E/M coding changes require education and technology updates

Jennifer SwindleCoding, E/M

E/M Coding changes

Evaluation and management (E/M) services occur in the hospital as inpatient or observation visits. They also occur in nursing homes, physicians’ offices, emergency departments and even in the home. While there have been guidelines since 1995 and guidelines updated in 1997, both of which are still used, E/M services still have been vulnerable to fraud and abuse. In 2021, major … Read More

Opioids and coding: An important new program to meet funding needs for treatment

Jennifer SwindleCoding

When you think of America’s opioid crisis, your thoughts probably don’t quickly turn to medical codes. And yet, the fact is that when medical crises arise, code changes are made to accurately capture and support needed services. Opioid addiction, with millions of people affected and horrendous loss of life as well as broken lives, is certainly such a crisis, perhaps … Read More

When it comes to coding-related claims denials, bring in the coders!

Jennifer SwindleCoding

There are often unintentional disconnects between AR and HIM, as coders focus on coding guidelines, medical necessity, and supportive documentation, but may not be aware of specific written payer instructions, payer manuals or unique contracts. This not only can create unnecessary denials or improper code changes, but it also can result in tensions between the two departments. Read the article.

Correctly coding the remote interprofessional consult

Jennifer SwindleCoding

The Centers for Medicare and Medicaid Services has unbundled the four existing CPT codes for Interprofessional Consultative Services – 99446-99449. It also created two new codes in 99451-99452 under Interprofessional Internet Consultation services. The new codes further allow the treating provider to be paid for the efforts made in initiating the consultation. Read the article.

Using Seventh Characters: What to Consider

Jennifer SwindleCoding

The proper use of seventh-character extensions, which designate episodes of care and are required for injuries, poisonings and external causes, are explored. Read the full article.

Coding for Smoking Cessation Services

Jennifer SwindleCoding

While smoking cessation is a medically necessary and payable service, it is often administered and not billed or billed but not fully supported in the documentation. There must be information capturing the patient’s opinions related to behavior change as well as providing input on a plan to change that behavior. Read the full article.

Coding for Diabetes

Jennifer SwindleCoding

Coding for diabetes used to present challenges because unclear documentation or poorly stated manifestation relationships prevented capturing the type of diabetes and its complications. ICD-10 has further delineated diabetes into five code categories and even greater specificity is necessary to code accurately. Read the full article.

Medical Necessity and E&M: It’s complicated

Jennifer SwindleCoding

Defining medical necessity for evaluation and management services is difficult. Clinicians and coders should be careful to include only those things that are necessary for patient treatments to determine the appropriate levels of E&M services. Read the full article.

Understanding the Fate of Modifier 59

Jennifer SwindleCoding

Modifier 59 is used when procedures normally bundled together should be reported as distinct and separate procedures. The determining factor for using X modifiers is if a service that is usually part of a bundle should not be in a particular instance, for a particular patient, on a particular day. Read the full article.