There are often questions and confusion on what is included and acceptable when choosing “Drug therapy requiring intensive monitoring for toxicity” in the Medical Decision-Making Risk category for Evaluation and Management coding. This article reviews the definition and guidelines as provided by CMS and their Medicare Administrative Contractors (MACs). Risk: High MDM – Drug therapy…
By: Sheila Haynes, Manager Coding & Compliance Defining Interactive Complexity +90785: Interactive Complexity (+90785) is an add-on code utilized for office visits with a psychologist or other mental health professional that are complicated by language, behavior, emotions, mandated reporting requirements or trauma. +90785 is utilized in addition to one of the following primary service codes…
Modifier 25 is an important Evaluation and Management service medical professionals need to understand. It is used for same-day procedures when services beyond usual pre and post-operation are necessary. Continue reading below for a breakdown and examples of modifier 25! By: Sheila Haynes, CPC Coding and Compliance Manager Pay close attention to billing E/M (office…
By: Sheila Haynes, CPC – Coding and Compliance Manager As of January 1, 2021, codes for office/outpatient medical evaluation and management (E/M) care can be selected on the basis of the complexity of the medical decision making (MDM) or on the basis of the total time on the date of the encounter. For psychiatrists who…
By: Sheila Haynes, CPC Observation care is a well-defined set of specific, clinically appropriate services, which include: Ongoing short-term treatment, Assessment, Reassessment These are furnished while a decision is being made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation services are…
In response to the COVID-19 pandemic, CMS made several policy changes that allowed Medicare beneficiaries to access a wider range of telehealth services, alleviating some of the burden and risk of an in-person encounter at a healthcare facility. This coverage was established due to the public health emergency (PHE) for COVID-19. The coverage began on…
When a consulting doctor skips the interprofessional consult verbal report, it may cause some confusion when trying to submit an accurate code. There is only one code available for an interprofessional consult done without the verbal report. Continue reading below to learn what code should be used in this scenario! Question: Our doctor frequently forgets…
The HHS Office of Inspector General (OIG) made a recent addition to their Work Plan which specifically cites dermatology as their primary area of focus in regard to use of modifier 25. The updated Work Plan indicates that on average, 60% of dermatologists submit claims for E/M services also include minor surgical procedures, a much…
Bringing additional revenue into your practice can be challenging. RT Welter’s 99211 factsheet was created to assist you in reporting 99211 so that you can ensure you don’t miss out on the revenue you deserve. Continue reading below for more information. Ginger Avery, CPC, CPMA, CRC Coding & Compliance Manager With a current reimbursement rate…
CMS proposed bi-annual ICD-10 implementation dates that would be in addition to previous coding from last October. With the ongoing COVID-19 pandemic, the industry has had to adapt and evolve quickly. Of course, with new coding comes new standards for the medical industry. Read more below to see the new CMS proposed bi-annual coding dates. …