DAVID STERN, MD (Practice Velocity) Q.I have been told that I can get credit for a complete review of systems (at least 10 systems) by simply noting positive findings in certain systems and then noting “all other systems negative.” A.This is, indeed, a general CMS “guideline,” but two Medicare carriers have issued contradictory guidelines. TrailBlazer Health Enterprises (Medicare carrier for Delaware, the District of Columbia, Maryland, Virginia, and Texas) and Wisconsin Physicians Services (Medicare carrier …
Read MoreHow to Define a Type B ED—and Other Vexing Questions
DAVID STERN, MD (Practice Velocity) The urgent care practitioner may not live by coding alone, but proper reimbursement depends on it. To that end, Dr. David Stern, who is in great demand as a speaker and consultant on coding in urgent care, will offer answers to commonly asked questions in every issue of JUCM. In this issue, he addresses a potpourri of issues raised by urgent care practitioners. Q.A consultant tells us that we have …
Read MoreCoding Conundrum: E/M with a Procedure
Q.We always get denials for the E/M code in addition to a procedure. Are we doing something wrong? A.Denials for payment for an E/M in addition to a procedure may stem from several sources: Missing modifier If you perform a procedure with a 0- or 10-day global period and you perform and document a separate E/M on the same day, always attach modifier -25 to the E/M to reduce denials and costs of rebilling. Use …
Read MoreS Codes (S9088 and S9083) in Urgent Care
The urgent care practitioner may not live by coding alone, but proper reimbursement depends on it. To that end, Dr. David Stern, who is in great demand as a speaker and consultant on coding in urgent care, will offer answers to commonly asked questions in every issue of JUCM. In this issue, he delves into the sometimes confusing realm of the S codes. Q.What is an S code? A.S codes are a set of Healthcare …
Read MoreEvaluation and Management: Coding Details
Q.Why is the (E/M) code important in urgent care? A.Because the majority of urgent care revenue is derived from E/M codes (mostly codes 99210-99215), accurate E/M coding is the most important coding variable in urgent care revenue. Inaccurate E/M coding is, also, the number-one reason that urgent care centers run into compliance issues with payors and regulatory agencies. Q.I see that the Centers for Medicare and Medicaid Services (CMS) lists two sets of guidelines, 1995 …
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