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Some practices that frequently report E/M services with modifer 25 (Significant, separately identifiable E/M service) are on track to face a dramatic pay reduction.
Brace for a big shake-up to E/M coding. CMS announced its intention to pursue “comprehensive reform of E/M documentation guidelines” in the 2018 proposed Medicare physician fee schedule released July 13.
Two medical centers in Massachusetts will pay more than $700,000 to settle allegations that they upcoded claims when they failed to follow the rules for new and established patients.
Look to your diagnosis coding to understand whether a patient fits the criteria for new cognitive-assessment code G0505 because the code does not confer blanket coverage for your elderly patients.
Good news – coders are cutting their ICD-10-CM coding error rate from an average of 15% just after the codes took effect in 2015 to 7% last year, attendees learned at this year’s AAPC Healthcon in Las Vegas.

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