Practice Management
Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Three elements determine the level for evaluation and management coding (E/M). “Amount and/or Complexity of Data to be Reviewed and Analyzed” is 1 of them and also the most confusing. Data Reviewed remained a point system after guidelines changed in 2021. As an auditor, I see both undercoding and overcoding in E/M caused by not applying the rules correctly. Let’s start with what tests count toward Data Reviewed. …
Read MoreOn March 9, 2021, the American Medical Association updated the new evaluation and management (E/M) coding guidelines with technical corrections. These clarifications apply to the office visit codes 99202–99215 and are retroactive to January 1, 2021. In the past few months there has been industry confusion over whether a test can be counted under the data element for the E/M level when the practice is also billing for the test. The AMA has answered this …
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President Trump recently declared the epidemic of opioid addiction and related deaths to be a national emergency, pledging the federal government would spending more money and pay more attention to stemming the crisis. While details are still to come, theoretically future actions could include mandatory education for prescribers nationally and increasing funds to treatment and prevention programs. Coinciding with that, Express Scripts, the nation’s largest pharmacy benefit manager, is trying to restrict access to opioids. …
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We’ve told you recently about plans some insurers have to stick patients with the bill for emergency room visits that are retrospectively determined to have been nonemergent in nature. In essence, if patients go to the ED with an illness or injury that could have been handled in a lower-acuity setting (such as an urgent care center), as determined by the insurer, the patient’s claim will be denied. Now the American Medical Association is demanding …
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Urgent care clinicians, operators, and staff will gather in Houston at one of the larger regional urgent care conferences in the country later this month. The 2-day Southwest Urgent Care Conference offers both a Clinical Track and a Leadership track in deference to the unique makeup of the industry, with clinicians often also being business owners and corporate leaders. The clinical curriculum was also designed with consideration for the fact that nurse practitioners and physician …
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The American Medical Association wants to help medical students deal with the reality of working within electronic health record (EHR) systems. They launched a new program, the brainchild of Indiana University School of Medicine and the Regenstrief Institute, to grant med students access to misidentified and deidentified EHR information in the classroom before they enter clerkships in order to address a gap between clinical medical education and practical skills needed in the practice setting. The …
Read MoreQ. When a patient comes in with ear pain due to impacted cerumen, the health-care provider would normally instruct the nurse to perform ear irrigation. If the irrigation successfully removed the impacted cerumen, the procedure would be considered part of any evaluation and management (E/M) service and we could not bill for the service separately. With new rules regarding cerumen removal this year, can we get reimbursed for the ear irrigation if it is not …
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