Many medical practices are now receiving letters from Cigna on their intent to review all claims with Evaluation and Management services reported with 99212-99215 for established patient services. This will create unnecessary burden on practices and delay payments. Could this action have been avoided? In a word yes. Since the induction of Modifier 25 it …
Medical coding audits are an essential part of the healthcare industry, as they help to ensure that organizations are accurately coding their services. There are numerous benefits to conducting external medical coding audits including ensuring that medical providers are compliant with coding regulations. The goal is to identify any errors and to help medical practices …
Does the Global Package need unpacking? In order to answer this question, it’s important look at the value (RVU or Relative Value Unit) attached to certain procedures. The Global Package has applied to over 4,000 physician services since 1992. Over time, providers have been concerned about the valuation of many of these services. Inflation and improvements to certain procedures …
In 2021, when the Evaluation and Management guidelines were revised, the area with the most confusion was ultimately the amount and/or complexity of data to be reviewed and/or analyzed. Like with other components, misunderstandings with definitions and descriptions were at the root of the problem. It is extremely important to read the full description and …
Every patient that walks through the door has a story to tell about what brought them in that day. How a physician tells that story through documentation is crucial to receive reimbursement that aligns with the payment policies set forth by various third-party payers. One area of reimbursement that can affect payment is the use …
In September 2022, the American Medical Association released the revised E/M guidelines for 2023, bringing the 2021 Guidelines in alignment with other code sets for Evaluation and Management Services. This is part of their ongoing effort to reduce physician documentation burdens. On November 1st CMS released their Final Rule in the CMS-1770-F for revisions to …
There are several things you need to know when choosing the correct administration code
In September 2022 the American Medical Association announced the new codes for 2023. Of note for General Surgery practices was a complete overhaul for Hernia codes. There are 15 new CPT codes (49591-49623) that will replace the existing codes which combines location, approach and specifies the size of the repair. For instance CPT code descriptions …
Are you struggling with your Evaluation and Management reimbursement for Radiation Oncology services? Radiation Oncology has nuances, and you may be leaving money on the table without a good understanding of how the 2021 Evaluation and Management guidelines impact Oncology services.
When capturing Evaluation and Management services, the goal is to capture the true data behind the risk and problems addressed to report the service accurately. Beyond the reimbursement, what else does the accuracy of code capture do?
In 2004 I took on my second specialty in Healthcare in the world of Opthalmology. I was introduced to the specialized procedures and services performed by professionals in this space. Over the next few years I dug into this specialty learning the Anatomy, Disease Process and importance of eye health. Years of Audits led me …
