Healthicity Blog

A patient’s history is a critical component to a physician for determining the etiology of a patient's problem. That’s why a history of present illness (HPI) is required in some form for every Evaluation and Management service.

Modifier 59 is shockingly confusing for coders, auditors and physicians alike. It’s frequently misused, for example, it’s often added as prevention or recoupment of an insurance denial as a way to get additional procedures paid.

As 2017 comes to an end, we’re all scrambling to wrap up a bazillion audits. ‘Tis the season for holiday cheer and audit anxiety, right?

The appropriate use of Modifier 25 can be a little tricky because the requirements are ultra-specific. On the one hand, Modifier 25 is really handy.

“Time is on my side. Yes it is.” But knowing whether or not time is a factor to qualify for a particular level of E/M can lead to uncertainty. So when is time a factor?

For this episode of Compliance Conversations, I sat down with Chad Peterson, a senior consultant at a large hospital, in their professional coding and reimbursement group. He educates physicians, mid-level providers/ advanced practice providers and even ancillary staff about E/M coding.

Compliance and coding are complicated.

Annually, the Centers for Medicare and Medicaid Services (CMS) publishes its Fee-For-Service (FFS) Improper Payment Report, a result of the accumulated totals of the Comprehensive Error Rate Testing (CERT) audits.