When can modifier –25 be used with an E/M code?

We were told that we could not use modifier –25 on an evaluation and management (E/M) code unless we have a new diagnosis. Is this true? No, this is not true for Medicare, nor is it true from a CPT standpoint. However, some payers will deny an E/M code with a modifier –25 if both

Medicare final rule: Urologists’ pay set to decrease (again)

It’s that time of year of again. As we wrap up 2017, it is time to prepare for next year. Urology was spared any significant changes in ICD-10 when that system was updated officially Oct. 1, 2017. In this article, we provide a summary of CPT changes for 2018, the Medicare Physician Fee Schedule final

How to get reimbursed for BPH water vapor ablation

How do I code for convective water vapor ablation for lower urinary tract symptoms/BPH (Rezum System)? Up front, we must disclose that Physician Reimbursement Services has contracted with NxThera to provide support for offices that have billed for Rezum. In this article, we will provide the basics as we know them at this point. Until recently, you

Practice ‘report card’ tracks performance

Is my staffing level appropriate for my practice? Is my overhead too high? Is my billing department doing a good job? These are just a few of the questions we are asked by urology groups around the country. One urologist recently asked a broader question: What should I be looking at each month to see

Health Management Brief: Physician Hospital Call Coverage Compensation

Working closely with many practices of all sizes PRS Consulting is acutely aware of key financial pressure points confronting the practice leadership team. Consistently near the top of the list is providing hospital on call coverage duties. This is a multi- faceted issue only magnified with increasing weak margins and soft physician incomes. Pressure points:

How to bill for discontinued vasectomy procedure

I was performing a vasectomy in the office but had to discontinue the procedure because the patient could not tolerate it. The incision had been made. Should I bill this with the –53 modifier or should I bill an E&M service? The procedure was performed 2 days later in the outpatient surgery center under sedation. The

Proposed MIPS rule modifies 2018 requirements

The proposed rule for MACRA and the Merit-based Incentive Payment System (MIPS) program was released June 21, 2017. As expected, the program requiring the implementation of the new MIPS scoring system and incentives to move to alternative payment models (APMs) will continue. This proposed rule represents a modification of the 2018 requirements as the program

What happens when prior auths don’t match services provided?

I received a preauthorization from the patient’s insurance company, but the doctor turned in a charge sheet with different codes. This happens frequently. The claim was denied. Should I appeal? You are not alone. In fact, we see this issue more frequently as some payers are increasing the prior authorization denials from CPT code only

How to charge for E&M services, procedure on same date

Our office has adopted a policy that does not allow coding for an evaluation/management visit on the same date as a previously scheduled cystoscopy. At your course, you said that if an E&M service is separate and identifiable, you can charge for the E&M with modifier –25. If I talk to a patient and/or treat

Telemedicine: Reimbursement in fee-for-service, quality models

Younger generations of patients will demand immediate answers to their health-related questions via electronic information and telemedicine. We need to bring health care into the 21st century. But how? The provision of health care via technology and without direct eye-to-eye and skin-to-skin contact is an area of growing interest in the U.S. It is also an