Tag: E/M code

Surgery global period modifiers

Surgical Global Period Modifiers: Modifier 54, 55, and 56 in Global Surgery Billing

Table of Contents The “Global” Concept Billing the Global Package Modifiers for Split Care Transfer of Care When Not to Use Modifiers 54 and 55 Modifiers: The Key to Accurate Medical Claims Processing To understand these modifiers, it’s essential to first examine the concept of the surgery global period modifiers. All medical procedures with a […]
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Medical-Necessity-Denials-Image

How to avoid medical necessity denials

How to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is normally addressed during an AWV. How to avoid it:“I often tell doctors to […]
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New-Patient-EM-Denials

New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
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E/M Coding Guidelines

4 Strategies For Accurate Medical Coding & Denial Prevention

4 Strategies For Accurate Medical Coding and Denial Prevention Payers typically deny evaluation and management codes (E/M code) on the back end of the billing process, which can cause costly reimbursement recoupments, according to Medical Economics. Four tips to avoid denials caused by inaccurate E/M levels: Make sure the E/M code supports the specific patient encounter. […]
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