1. J

    Question Aetna Medicare Mid-Level E/M

    Our office is having problems with Aenta Medicare (specifically Aetna Medicare Elite and Premier) denying our Physician Assistant E/M charges stating the provider type is ineligible to bill/perform the service (PI-170). They will pay other services on the claim, if any, (like a UA, EKG, etc) but...
  2. K

    Question E/M visit performed without patient present

    Patient was scheduled for a normal e/m appointment after they were recently hospitalized. Patient is currently living in a group home. The provider did not have a chance to speak to the patient and only spoke to the caretaker. This was also done via telehealth due to the current pandemic. Could...
  3. KStaten

    Answer Coding / Billing Audio-Only Telehealth Visits

    Hello Everyone! :) Here's my silly question for the day. (Brace yourselves, as I am sure more are to come. ;) ) As I have interpreted from articles, the accepted Telehealth services have been expanded to include audio-only telephone calls, as well. (Yay!) Now this is the part where I am...
  4. T

    Question Physical exam in a Telehealth visit

    Does anyone have information about documenting physical exam for established patient telehealth visits billable using 99201-99215? It would seem a limited exam could be documented based on physician observations during the call. I know it isn't technically required (2/3 elements and all that)...
  5. A

    Question Acceptable ROS/PFSH notation?

    My provider usually documents ROS/PFSH for establish patients as such: PAST MEDICAL HISTORY, SOCIAL HISTORY, MEDICATIONS AND ALLERGIES: Reviewed and not changed since last visit. REVIEW OF SYSTEMS: Reviewed in chart and signed. Per E/M guidelines, the provider has to indicate that the...
  6. C

    2021 E/M Documentation Changes - What are your EHR vendors saying

    Good afternoon AAPC members. I am working to find out if anyone out there is in discussion yet with your EHR Vendor about the changes for 2021 E/Ms. If so, would you mind sharing the name of your EHR Vendor and their level of preparations? Thank you!! Carol J. Self, CPPM, CPC, EMT AAFP
  7. W

    E/M pending test

    Hello, How would you handle leveling for E/M when pending lab results? Patient was seen today at her pcp office for lower abdominal pressure with frequent urination. The dr. decided to have the patient take otc, rest and hydrate until the urinalysis comes back with results. New patient: 99203...
  8. J

    2nd Opinion, fracture, can we bill Office Visit?

    If someone could PLEASE shed some light on this because there are differing opinions in the office. A child was seen by a different practice, he has a broken arm, I am ASSUMING they billed a fracture code. Mom wants him to come see us for a second opinion because they are removing the cast...
  9. W

    Question Number of dx/mgmt options

    Good Evening, Quick question regarding the # of dx/mgmt options table, just a few examples: 1st ex: Patient presents with a complaint of sore throat along with left ear pain which was diagnosed as acute pharyngitis and otitis media, assigned 2 points as I see as self limiting. 2nd ex: Patient...
  10. J

    Question Separately identifiable E/M

    There seems to be a lot of ambiguity in defining separately identifiable E/M services. We have scenarios where patients were referred to different specialtists (Cardiology, ENT, GI, etc) who come and evaluate the patient. They eventually decide that the pt will have to undergo a procedure (Heart...
  11. A

    Seperatly Identifiable

    We have an encounter that our offices coders dissagree on. We did a procedure after an Office visit. One says because the pt came in for an Office visit and the "decision for surgery" (no global period for this procedure) we should bill the Office visit with a -25 modifier. Another says the work...
  12. M

    Return to work exam

    I'm confused about how to code return to work visits. We get patients who have been off work due to illness and they come in for a return to work exam and form to be filled out. Should this be coded as a preventive exam if the illness is resolved and no other problems are found?
  13. G

    AWV vs Preventive vs E&M

    We are having a difference of opinion between coders and billers, Coder coded as 99397.GY No HPI Missing updated written screening schedule 5-10yrs Visit qualified as preventive and preventive 99397 is not covered by Medicare Biller wants code changed to 99214 as provider refilled RX looked at...
  14. K

    Question HPI elements

    Good afternoon I have a question in regards to HPI elements for the following example and would appreciate any advise and insight Established Patient visit Reason for visit - HIV Followup Last seen 1.2.2019 CD4 660/30% ,viral load 21 on current meds Dx HIV 2011 . Risk Factor Heterosexual...
  15. J

    Is this a 99204?

    My provider reported 99204. I only see the HPI as a EPF which would bring this to a 99202. Can anyone take a stab at this and let me know what you think? Thanks, Jo ------------------------------------------------------------------------------------------- Chief Complaint: new patient...
  16. K

    E/M, Therapy, Injection same day (modifiers?)

    If an E/M like 99213 takes place the same day as a separate psychotherapy like 90836 . But then an injection is also done on the same day.. Should it be 99213 -25, 90836, 96372 -59? Is it possible to be able to use both modifiers on the same day? Is the injection included in the e/m and not to...
  17. J

    Two E/M Services, Same Day at Same Clinic, But Two Providers? What modifier??

    Hello! So I work for a clinic, where we have a bunch of different providers who do different things, but they are all under E/M codes. So I just ran into something that I have never seen before. I was entering a 99215 encounter for a provider, and I saw that our EMR system automatically put...
  18. K

    Modifier -25 with 99205

    Is it possible to use modifier -25 with 99205 if psychotherapy is also on the same day as a new patient E/M? Is there a better way to code this? So; 99205 -25, 90838
  19. A

    When can an E/M be coded with 12002

    Hello - Any help or guidance to the information would be great. I am trying to find a document or something in writing that states when the E/M code is appropriate to be with a 12002 and when it is not. Thank you, Aimee ;)
  20. A

    Need E/M Scoresheet for 1995 Guidelines

    Hello - Any suggestions on the best E/M score sheet you have found for 1995 guidelines would be great :) It can be a paper form or interactive. Thank you, Aimee
  21. A

    Urgent Care referred to the ED

    Hello - I need some advice on if this can even be coded. We had a patient present at our Urgent Care that was referred to go to the ED. Is there enough information below to support a 99211? Visit Type: Urgent Care Visit Document Type: Chart Note...
  22. R

    E/M in Urgent Care with Simple Laceration repair

    Is it common to charge an E/M with -25 mod along with simple laceration (dermabond) ? The E/M note is showing all components, however, nothing "above and beyond" is being documented? If not does anyone have a link or source information? Thank you in Advance. Robyn
  23. K

    To bill Preventative or Not to bill Preventative???

    I'm running into issues billing for several of my sites... The doctors will have the CC as "follow-up" or "routine" sometimes even "dm check 6-months" and there is always a full workup but the doctor puts like, 7-10 diagnosis codes in there, usually insignificant things like HTN, DM, obesity...
  24. J

    Secondary Office visit Billed with Annual Physical

    I have a Physician who regularly bills an Annual Physical (99395-99397) with an Office visit E/M(99212-99215). I have tried telling him the differences as to when and how this should be done and for the most part, he has cut down on billing an office visit(99212-99215) with an Annual...
  25. baroquecoder

    RHC E/M w/Vaccine

    Hello! Is an E/M always billed with a vaccination in the RHC? I am being advised that ‘since the doctor has to see the patient in an RHC’ to always bill with E/M, when the sole purpose of the visit is the vaccination... my understanding is that all E/Ms regardless of location must be medically...
  26. A

    Newborn NAS on mophine...considered critical care?

    Good morning- If a newborn (28 days) is being treated in the nicu for NAS (neonatal withdrawal syndrome) with morphine, and no other issues...should it still be coded as critical care? And if so, is there anywhere to find any confirmation (CMS website?) that it should be coded as such? Or...
  27. A

    99401-99404 Medicaid

    Our Doctors and Nurse Practitioners have begun to see patients for weight loss. The dx is usually Morbid Obesity, and they list a diet and exercise plan in the medicine section of the progress note. ( They tend to forget to mark the education sections for this) I am wondering what E/M to use...
  28. M

    Billing E/M code for new pt STD screening only

    Our provider sometimes sees new patients at our walk-in clinic who only want STD screening and have no symptoms. An ROS and brief exam are always done. Can I bill an E/M code for these cases or just the lab draw?
  29. W

    E/M Coding ...

    Evening, Just want to double check with everyone to make sure I'm handling the following coding correctly. For this example I would code as a 99202, guidelines 1995. But with the oral decadron given and a prescription would this change to a level 3? CC: Ear pain for 3 days 27 year old male...
  30. W

    E/M Coding .

    Good Evening, Need anyone's insight regarding presenting problems. There was insight that I had received stating that a presenting problem that is less than 72 hours with a prescription being prescribed would be a 99203 instead of a 99202. Is this true? The following example I usually would...
  31. W

    E/M Leveling Question 3

    Prescriptions Good Evening, For Motrin, Tylenol etc...anything above 200mg needs to be prescribed?
  32. W

    E/M Leveling New patient

    Drug Prescription Evening, Motrin, Tylenol etc... when the mg is above 200 this would be a prescription?
  33. T

    Modifier need on a 93010 when billed with 99281-5

    I am being told in order for a claim to go thru and get paid that 59 modifier has to be amended to the interpretation 93010 when also billing the ED EM code group 99281-99285. I just can' t see why a 59 modifier has any bearing in this scenario. If any one can help with clarification on this is...
  34. M

    ER coders/auditors that use a "grid" vs. points to establish E/M level of service.

    ER coders/auditors that use a "grid" vs. points to establish E/M level of service. I would like some thoughts and info on FACILITY coding of ED services using a grid rather than a points based system. How long have you used a grid? How did you go about transitioning to it and how did you set...
  35. V

    shared visit

    Hi all, In the facility setting if a NP sees an in-patient and documents all of the HPI, exam and MDM in the EMR progress note. Later that day the physician "sees" the patient and attaches an attestation that states " Patient examined, Chart reviewed, Discussed with R.N. Nurse practioners note...
  36. J

    NP visit with IV treatment?

    I work in Pediatrics, but have a question about a recent Oncology visit within my family. Patient was told by her Oncologist/Hematologist MD that she needed an IV treatment. When she arrived at the appointment, the office had added labwork and a visit with the Nurse Practitioner before...
  37. M

    CEMC study guide

    Hii This is ganesh , i am preparing for cemc exam , i have little confusion on exam pattern. Please send me the cemc exam guide if any one have.mail:metlganesh7@gmail.com
  38. 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...
  39. C

    Home visit for Hospice Patient

    I have a provider that will be doing a home visit to a hospice patient for a non hospice problem. How do we bill for this? Modifiers? Thank you!
  40. M

    BCBS denying E/M codes with 25 modifier

    I do billing for five different practices across Texas and am having an issue with BCBS. They are denying most E/M codes when we use the 25-modifier (to distinguish from other services rendered the same day). I've gotten dozens of these so far. I have read some info online from different...
  41. S

    Critical Care documenting by ED physician

    With Critical Care codes being time based can the provider document Critical Care time and that plus the medical necessity evidenced by the diagnosis be enough to constitute Critical Care? Is the fact that they ordered intervention (labs/tests/intubation/etc) enough to show the intervention or...
  42. A

    Tpi & e/m 99212

    If billing TPI 20553 done with PT 97110, Would it also be appropriate to bill 99212 considering 10 minutes or so are spent face to face with patient discussing issues?
  43. baroquecoder

    Recurring Periodic F/U visits for Resolved Conditions

    chief complaint; follow-up. Can a cardiologist continue to report a resolved I48.91 at every subsequent visit, complete with EKG of course, even though patient is asymptomatic? How about the extent to which they can report CAD I25.10 whereby the patient was treated and is asymptomatic now?
  44. baroquecoder

    Denials for 93042 with 99223

    I am seeing a lot of denials from the earlier part of the year for a 93042 when ordered in the inpatient setting. Has anyone else experienced this? Biller is telling me to put a modifier 59 on it. Any advice would be appreciated. Should mod 25 go on it?
  45. A

    Data Reviewed Points Scoring for tests ordered, read, AND charged for?

    There are 2 data reviewed points available if the provider orders/reads, interprets a test. I have heard mixed reviews on whether it is acceptable to count the ordering/reading of a test that is also billed to the insurance co. For instance, the provider performs an EKG and interprets it. That...
  46. A

    HIGH Risk MDM for IV Morphine in the ED (discharged, not admitted)

    Pt presents to the ED with hand pain. ED provider orders Xray which confirms fractured metacarpal. Provider performs a closed reduction/splint application with no documentation of the patient having to f-u with an ortho for additional casting. Gives the patient IV Morphine and IM Diazepam "FOR...
  47. baroquecoder

    Scheduled Follow Up with Pacemaker interrogation

    Patient seen every 4 months. Chief complaint exactly the same every time ; dual chamber pacemaker implant due to complete av block, 2003, Hypertension, Hyperlipidemia and Hypothyroidism. HPI: also the same copied and pasted from original history of pacemaker implant and continues as HPI with...
  48. baroquecoder

    Scheduled Follow Up with Pacemaker interrogation

    Oops this post is duplicated on the E/M forum. Please disregard.
  49. baroquecoder

    11606 with 99214

    Patient's chief complaint is 'presents for removal of lesion' HPI: lesion present for 3 months and growing ROS EXAM Lesion removed impression; BCC not sent to pathology not confirmed as BCC Since the patient presented for the sole reason of having the lesion removed, and the procedure was...
  50. baroquecoder

    E/M with Treadmill

    TMT was planned and was stated as chief complaint. Reason for procedure; palpitations. An Exam and ROS are done Impression: palpitations. Does an ROS and Examination done on same day as a planned TMT, qualify as an E/M? 99214-25 + 93016 + 93018. Thanks!