evaluation & management

  1. T

    Question 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.
  2. S

    Question 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.
  3. M

    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...
  4. N

    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...
  5. S

    Question 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...
  6. 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...
  7. 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...
  8. S

    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...
  9. 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...