CPT® codes for patients at home in a residence: New patient: 99341, 99342, 99344, 99345 Established patient: 99347−99350 These codes are used to report services in a patient’s home or in a residence. “Home may be defined as a private residence, temporary lodging, or short -term accommodation (eg, hotel, campground, hostel, or cruise ship).” These […]
The Ideal Audit Review Meeting
Do you hope for the perfect audit review meeting? You audit an entire team of providers who either have 100% accuracy or they don’t, but they greet your feedback with grace and humility. It helps when you of direct communication and real curiosity and engagement with the medical team, but results are not guaranteed. Auditing […]
Coding vs. Clinical Validation
Understanding Distinct Roles, Responsibilities, and Qualifications in Healthcare Documentation Two critical functions are often misunderstood or conflated: medical coding and clinical validation. While both are essential to accurate documentation, appropriate reimbursement, and regulatory compliance, they are fundamentally different disciplines that require distinct skill sets, credentials, and areas of expertise. Confusing these roles—or allowing one professional […]
Depression Coding and Hierarchical Condition Coding (HCC)
Introduction | Depression coding in HCC In fee-for-service medicine: Diagnosis coding establishes the medical necessity for a service. At times, it may be the reason for a denial, particularly for diagnostic tests or procedures. Services with national or local coverage policies often have specific diagnosis codes that are required for payment. In V28 of HCC, […]
HCC Coding for Medical Practices | Webinar
Recorded March 19th, 2026
1 CEU expires 3/30/27
Risk adjustment coding is a hot topic for Medicare Advantage Organizations and medical practices with risk-based contracts. It’s one of the pillars of payment for Value Based Care. At this webinar, participants will learn how Hierarchical Condition Categories work based on ICD-10-CM rules.
E/M Frequency Data for Dermatology
For dermatologists, revenue in the office is generated by procedures and office visits. Often, both are provided on the same day. See the dermatology section of our specialty page for articles about the use of modifiers 25, 51, and 59. Frequency distribution for new and established patients 2024 E/M data released at the end of […]
E/M Frequency Data for Surgical Specialties
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Unfortunately, there aren’t specialty designations for breast, bariatrics, or trauma surgery, and those surgeons are usually enrolled using the category for general surgery. There are specialty designations for vascular surgery, plastic surgery, thoracic, and surgical oncology. The data below […]
E/M Frequency Data for Psychiatrists
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. This is the data for psychiatrists. The data below is from 2024 released in late 2025. Office services Psychiatry New OV 2024 99202 0.74% 99203 8.05% 99204 38.58% 99205 52.63% Established office visits 2024 99211 0.73% 99212 4.33% 99213 […]
E/M Frequency Data for Infectious Disease, Pulmonary Medicine and Cardiology
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Infectious disease, pulmonary medicine and cardiology are all specialties with active inpatient services, and of course, busy office services. That’s why I’ve elected to show them together. The data below is from 2024, released in late 2025. Office services […]
Cerumen Removal
There are two codes for cerumen removal 69209 Removal impacted cerumen using irrigation/lavage, unilateral 69210 Removal impacted cerumen (separate procedure), 1 or both ears Key points Document the medical necessity for cerumen removal (patient’s complaints, diminished hearing, physical exam) Document the results: was the procedure successful? Whether it is a clinical staff member or practitioner […]
Removal of a Foreign Body
Integumentary 10120 Incision and removal of foreign body, subcutaneous tissues; simple 10121 Incision and removal of foreign body, subcutaneous tissues; complicated Note that incision is required. Musculoskeletal From Principles of CPT® Coding, “If fascia is penetrated and a foreign body to be removed is within the fascia, subfascia or muscle, use an anatomic-specific code in […]
Remote Physiologic Monitoring Treatment Management Services
The remote physiological monitoring section describes providing equipment and data collection, initial set up and education on the use of the equipment, and treatment management based on the data that was measured. The codes are confusing because they are sorted/divided in confusing ways. Codes 99454, 99445 and 99454 are for the initial set up and […]
Remote Therapeutic Monitoring
There are two sets of codes in the CPT® code set for Remote Therapeutic Monitoring (RTM). The first set is for the monitoring itself, and includes codes for initial set-up and patient education and for the device supply or data transmission. The second set of codes is for treatment management services based on the data […]
Diabetes Coding in Hierarchical Condition Coding (HCC)
Diabetes is a common chronic condition, included in three distinct HCC categories Patients often have more than one chronic condition of the disease; page down for a Q&A related to how multiple conditions do–and don’t–affect the risk score CodingIntel members can download our guide to Risk Adjusted Diagnosis Coding for Medical Practices for more explanation and […]
Compliance Issues in ICD-10 Coding for Risk Based Contracts and HCCs
How to be a great HCC coder? Know ICD-10-CM Official Guidelines for Coding and Reporting During an encounter: Code conditions assessed and managed. If treatment of an acute or chronic problem is affected by an ongoing condition, note that, and add the ongoing condition to the claim form. If the condition has a manifestation or […]
Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices
Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24 page guide from CodingIntel is an introduction to risk adjustment coding and the risk adjustment factor (RAF).
Lesion Destruction Tip Sheet
CPT® does not make it easy to locate codes for destruction of lesion(s). These codes are found in multiple chapters throughout the CPT® book, and are classified by a variety of factors (size, method of destruction, type (pre-malignant/malignant/benign), etc.) Accurate coding is essential to accurate payment. This tip sheet was created to help you quickly locate the correct CPT® code for lesion destruction.
Remote Monitoring 99453, 99454 | Reference Sheet
CPT codes 99453 99454 are used to report remote monitoring device set up, supply and recording. This resource answers the questions: who does the work, what is being monitored, how is it done, and what does the practice do.
Remote Monitoring Management 99091, 99457 | Reference Sheet
This quick reference sheet includes descriptions and examples for CPT ® codes 99091 and 99457-99458 for reporting Remote physiologic monitoring treatment management services.
Checklist for CPT® code 99483 | Cognitive Assessment Code for Dementia
Is your practice performing cognitive assessments for patients with dementia, using CPT® code 99483? If so, use this checklist to make sure you have documented all of the required components.
Coding for Telehealth
In this article: Telehealth and Extended Flexibilites – Feb, 2026 Telehealth Prior to the Pandemic Current Telehealth Rules Important Details (modifiers, frequency, teaching physicians, and more) RHCs and FQHCs Place of Serivce CPT® Codes for Telehealth Is it or isn’t it a Telehealth Service Communication-Based Technology Services Telehealth Flexibilities Extended Until Dec. 31, 2027! Date […]
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