Payment systems and reimbursement are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. Medical practices continue … [Read more...]
Coding Guide – Care Management Services
CMS has a stated goal of recognizing management services provided outside of an office visit. In particular, valuing and paying for care management … [Read more...]
Let’s Go to the Source! Should this Visit be Downcoded?
This article describes the use of time using the 1995/1997 guidelines. Be sure to read about the 2021 guidelines for codes 99202--99215. A … [Read more...]
Do I Need Modifier 52 for this Repair?
Question: Can you please give me your opinion on a coding case? We have a surgical oncologist that performed an excision of malignant skin … [Read more...]
Prolonged Services and Nursing Home Visits
Question: Prolonged Services and nursing home visits. I'm getting a "Code 99358 is a column 2 code for 99309, these codes cannot be billed … [Read more...]
Denial Management Strategies
On-demand webinar Medical practices can decrease denials and accelerate payments by setting up work processes that use advance functions in their … [Read more...]
Can We Bill for IUD Removal and Insertion on the Same Day?
Question: Can I bill 58301 for IUD removal and bill 58300 for IUD insertion on the same day, if the provider removes and then inserts another IUD? … [Read more...]
HCC Diagnosis Coding: Can you Add a Code from the Past Medical History?
This post describes rules for office/outpatient coding, not facility/DRG rules. Recently a fellow coder wrote to me about risk adjusted diagnosis … [Read more...]
CPT® Code 99483: Cognitive Assessment and Care Plan Services
Developed in 2018, this service describes an in-depth assessment and development of care plan services for new or established patients who have signs … [Read more...]
General Behavioral Health Integration Care Management
99484 Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other … [Read more...]
Selecting CPT® Rules for Excision of Skin Lesions
Many medical practices perform skin procedures. A patient may see a dermatologist, a family physician or a surgeon when the time comes to find out, … [Read more...]
Destruction of Benign or Pre-Malignant Lesions
Finding the right code for lesion destruction is not easy. The codes are distributed in the CPT® book in the integumentary, digestive, male genital … [Read more...]
Avoid These 4 Costly Errors When Coding Minor Surgical Procedures
Does your practice perform any minor or major procedures? If so, this post is for you! Primary care practices and urgent care centers should pay … [Read more...]
What’s the Difference Between B20 and Z21? Which is Right for Positive HIV Status?
In this post ICD-10-CM diagnosis coding for positive HIV status Update to HIV coding in 2022 Medical practice reimbursement for individual … [Read more...]
To Credit or Not to Credit: Auditing E/M Services
Recorded September 21, 2017 When it comes to auditing E/M services, there’s black, white and a whole lot of gray. Reasonable auditors can disagree. … [Read more...]
Everything You Want (And Need) to Know About E/M Services
Evaluation and Management (E/M) services account for 30% of the revenue paid by Medicare for all physician services. For many specialties, E/M codes … [Read more...]
CMS is Seeking Comments About Updating E/M Service Definitions
I hope you’re sitting down, because there is big news! The proposed physician fee schedule rule was released in mid July and includes a section about … [Read more...]
Reporting Excision of Multiple Lesions of the Same Size
Question: The doctor I work with excised two benign lesions from a patient’s arm, of the same length.  Do I add them together and report one code? … [Read more...]
History | Documentation Guidelines for E/M Services
ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong....) However, we will still need to use them when auditing … [Read more...]
Screening Pelvic/Breast Exam and Pap Smear Denials | G0101 and Q0091
HCPCS codes and Q0091 We received this question from one of our members: "We have a Medicare patient for whom we provided a pelvic and a breast … [Read more...]
7 Sure Fire Ways to Owe the Government $4 million in Fines and Repayments | Coding Compliance
Most practices aren’t looking to pay the government any money in fines and repayment because of coding errors. Two recent OIG settlements described … [Read more...]
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