CodingIntel Editor, Author at CodingIntel Page

Leveling a Visit for an Acute, Uncomplicated Presenting Problem

Question: What’s the accurate level of service for a patient who presents with a sore throat, has a positive strep test, and is put on antibiotics? Answer: The September 2025 CPT® Assistant posed this question and said the level of service was 99213. Let’s look at this in grid form to see why. You need […]

Take the guesswork out of Separate Procedures, Global Packages, and E/M Billing Rules

Navigating medical coding can be a challenge, especially when it comes to understanding when procedures and Evaluation & Management (E/M) services are separately billable. Three key concepts—separate procedures, global surgical packages, and E/M modifiers play a critical role in accurate and compliant billing. Let’s break them down. Separate Procedures: When to Bill and When to […]

Does 99459 Require a Chaperone?

Question: The E/M session of the CPT® symposium this year was in question-and-answer format. One of the questions was, “Is a chaperone required to use add-on code 99459?” Answer: Their answer: no. Some consultants stated that in order to use code 99459 with an office visit, consult, or certain preventive medicine services, a chaperone was […]

Crediting Independent Interpretation

Question: Can a practitioner get credit for both ordering and interpretation of a test if documented? Can you address the change from 2023 related to this? Watch this brief video, or read on for the answer. Answer: In March of 2023, CPT® issued an “Errata and Technical Corrections” which added one line to the section […]

Teaching Physician Rules – Moonlighting

Question: Resident is moonlighting in an urgent care setting. The resident is licensed but not enrolled with insurance companies. Can we follow the Teaching Physician rules for this resident and bill for services jointly performed between an attending and the resident? Answer: For Medicare, no, not based on my reading of the applicable statutes. “Moonlighting” specifically refers to […]

Visits in the Maternity Package

Question: How many visits are included in the payment for the maternity care package? Answer: The global maternity package includes approximately 13 routine antepartum visits for an uncomplicated pregnancy: monthly visits up to 28 weeks, biweekly visits to 36 weeks, and weekly visits until delivery. Fewer than four prenatal visits do not qualify for global reimbursement and […]

Advance Care Planning Q&A

Does your practice provide Advance Care Planning (ACP) services? If so, read on and watch the video below. Advance Care Planning is reported with two CPT® codes from 2015. CMS gave it a status indicator of Invalid in 2015, but in 2016 changed that to an active status and began reimbursing for the service. But, […]

Coding Guide – Maternity Services

Download Guide Guide updated Sept. 2025 This guide addresses CPT® coding for maternity care services. It covers coding for professional services performed by physicians and other qualified health care professionals including Certified Nurse Midwives in obstetrics, family medicine, and maternal-fetal medicine. It describes how to code for global maternity care, antepartum care only, delivery services […]

Care Management Services | Webinar

Event date: October 30th, 2025
1 CEU expires 10/30/26

Guest presenter Pam Warren of MaineHealth

Care management services include Transitional Care Management, Chronic Care Management, Principal Care Management and Advanced Primary Care Management. Each type of care management has its own purpose and service requirements.

Reporting the Global Surgical Package | Webinar

Event date: October 16th, 2025
1 CEU expires 10/30/26

The global surgical package provides a single payment for services normally performed before, during and after a procedure. This webinar will review both CPT® and CMS rules and explain what services are included in the payment and what services may be reported separately.

ICD-10-CM Update | Webinar

Recorded September 25th, 2025
1 CEU expires 9/30/26

Guest Presenter Shannon McCall of HCPro

ICD-10-CM updates are here and effective starting October 1, 2025. This webinar will describe changes to the all-important ICD-10-CM Official Guidelines for Coding and Reporting.

Selecting the Correct Place of Service Code

Pam Warren, MHA, COC, CPC, Fellow We’ve all seen that two-page chart in the CPT® book that indicates the place of service code (POS) that is expected to be reported for physician services. But not every physician performs in office settings; not all physicians perform office visits, and some services can be billed by physicians when […]

2026 CMS Proposed Physician Rule | Webinar

Recorded August 14th, 2025
1 CEU expires 7/30/26

CMS released its proposed policy changes for physician practices in mid-July this year, with the usual 60-day comment period. Our webinar will tell you what’s in it.

Provider-Based Billing | Webinar

Recorded July 17th, 2025
1 CEU expires 7/30/26

Guest presenter Pam Warren of MaineHealth

Reporting services in provider-based clinics requires knowledge of Medicare rules related to the technical and professional components of visits. It requires understanding of both the CMS 1500 form and the UB04.

Fueling Compliance: Cracking the Code on DSMT & MNT | Webinar

Recorded June 26th, 2025
1 CEU expires 6/30/26

Guest presenter Darren Goodwin of MaineHealth

Join us for an overview of Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT) services., outlining key coverage criteria, provider qualifications, and documentation requirements.

Problematic Modifiers – 22, -52, -58, -78, -79 | Webinar

Recorded June 19th, 2025
1 CEU expires 6/30/26

Guest presenter Shannon McCall of HCPro

This webinar focuses on selected CPT® modifiers that tend to be problematic for coders and claims processing, with emphasis on the application of modifier-22 and -52 including commonalities and differences as stated by the AMA and supportive citations from the Medicare Claims Processing Manual.

Behavioral Health Screening and Testing

This article will review the codes and guidelines for the following behavioral health screening and testing services: Assessment of Aphasia and Cognitive Performance Testing Developmental And Behavioral Screening and Testing Neurobehavioral status examination Assessment of Aphasia and Cognitive Performance Testing CPT© codes for the assessment of aphasia and cognitive performance testing include: 96105 – Assessment […]

Anatomy of an Audit™: Complexity of Problem Addressed | Webinar

Recorded May 22nd, 2025
1 CEU expires 5/30/26

Guest presenters Pam D’Apuzzo and Debra Rossi of VMG Health

Combining CPT® guidance and audit experience, this session addresses definitions and documentation for the first element of medical decision making, the number and complexity of problems addressed. It includes guidance for all problem levels in the E/M grid.

Coding and Auditing Critical Care Notes | Webinar

Recorded May 8th, 2025
1 CEU expires 5/30/26

This webinar will review CPT® guidance for reporting critical care, including the condition of the patient, the interventions, and time spent. The webinar will discuss what services may be reported separately from critical care.

Coding for Medical Nutrition Therapy Services

Medical Nutrition Therapy Services (MNT) have been a covered benefit under Medicare since the early 2000’s. This article will describe the rules related to coding for medical nutrition therapy services for Medicare patients. This article also addresses common questions about coverage under the Medicare benefit with brief answers and links to the source documents for […]

Can I Get Paid For…Removal of Sutures or Staples

For a code that reimburses at about $10, can you even remember how many times you’ve been asked that question? How do I bill for suture removal again? The answer to the second question is that there are three CPT® codes for removal of sutures or staples. Back to list

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