Code G2211: The Medicare Physician Fee Schedule for 2024 was revealed by the Centers for Medicare & Medicaid Services (CMS) on November 2, 2023. This finalized rule outlines modifications slated to begin on January 1, 2024. These changes largely mirror the proposals made in July, with a focus on adjustments pertinent to urology. This article […]
To determine the appropriate use of modifier 25, review this case study in otolaryngology. The Cigna Group has delayed the requirement for submitting documentation with claims that involve a 25 modified offices or other outpatient evaluation and management (E/M) service (CPT® 99212-99215) and a minor procedure. Despite the payer not enforcing this requirement, physician practices […]
In recent years, there has been an increase in scrutiny regarding the use of modifier -25 to identify separate evaluation and management (E/M) services on the same day as another procedure. Insurers are now demanding documentation of such services both before and after payment, leading to a significant administrative burden for urology practices. The reason […]
During a typical office visit, physicians may provide evaluation and management (E/M) services, minor procedures and more. The question is: Can they bill for each one separately? In some cases, the answer is no. In others, though, the answer is yes — but they must know what current procedural terminology (CPT) modifier to append. Modifiers […]
Despite myths to the contrary, physicians are not prohibited from coding and billing for both preventive and problem-focused evaluation and management (E/M) services when they are performed during the same appointment. Motivated by a desire to avoid audits, many physicians tend to undercode for the work they perform. Others, however, are just unaware that the idea that […]
Question:Â Why do my Evaluation & Management (E&M) codes keep getting denied when I bill them in conjunction with spinal manipulation? I have been receiving increasing inquiries regarding the denial of Evaluation and Management (E&M) codes 99201-99215 when billed with chiropractic manipulation. It appears to be happening on a wide scale, so I want to address […]