1. D

    Wiki 2 inpatient visits on same day

    Can 2 providers in the same specialty, same practice, bill for inpatient visits on the same date of service? If so, is there a modifier required on one or both visits?
  2. C

    Wiki Exam Components for E/M

    Dr. does a Physical Exam on his patients for these following areas: General (Constitutional) Head Eyes Ears, nose, mouth, throat Extremities (Excluding a separate hand exam that he documents seperatly, below) Neuro Skin He then usually does a Normal Wrist exam for Carpal Tunnel (He is a hand...
  3. M

    Wiki Modifiers with Level 5, prolonger service, fingerstick, and flu vax and admin

    Hi all, One of our providers is billing: 99215 - level 5 established patient e/m 99354 - prolonged service 82962 - glucose fingerstick 90661 - flu vaccination 90471 - vaccine administration What I am confused on is what modifiers to use in this situation, and where. I believe 59 would go on...
  4. E

    Wiki 20611 with level 4 E/M?!?!?

    Hi All, I really need some help with this one. :confused:I have been in the medical field for 10+ years but am newly certified in coding, so I would like to come at this problem with as much data and references as I can to support my perspective. Our Sports Med guy keeps billing 20610/20611...
  5. F

    Wiki Review of Systems

    Please help! One of the physicians in our practice routinely uses this statement when making an initial hospital visit or consult: "Review of systems: Reviewed. The patient's review of systems found on the patient's chart under physician documentation is noncontributory." How could that even...
  6. D

    Wiki Correct ROS documentation

    I do coding for inpt consult and initial hosp visits. My attendings are under the impression that they should get credit for a comatose or intubated pt if the ROS are not done. How should ROS be documented in this case?
  7. A

    Wiki Do you see a comprehensive exam here?

    Do you count 8 organ systems for a comprehensive exam? Patient is in a coma. VITAL SIGNS: BP 100/60, HR 90, Intubated on vent, sedated. Weight 171 kg. HEENT- face is cushingoid CHEST: bilateral rhonchi ABD: soft EXT: legs show edema NEURO: corneal and gag reflex absent. No movement or...
  8. A

    Wiki EM Exam components- does this meet a comprehensive exam?

    Do you count 8 organ systems for a comprehensive exam? Patient is in a coma. VITAL SIGNS: BP 100/60, HR 90, Intubated on vent, sedated. Weight 171 kg. HEENT- face is cushingoid CHEST: bilateral rhonchi ABD: soft EXT: legs show edema NEURO: corneal and gag reflex absent. No movement or...
  9. K

    Wiki 95971 with a E/M visit

    (patient has VNS in place) If a patient comes in for a scheduled F/U due to seizures or parkinsons and the physician decides to interrigate his/her VNS, would a separate E/M be appropriate with modifier -25? -I am asking because I am assuming that the decision to check it would be considered...
  10. L

    Wiki E/M with injection same day

    I work for an orthopedic practice where the physicians see patients and do injections same day all the time. I have been trained to bill the E/M level for the visit and the injection code and append modifier 25 to the E/M level. Recently I went to an E/M workshop and the instructor told me...
  11. K

    Wiki E/M coding, ROS

    when coding E/M, does anyone know if a doctor states hx of colectomy, hx of appendectomy, hx of CABG, ext, for example, can you use that as ROS, if he only states past surgeries?
  12. K

    Wiki E/m visit with prolonged service on separate day

    I have a coding question regarding inpatient billing. I've been looking for information in regards to this, but I have yet to find anything conclusive. Let's say a palliative care dr saw a patient on may 2, 2016 and billed for these services..let's say 99222. Then he goes back may 5, 2016...
  13. R

    Wiki Urgently looking for 10 Medical coders for Onsite and Remote coding positions

    Looking For Remote coders for Auditing Physicians Charts. Willing to travel when necessary. • Surgical oncology coder/Auditor for physician services with E&M coding. • Radiation oncology coder for physician services with E&M coding. Responsibilities: • Surgical coder with oncology experience...
  14. M

    Wiki E/M Office Visit with G0436 Smoking Cessation to Medicare

    We are billing e/m such as 99214 with G0436 and Medicare is denying the 99214 stating CO50 medical necessity, M25 information doesn't support level of service and N386 denied based on NCD. I called Medicare and the NCD they reference is 210.4.1. I asked rep if it is due to DX and she said...
  15. J

    Wiki Expert E/M Coders Needed (REMOTE)

    Contract E/M CODER - Aviacode is looking for 3-4 expert PRIMARY CARE E/M coders that can work a minimum of 15+ hours a week. This is for a long-term remote coding position, with the opportunity to move to a FTE or supervisory position.. Reports to: Coding Supervisor/Manager Employment Status...
  16. E

    Wiki Prenatal Coding (Commercial Insurance)

    Hi all - we have a patient who presented one time in the office for prenatal care. She was previously seen by another provider at a different office for her prenatal visits but when her insurance changed she was told she wouldn't be able to see the other doctor, so she came to us. However, after...
  17. N

    Wiki Payment For Advance Care Planning - 99497 and 99498

    Has anyone yet received an actual payment for Advance Care Planning - 99497 and 99498? Can you explain what you did if you have received payment. Was a diagnostic code used or does it only require an e/m code? I called Medicare and they said to just document the medical necessity?! I'm not...
  18. C

    Wiki Policy for Selecting E/M Level

    Can an outpatient physician's clinic implement a policy that the coder doesn't change the e/m level because they want to establish a written policy that the physician is responsible for the e/m selection? I would think the coder should determine e/m level since they are checking the...
  19. P

    Wiki 1995 or 1997 for answering E/M questions on CPMA exam

    Hi Should I use the 1995 or 1997 Audit tool to answer the E/M questions on the CPMA exam. Does the questions tell you which one to use to come up with the correct answer ? Thanks
  20. L

    Wiki E/M vs Preventive Visit

    Patient states was only see for annual physical exam provider billed e/m with diagnosis. The CC & HPI both indicate patient was being seen for annual routine exam and the ROS and Exam portion also support this. Is it reasonable to code a routine physical Z00.00 even though the providers...
  21. M

    Wiki NY State United Healthcare community dual coverage

    Just wondering if anyone else in physician billing getting a denial for an E/m billed with an X-ray as inclusive? When I called I was told the E/M is part of Xray and must bill E/M with 25 modifier. Looking for help, and or link for correct billing? New to dual coverage thru state
  22. J

    Wiki Billing Observation Codes

    My Cardiologist see's patients as observation at the hospital frequently and is not the admitting/attending Dr and he bills 99212-99215. Some insurances state that 99212-99215 is an OV and charges the patients a copay. If I can not bill a new patient code 99201-99205 or a consult 99241-99245...
  23. A

    Wiki Home health POS question

    Hello Does anyone have an CMS information that states physicians cannot bill E/M codes 99211-99215 with POS 12 (home). I have seen some doctors bill with this POS and E/M codes and I am not sure if CMS will allow the location to bill with office/outpatient. thanks
  24. D

    Wiki E/M with a procedure

    Question...I know that to bill a E/M with a procedure the visit has to be distinct from procedure. But I question this........New pt come in to see GYN with irregular bleeding. Provider does COMPLETE work up and gives pt options. One of those options being a endo bx. Pt chooses endo bx. and it...
  25. H

    Wiki Pap Only

    I have a question. If one of our Providers see a patient for a pap only, no blood work was done she had her annual already but the pap was not done. They are using the diagnosis Z01.419. The research I have done is stating you should only bill the pap and not an E/M, is this correct? I need...
  26. C

    Wiki Assistant coding out patient / hospital setting E/M code

    Sometimes the providers do the H&P on OB patients who are seen in the labor and delivery floor. However, it states patient are seen as out patient. Do you bill an out patient e/M code or do you bill observation codes? It doesn't mentioned patient is on observation status... I would like to say...
  27. M

    Wiki Best Auditing Tool to use?

    Hello Fellow Coders, i hope you all are healthy and doing well. I have recently started an auditing position (which i have done in the past) but I have several different tools I can use to determine the correct E/M level. Is there an easy to look at tool that you auditors prefer to use when...
  28. B

    Wiki Exam documentation - I know that VS can be counted as constitutional

    Hello everyone, I code E/M for ED providers, and I have a question about exam documentation. Occasionally, for whatever reason, the exam portion of our notes will be blank, with the exception of the vital signs. I know that VS can be counted as constitutional, but is that a billable service...
  29. O

    Wiki OB case

    Hi everyone! Case: pt is 39 weeks pregnant admitted for L/D the Epidural was not done because the patient had to push/deliver What ICD-10 would be used in a case like this? Do I bill for a E/M service based off of the eval? Thank you for your help! Sherri, CPC
  30. L

    Wiki office visit and consult code

    We had a patient come in for a office visit for constipation. during that visit the provider also did a pre op exam. Can you bill for both the E/M level and a consult code for the Pre-Op? or would you just use a E/M level?
  31. D

    Wiki E/M w/ 57 modifier and operative report denial

    We have seen an influx of denials from payer sources (VA, BCBS and work comp) denying the E/M with a 57 modifier because the E/M and operative services weren't billed on same claim. Is anyone else seeing this? Thank you. Deb Knight, CPC, COC Missoula Bone & Joint & Surgery Center
  32. W

    Wiki prolonged services question

    When attempting to determine the appropriate E/M codes to use when an extensive amount of time has been spent with the patient (and documented appropriately :) ), how do you figure out the initial E/M code to use? For example, if you have a 90 minute established patient office visit, do you...
  33. M

    Wiki New to ENT. Lots of Questions re: when to bill E/M with a scope

    Hi. I'm new to ENT coding and I have several questions that I hope you can help me with. First when the doctor does a laryngoscopy in the office, how do you count this in the data complexity part of the audit sheet? I'm thinking that he should get a point in the medicine part-- The same line...
  34. M

    Wiki E/M Specialty Certification Question

    I am preparing to take the E/M Specialty Certification. On the list of approved manuals, along with the usual AMA CPT, ICD-10, HCPCS ll, I'm allowed to bring the '95 & '97 CMS DG's, audit worksheet & also: Optional References: One reference of your choice Does anyone have any suggestions on...
  35. J

    Wiki Modifier 26

    May modifier 26 ever be used with an E/M code? Thanks!
  36. T

    Wiki Coding E/M with NST

    Can E/M codes be coded with a non stress test?
  37. K

    Wiki New to Chrio Coding

    Hi there, I am new to chiropractic coding. I understand that if it is an established patient you can not code an E/M level and a manipulation on the same day if it is the same diagnosis as before. My question is the Chiropractor I code for almost every time has an office level visit and a...
  38. D

    Wiki History of Colonic Polyps and E/M Codes

    Hello our physician at our practice used an E/M code of 99397 for a Dx code Z89010, this is a Medicare patient is this coding correct? Will Medicare pay?
  39. C

    Wiki Coders Needed! Remote or in NJ Office

    We are looking for E/M, Cardiology and multi-specialty coders. There are 3 positions currently open. Position: Onsite Full Time Permanent or Contract Medical Coder Location: Remote or In Jersey City Office CPC or equivalent. CPC-A’s are also welcome to submit their resumes for consideration...
  40. R

    Wiki billing E/M level instead of injection

    I have a Dr. who has a question about billing just for his E/M level vist and not for the injection that he gave the patient due to it probabaly being denied. Is this kosher. I am under the impression that you cannot just do this? Any feed back would be appreciated.
  41. C

    Wiki Billing ills and wells together

    I believe there is some controversy on this. Our office is billing both for same visit and we are getting paid for it. I assume others are as well. For those that are comfortable with this my question is how do you determine the level of e/m? Do you look at the components and kind of subtract...
  42. C

    Wiki Billing an annaul & E/M at the same time.

    It is my understanding that the annual exam needs a complete past, family & social history. pt. also has a level 4 (99214) illness, how do you separate the history for the annual and the E/M code?
  43. T

    Wiki E/m level 99221 - 99223 and 99231-99223 initial and subsequent hospital care

    Please help, can we as the hospital charge a e/m level for inpatient for a doc either employed or not by the hospital, even if the doc charges a e/m level through their clinic. We are having a discussion on this issue and of course we all do not agree and need outside advice. Or do you know...
  44. A

    Wiki E/M Leveling

    When coding for outpatient physician visits do i consider the diagnosis Z23-incounter for immunization as a diagnosis for the overall leveling of the e/m code??
  45. C

    Wiki FT onsite, coder needed

    Oklahoma City - Large multi-specialty physician group. E/M experience helpful. Please contact Terri @ 405-553-0852, for more information.
  46. C

    Wiki Modifier 59 help

    IBC stopped paying my claims for 2 e/m's (an office visit and preventive visit) and a flu shot . The claims had a 25 modifier on them but now all of a sudden because of NCCI edits I am being told that I have to use a 59 modifier. Is anyone familiar with this modifier - can you tell me if...
  47. J

    Wiki E/M & Surgery Coder Needed (Remote, Contract) - Gastroenterology

    Hi Coders, Aviacode is looking for coders that can code both E/M and SURGERIES for the following specialties: Cardiology Gastroenterology General Surgery Nephorology Neurology Neurosurgery Orthopedic Pulmonology If you have experience in one or more of those specialties with BOTH E/M and Surgery...
  48. J

    Wiki E/M & Surgery Coder Needed (Remote, Contract)

    Hi Coders, Aviacode is looking for coders that can code both E/M and SURGERIES for the following specialties: Cardiology Gastroenterology General Surgery Nephorology Neurology Neurosurgery Orthopedic Pulmonology If you have experience in one or more of those specialties with BOTH E/M and Surgery...
  49. S

    Wiki Intraoperative consults

    What E/M code do you use when billing for an intraoperative consult?
  50. S

    Wiki What is your go to refrence that is not the DG's or google?

    I know there are lot of books that provide guidance for documentation and auditing of E/M services. I'm curious which one book is your go to . . . ?