Skip to main content
  • Helping you with HIPAA Security Solutions.
  • Call Us (631) 403-6687
  • Office HrsMon - Fri: 9.00am to 5:00pm

E/M

Coding

The 59 Modifier

by Dr. Michael Warshaw, DPM, CPC

When is it appropriate to bill for the trimming of a callus and the debriding of a nail on the same toe on the same date of service?
Read More
Coding

E/M Billing & The 25 Modifier

by Dr. Michael Warshaw, DPM, CPC

Why can’t an E/M service be billed every time that a procedure is performed on a patient in the office setting? When can an E/M service be billed when a procedure is performed on a patient in the office setting?
Read More
Coding

Cigna and Modifier 25

by Dr. Michael Warshaw, DPM, CPC

“I just received a letter from Cigna insurance. As of August 13, 2022, they will require the submission of office notes with claims submitted with Evaluation and Management/E and M codes (ie. 99212, CPT 99213, CPT 99214) appended by modifier -25 when a minor procedure is also billed the same day by the same physician. The E/M will be denied if documentation is not received. The claim can be sent electronically with attachment indicator and notes should be faxed. Is this happening with other insurance companies? The amount of paperwork for a small office is crazy and along with continued decreasing reimbursements, higher prices for supplies, shortages, etc. The insurance companies are making greater profits than ever. The insurance premiums have increased and out-of-pocket patient billing has become more significant. The system is not right. What can we do? How do we fight back? Please don’t say take cash rather than insurance, it’s not practical in many circumstances. Any thoughts?”
Read More
Coding

E/M Revisited

by Dr. Michael Warshaw, DPM, CPC

“For Medicare, it has been well established that debridement for callouses is not covered when class findings are not present. But what about that patient that complains of pain from a callus. If you evaluate the painful callus and manage the painful callus, would it not be appropriate to bill a low level E/M code? This patient does not want surgery but this is a recurring problem. Can the E/M be billed each time the patient is seen?”
Read More
Coding

Medicare TPE Review

by Dr. Michael Warshaw, DPM, CPC

“I received notice I am being selected for a TPE (targeted probe & education) review by Novitas Medicare. I practice in New Jersey. I have gone over the LCDs and the “educational” materials they sent. My documentation seems to be aligned with what they want. Any advice for working with them to have this resolved as soon as possible? Any things to avoid? Should I have someone other than myself act as a liaison between Medicare and me?”
Read More
Coding

E/M Coding Psychiatric Facility

by Dr. Michael Warshaw, DPM, CPC

“What is the E/M code series that would be considered for an initial visit when seeing a patient in an inpatient, psychiatric facility (POS 56)? Would it be a home code CPT 99341 or 99347?”
Read More
Coding

Trauma Coding: Combination of Injuries

by Dr. Michael Warshaw, DPM, CPC

“I have a patient who suffered an inversion, ankle injury. This injury resulted in a severe sprain of the lateral ankle ligaments and a fracture of the fifth metatarsal. The initial treatment involved immobilization using a CAM boot. I billed an E/M code and CPT 28470 at the initial visit. Eight weeks later the patient is in clinic, the 5th metatarsal fracture has healed clinically and radiographically. However, the ankle ligaments are clinically symptomatic and the patient is complaining of continued ankle instability. This clinic visit was focused on continued treatment of the lateral ankle ligaments and we are considering an MRI for further evaluation. I know I am still in the global period for CPT 28470, but I am still working on this ankle! Can we bill an E/M for this visit?”
Read More
Coding

Reading X-rays from an Outside Source

by Dr. Michael Warshaw, DPM, CPC

“We have a disagreement among our group regarding radiology billing. If a new patient presents with x-rays, MRI, etc., from an outside source, without a report (or with an inadequate report), can the podiatrist bill for the professional component of reading the imaging studies provided?”
Read More
Coding

Stable, Chronic vs. Chronic With Exacerbation/Progression

by Dr. Michael Warshaw, DPM, CPC

“As a general question, I am wondering if a physician documents that the patient has had symptoms for longer than a year and has failed conservative/other treatment, can this problem be considered as “chronic with exacerbation/progression”? I am referring to the verbiage in the CPT book (page 13, under Stable, chronic illness) regarding the expected duration of at least 1 year and am wondering if it is applicable in this scenario. Also, I know that a diagnosis of osteoarthritis is inherently considered “chronic”, but I am wondering if there are other diagnoses that can be considered ‘chronic’, as well?”
Read More
Coding

Annual Diabetic Foot Exams

by Dr. Michael Warshaw, DPM, CPC

“I think it is time for this topic to resurface. Being a coder/biller for a number of podiatrists around the U.S., I am finding that some are still scheduling “annual diabetic foot exams” as a routine on all of their diabetic patients. They are then performing a “full physical exam” and trying to bill an E/M. Sometimes this coincides with callus or nail treatment, at which time they want to add the 25 modifier. Of course, I am telling them that Medicare does not pay for an “annual diabetic foot exam” and that it is not a benefit and as such should be CASH. Has anything changed?”
Read More