Coders select E/M levels based on criteria developed by their organization. CMS has proposed a significant change to E/M coding-replacing the current 20 E/M levels for new patients, existing patients, and ED visits with three G codes-but that change would only apply to Medicare patients and only to the facility side.
Our experts answer questions about NCCI edits for injections, modifier -25, modifier -59, laminotomy with insertion of Coflex distraction device, billing mammogram for needle placement, and auditing electronic orders.
CMS released a number of proposed changes to the outpatient prospective payment system (OPPS) July 8. The 2014 OPPS proposed rule (available at http://tinyurl.com/oyu33jx) is shorter than normal at 718 pages, but the proposed changes are significant and probably the most sweeping since the inception of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting in Washington, D.C.
Our experts answer questions about billing vasectomy and sperm analysis, coding for ED visit when the patient is admitted for surgery, billing glucose reading before a PET scan, documentation required for the functional limitation codes, and appropriate reporting of observation.
E/M coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT® codes with three G-codes.
In a time when so much attention is focused on issues such as cyber security and the dangers posed from evolving technology, it's easy to forget the HIPAA basics, such as the need for workforce members not to gossip or chitchat about patients with other staff members or people in the community.
