E/M

Top Compliance Issues Webinar Q&A with Michael Warshaw, DPM, CPC

Does a patient have to be “Homebound” in order to provide foot care services in the patient’s home?

Help! Can you please explain what is needed to determine the most appropriate E/M code to bill in the office based upon time?

What are the guidelines for selecting the level of E/M service based upon Medical Decision Making (MDM)?

What are the guidelines/rules for billing an E/M service based upon total time?

What are the Proper Ways to Use the 25 Modifier?

“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?”

“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?”

“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?”

“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?”