and no physical exam is done, can I charge an E&M visit? I have read in a couple places that even though you only have to have 2 of the 3, if an exam is not done, it's not considered a visit. When patient's come back for MRI results, the physician...
  27. Y

    Need Some From My Fellow Coders!!!

    I recently to an exam for a coding job and had the following question: What is the level of HISTORY represented by 4 HPI items, 8 systems on ROS, and 0 PFSH? I have never been strong in E&M coding.... will some please provide with me with the answer? and explain the answer? By the way I...
  28. M

    New Patients for Pain Management

    A new patient is referred for evaluation and treatment, and based on imaging and medical documentation from the referring the provider performs an epidural steroid injection. Is it appropriate to bill a new patient E&M with modifier -25 in addition to the procedure to establish patient care or...
  29. V

    E&M Coding: New vs Established

    Hello Friends! I have recently been asked for some clarification on how we do E&M coding for an inpatient setting. We are an infectious disease specialty clinic and are called in for consultations. Sometimes it is a patient that we have already seen in our clinic, and the consult is for the...
  30. D

    lcd

    I have a person who was seen and E&M code was 90791 with dx code 296.90. Not sure why this was denied. Could someone maybe have a better insight on this? Thanks!
  31. S

    Another New vs Est Visit, Subspecialties, Etc.

    I have an otolaryngology group that has different subspecialties in it (ear, oncology, etc) and I'm a little confused. They all share the same tax id. I was told I would be able to bill 2 visits to Medicare on the same day for my physicians because the 2 that the pt saw were of different...
  32. L

    Immunizations & Injections

    Does anyone have a good procedure for coding nurse visits for immunizations and other injections? I work at an FQHC and there are several people here with different approaches to handling the documentation and coding of such visits... Thanks for any suggestions you can provide!
  33. M

    E & M on same day a Chemo

    I am having some issues with insurance companies denying (saying not seperatly identifiable) an E&M on the same day as chemo. Our docs not only have to verify that the patient is well enough to have the chemo but also wants to schedule a follow-up on the same day so that the already compromised...
  34. M

    Opinions on HPI please

    Hi I was wondering if anyone could tell me what elements they would pull from the following HPI. Pt has a history of bladder cancer, transitional cell, advanced initially treated with Gemzar, carbo, Taxol, and had surgery done and there was residual small cell component. She had four cycles...
  35. L

    Experienced Certified Coder

    LaParsha White: BS, CPC-H p:239-222-1779 Email:laparsha@aol.com Southwest Florida Fort Myers, Cape Coral, Naples area seeking full-time employment Education: Bachelor Of Science Business Administration Hodges University 6/2006 CPC-H American Academy Of Professional Coder 10/2010 AAPC CPC-H...
  36. N

    ER E&M level for migraine

    What level would this be? my coworkers are debating: patient came in to er with cc of headache, the hpi is has the quality, severity, duration and associated symptoms, the ros is complete, the pfsh has 2 areas. the exam is a 8 system they gave the patient iv medications and did a xray...
  37. N

    HELP! E/M confusion (99214)

    The majority of the patients we code are established patients. I was taught always to use the MDM in the EM selection. However this has brought on somewhat of a confusion. In all documentation I've researched, I've found the same thing... it only takes one element of risk to qualify for that...
  38. K

    Payer reducing payment for E&M billed with other procedures on the same day.

    A few weeks back I was doing some research and stumbled across a provider newsletter (bc/bs ??) that indicated that payment for E&M's would be reduced by 50% for the office visit when performed with other procedures. Now I can't find it. Has anyone seen/heard/experienced this yet ? If so can...
  39. E

    Counseling and Coordination of Care

    In the Edge Blast #123 - Question # 3 I beg to differ: Answer should be 99213, 99401 as opposed to 99212, 99401. Assumption 15 minutes of time spent counseling the patient constitutes more than 50% of the E&M and time becomes the key factor. That is, 15 minutes out of 25 minutes (99212...
  40. M

    Radiologist performing E&M

    Can a radiologist perform and E&M Service. The group actually manages the patient care as they are specialists in mammography and carcinoma and will work with the patient by bringing them back for further exams, recommend several surgeons when a carcinoma is discovered, etc. The radiologist...
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