by Leah Culley | Jun 12, 2026 | Auditor Insights
Split/shared visits continue to be a frequent source of audit findings—not because the services weren’t appropriately provided, but because the documentation doesn’t clearly identify who performed the substantive portion of the visit. The Documentation...
by Susan Bonham | Jun 1, 2026 | Auditor Insights
Coding assistant-at-surgery services in a teaching hospital can be challenging, particularly when determining whether Medicare will reimburse the assistant. One of the most common misconceptions is assuming that an assistant surgeon is automatically paid whenever they...
by Leah Culley | Jun 1, 2026 | Auditor Insights
Point-of-care (POC) testing is common in today’s clinical setting, but it’s also one of the most frequently misunderstood components of E/M coding. A common misconception is that every POC test performed automatically counts toward the Amount and/or...
by Deanna Upston | May 6, 2026 | Auditor Insights, Uncategorized
Modifier 22 is often used to capture cases that required increased procedural services, but a key question remains: do your claims truly support it—and is it worth the effort? What Payors Expect To justify modifier 22, documentation must go beyond stating that a case...
by Emily Lomaquahu | Apr 22, 2026 | Auditor Insights, Profee Coding, Webinar Q&As
Using scribes can help reduce documentation burden, but when that scribe is a physician assistant (PA) or nurse practitioner (NP), things can get complicated quickly. What Defines a Scribe? A scribe’s role is strictly to document the physician’s or NPP’s work during...
by Susan Bonham | Mar 31, 2026 | All Posts, Auditor Insights
Time-based E/M coding can be tricky, and audits often reveal a common mistake: including separately reported services in the total time. CPT® guidelines are clear—time spent on other billable services, travel, or general teaching unrelated to the patient’s management...
