June 2, 2023 | By Grant Huang, CPMA, CPC You’ve got just over a month before July 1, the day that modifier JZ (zero drug wasted) becomes mandatory on all claims for drugs in single-use containers that are used up without wastage. It’s a seemingly simple change that is being backed up by explicit…
February 10, 2023 | By Grant Huang, CPMA, CPC The realm of E/M auditing is vast, and 2023 will bring more work here than before thanks to CPT’s extensive revisions to its E/M guidelines for inpatient, facility, and home visit services — now in effect. Both compliance professionals and providers must always keep in…
November 25, 2022 | By Grant Huang, CPMA, CPC It’s been two years since CMS collaborated with the AMA to revamp Evaluation & Management (E&M) coding guidelines, including a rework of prolonged services codes in the office/outpatient setting. This process culminated in a disagreement between the AMA’s CPT manual and CMS’ fee schedule final…
April 22, 2022 | By Grant Huang, CPMA, CPC You’ve taken the time to complete a painstaking audit of a provider, combing through their documentation on an EHR or maybe even navigating through a handful of handwritten notes. You’ve calculated their score – it doesn’t look too good – and now it’s time for…
April 22, 2022 | By Grant Huang, CPMA, CPC Prolonged services have been around for a long time – no pun intended – but in recent years the number of codes involved has grown and their requirements have changed, making them a potentially risky area for providers. For this reason, auditors should take the…
March 11, 2022 | By Grant Huang, CPMA, CPC For the first time since CMS and the AMA implemented their 2021 revisions to office/outpatient evaluation and management (E/M) guidelines, we now have data on how those revisions may have impacted actual E/M code selection by healthcare providers. Utilization of level 4 visits is up…
December 24, 2021 | By Grant Huang, CPMA, CPC The 2021 E/M guidelines’ more permissive rules for time-based coding is a potential watershed moment for physicians who want to spend less of their time documenting E/M notes. But if we interpret these changes to mean that the longstanding concept of “medical necessity” can be…
October 1, 2021 | By Grant Huang, CPC, CPMA A year and half into the coronavirus pandemic, confusion still remains over a variety of remote services that are often lumped into the same category as telehealth but have their own unique codes and billing guidelines. CMS has given them the somewhat unwieldy label of…
August 13, 2021 | By Grant Huang, CPC, CPMA With Americans having widespread access to effective vaccines, the COVID-19 pandemic is finally fading into the background for most practices, but the issue of compliance is once again rearing its multi-faceted head. This time, after billions of dollars in federal spending as part of pandemic…
March 26, 2021 | By Grant Huang, CPC, CPMA If you thought some of the language in the 2021 E/M guidelines was confusing, you’re not the only one: The AMA has gotten enough questions about its new guidelines to issue a six-page document packed with clarifications and corrections. The document also includes an additional three pages…