Tag: E/M Services

Medical Coding Modifiers

Decoding Complex Modifiers: Advanced Tips for Coders in 2025

In the world of medical coding, modifiers are like the punctuation marks of clinical documentation—they clarify intent, add nuance, and ensure that payers fully understand the story behind the service provided. When applied correctly, modifiers safeguard compliance, prevent denials, and guarantee appropriate reimbursement. When applied incorrectly, they can spark audits, lead to revenue loss, or […]
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G2211 CPT Code Guide to Reimbursement, Billing, and Usage

G2211 CPT Code Explained: Billing Guidelines, Reimbursement, and Modifier Use

 Key Takeaways G2211 is an add-on HCPCS code representing visit complexity tied to ongoing, longitudinal patient care. It must be billed with E/M codes (99202–99215) and cannot be billed independently. Medicare reimburses G2211 (approx. $16 nationally), but commercial payer acceptance may vary. Use accurate documentation to demonstrate the longitudinal care relationship. No modifiers are usually […]
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Understanding Modifier 25: A Comprehensive Guide

Understanding Modifier 25: A Comprehensive Guide

Often, a seemingly routine preventive visit or minor surgery can take an unexpected turn when a patient mentions a new concern, such as “Oh, by the way…” If a physician provides additional care beyond the originally scheduled service, you may be able to bill for a separate evaluation and management (E/M) service using modifier 25. […]
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349 Ways CPT Codes Set is Revolutionizing Medical Practice for Physicians in 2024

349 Ways CPT Codes Set is Revolutionizing Medical Practice for Physicians in 2024

The user-friendly descriptions associated with the over 11,000 Current Procedural Terminology (CPT®) codes are integrated into various medical documents, insurance forms, price lists, and patient portals. They serve as crucial references for numerous hospitals, health plans, and medical offices. To address language barriers, the recently released 2024 CPT code set now incorporates these descriptors in […]
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CMS Corrects Time Thresholds for Prolonged Services

CMS Corrects Time Thresholds for Prolonged Services

What a difference 15 minutes can make when billing E/M services. The Centers for Medicare & Medicaid Services (CMS) issued a notice March 14 correcting several errors in the 2023 Medicare Physician Fee Schedule (MPFS) final rule. Most notably, CMS is correcting technical errors in the calculations of the time thresholds for reporting evaluation and […]
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Append Modifier FT for Unrelated Critical Care Services

Append Modifier FT for Unrelated Critical Care Services

On Jan. 14, coders and billers gained insight into proper use of novel HCPCS Level II modifier FT Unrelated evaluation and management (e/m) visit during a postoperative period, or on the same day as a procedure or another e/m visit. (report when an e/m visit is furnished within the global period but is unrelated, or […]
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Medical decision making and coding

Medical decision making and coding

MDM elements during a preventive visit Q: Is it appropriate to count laboratory tests and other tests ordered during a preventive medicine service (99381-99397) visit in medical decision making (MDM) selection? No, because the 2021 revisions to the E/M office or other outpatient MDM do not apply to codes 99381-99397 (preventive services). These codes are […]
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Understand Critical Care Before You Code

Understand Critical Care Before You Code

A solid understanding of guidelines and COVID-19-related complexities will limit claim denials and audits. Deciphering documentation to determine what qualifies as critical care services can be challenging for medical coders and auditors. With limited critical care codes available for assignment, reporting may appear relatively straightforward at first glance. However, there are many considerations that coders […]
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