This Coding Alert offers some reminders for Healthcare providers to help them properly document and bill Medicare for a Modifier 25 code [significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service]. It is not always the case that a notable medical record finding during a patient encounter warrants appending a Modifier 25. 

November 2018

It happens—a patient’s simple visit turns into an extended appointment. In this situation, it is critical for providers to properly document and bill for prolonged services in the office or outpatient setting. Providers must understand and follow the applicable coding/reimbursement standards and ensure services are accurately documented to support a prolonged services billing/claim.

October 2018

In the last CodingAlert, LW Consulting, Inc. identified specific proposed changes to the Physician Fee Schedule (PFS) for CY 2019. Highlighted below is the Centers for Medicare & Medicaid Services (CMS) proposed guidance for Evaluation and Management coding in the educational environment. Additionally, we have included corresponding links for you to voice comments to CMS (accepted on/before 9/10/18).

September 2018

The ground has shifted for physician services coding. The proposed Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) represents a fundamental shift in payment. Mid-July 2018, CMS released the PFS Proposed Rule which, when goes into effect, will change the current way evaluation and management codes in the office setting are selected and reimbursed. 

August 2018

In March 2018, LW Consulting, Inc. provided a CodingAlert outlining the components needed to credibly submit a level 4 new patient visit for billing. Because the topic spirited a great response, and approximately 40% of all our audit results are demonstrating a need for education on new and established patient encounter requirements, we decided to expand level 4 details to this topic.

July 2018

Fraud has become a growing concern under the Medicare program. LW Consulting, Inc. (LWCI) can help medical practices identify areas of potential risk and what to be mindful of in their medical record documentation.

June 2018

LW Consulting, Inc. (LWCI) has identified that within the components of Evaluation and Management (E&M) leveling, there are those that are more difficult than others to understand and apply. One component that, in our experience, has the most difficulty is in medical decision-making.

May 2018

In calendar year 2010, the Centers for Medicare and Medicaid Services (CMS) made revisions to the payment policies under the physician fee schedule (CMS-1413-FC), eliminating the use of all consultation codes for office/outpatient (99241-99245) and inpatient (99251-99255).

March 2018

As with so many forms of healthcare delivery, coding for a new vs. an established patient can be confusing. In this month's CodingAlert, we will review how to properly code for each type of patient visit.

February 2018

It's that time of year again, when the new CPT codes become effective. Make sure to get the current year’s CPT book or you could be coding inappropriately since this year, among other changes, observation codes have been revised and five new evaluation and management codes were added.

January 2018

It’s that time of year again when patients are coming in for their annual flu vaccines. Before selecting the proper code administration of a vaccine, make sure your practice knows what to check for.

November 2017

Now that more medical practices and health care facilities are utilizing electronic medical records (EMRs), regulators are finding that many records look identical in wording and elements. This can be cause for suspicion, leading to audits and claim denials. Are your medical records cloned? You should be on the look out for these documentation shortcuts and avoid them at all costs.

October 2017

Are your physicians and coders ready for October 1, 2017 when the new diagnosis codes and coding changes take effect? The 2018 ICD-10-CM codes are to be used for discharges occurring from October 1, 2017 through September 30, 2018 and for patient encounters occurring from October 1, 2017 through September 30, 2018.

September 2017

Documentation has been under increased scrutiny as the role of the medical record has substantially changed over the past several years. Managed Care, Health Care Reform and the implementation of Electronic Health Records have made chart documentation vital for every service that is being submitted for payment.

August 2017


As a healthcare professional, we're sure your health system or physician practice provides many annual wellness and preventive visits for Medicare patients. However, are you certain your Initial Preventive Physical Examination (IPPE) documentation meets the necessary requirements?

May 2017


There are many pitfalls to coding compliance that could jeopardize your hospital or physician practice. Incident to billing is one of those areas many physician groups and hospitals struggle to get right.

April 2017

Whether your medical record is electronic, paper-based, or a combination of the two, accurate and complete coding is critical to care delivery, appropriate reimbursement and compliance. It's important you understand and adhere only to the codes supported by the clinical documentation.

March 2017