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Billing for e-visits proves tough climb; more training needed?

01/27/2025

If you conduct e-visits and have difficulty billing for them, you’re not alone: Recently released survey data from the Mayo Clinic in Rochester, Minn., shows that even when patients agreed to be charged for queries sent though a portal, only a tiny fraction of these asynchronous encounters were billed.

Can you report audio-only office E/M? Yes, but be very careful

01/27/2025

by: Julia Kyles, CPC

Treating providers can perform audio-only E/M visits via telephone for patients who are at home, regardless of their geographic location, thanks to the three-month telehealth extension.

Don’t be rash: Capture accurate ICD-10-CM dermatology coding

01/27/2025

by: Betty A. Hovey, BSHAM, CCS-P, CDIP, CPC, COC, CPMA, CPCD, CPB, CPC-I

ICD-10-CM coding is one part of the proper claims partnership. While CPT codes indicate to a payer what service was provided to the patient, the ICD-10-CM codes indicate why it was medically necessary.

Clarify risk adjustment goals and financial directives

01/27/2025

by: Jennifer Brettler, DO, FACP, CHCQM-PHYADV

Question: We know that risk adjustment can impact reimbursement, quality of care, insurance plan ratings, and overall performance, but what does risk adjustment really mean?

Long e-visit decline arrested, thanks to a single code

01/27/2025

by: Roy Edroso

After a fast start in 2020, utilization of the e-visit codes 99421-99423 (for physicians) and 98970-98972 (for non-physician qualified health professionals) declined precipitously. But claims ticked up slightly in 2023, and one relatively simple service surged, according to the most recently available Medicare data.

New HIPAA rule makes the ‘addressable’ required, even before it’s finalized

01/20/2025

by: Roy Edroso

A proposed rule from HHS would confirm that cybersecurity measures such as multi-factor authentication (MFA) and encryption of electronic protected health information (ePHI) are not optional safeguards, but something covered entities such as physician practices are required to implement to stay compliant with HIPAA. Because of the way the policies are directed, experts say you should work to meet the proposed rule’s requirements whether or not the rule is finalized.

CMS closes modifier 25 loophole in the 2025 NCCI manual

01/20/2025

by: Julia Kyles, CPC

Teach the tighter modifier 25 guidelines in the 2025 National Correct Coding Initiative (NCCI) Manual and pass along the latest updates on mutually exclusive edits.

Note 63 services reportable with G2211 and 25-appended E/M visits

01/20/2025

by: Richard Scott

As of Jan. 1, practices are eligible to report visit complexity add-on code G2211 with office visit codes 99202-99215 when appending modifier 25 to the primary E/M code. However, take note of the billing restrictions that CMS placed on the same-day services eligible for the billing opportunity.

Highest level E/M reporter depends on who, where and encounter type

01/20/2025

by: Julia Kyles, CPC

A review of the top three specialties that reported high-level E/M codes in 2023 reveals a variety of primary care providers and other specialists at the top of the list. When it comes to the highest-level office visit code for new patients, three specialties dominated claims for 99205, the E/M visit with the highest payout.

Active status physician fee schedule codes with an XXX global surgery indicator

01/20/2025

by: Julia Kyles, CPC

CMS updated the guidelines for reporting an E/M service on the same day as a procedure with an XXX global surgery indicator – global surgery concept does not apply – in the latest National Correct Coding Initiative (NCCI) Manual.

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