evaluation & management

  1. A

    Wiki Difference between Independent Clinic (POS 49) vs Office place of service (POS 11)

    Can someone help me in explaining what is the difference between independent clinic (POS 49) and Office ( POS 11) as well as the scope of practice and types of services offered in both?
  2. A

    Wiki Can you bill an E/M (LOS) instead of a minor procedure?

    Hello, I am doing research on what types of procedures are NOT significantly separate and are typically performed as part of an exam. So far my research has led me to the following types of services that a LOS is billed instead of the procedure: 1. Pap smears when a patient presents with...
  3. T

    Wiki External notes from each unique source

    For the 2023 E/M guidelines, data section, category 1, "Review of prior external note(s)" from each unique source*"-- if the provider reviewed an external note from Cardiology, and an external note from GI- two unique sources- would this be 2 points? Thank you!
  4. S

    Wiki Is documentation of procedures in a separate note from E/M necessary?

    I work for an EHR vendor and we've had some ophthalmology clients complain that payer audits have dinged them for having minor procedures, such as injections, documented within the same encounter as an office visit. According to these clients, the audit results state the procedure has to be...
  5. firetorah

    Wiki Nutrition/Diabetes Counseling Group E/M visit

    OK, here's the deal: I have a physician and a Registered Dietitian who wish to hold group nutrition and/or diabetes counseling sessions. Let's assume the session is 30 minutes long and involves 10 patients. This is their scenario: The physician wishes to charge each patient with an E/M...
  6. T

    Wiki 99310 billed with POS 61

    BCBS denied 99310 with POS 61 saying the place of service is not compatible with the procedure. Per the documentation, the pt was seen in an inpatient rehab facility. I'm a little stuck on if I should update the E/M or the POS.
  7. S

    Wiki Outpatient or Inpatient E/M

    I have a provider who saw a new patient via telemedicine. This patient was an 'inpatient' at an outside facility for unrelated symptoms. My provider isnt privileged at the patient's hospital. What would be the correct E/M code or location? Thank you.
  8. M

    Wiki Virtual PT Evaluation

    Hi helpful community! We have an insured client that, due to covid, had to start her care via virtual visit. I'm not sure how to code for the evaluation as I'm not finding any virtual E/M codes for a new patient. Ideas? I know of 99499, but I'm hoping there is something more specific for...
  9. N

    Wiki Unrelated E/M with procedure

    Hi, general question... Is it appropriate to bill an E/M -25 when its unrelated to the primary procedure on every visit? It's not bundled due to both codes being unrelated. For example, patient comes in for debridement 11042 on right ankle, but provider treats edema in another area which is new...
  10. R

    Wiki Prolong office service cpt 99417

    Established patient had office visit with ob-gyn. Doctor documented note with 60 mins total time for the encounter. The claim billed to a commercial payer were 99215+99417. 99417 was later determined to be inadequate for the time of the encounter. Was 99215+99417 applicable for 60 mins est...
  11. J

    Wiki 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...
  12. J

    Wiki 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...
  13. S

    Wiki Over Coding Issue

    Hi Everyone, I've recently started a new position with a family planning clinic and I'm the first coder they've ever had. The previous billing supervisor, who is no longer with the company, put a rule in place that all procedures should be billed with an E/M code & modifier 25. As we all know...
  14. D

    Wiki 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...