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.
Cognitive and 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.
Can I Get Paid For…Removal of Sutures or Staples
In 2023, CPT® deleted code 15850 and revised code 15851. Prior to then, these codes differentiated between suture removal by the same surgeon who performed the primary procedure and suture removal performed by a different surgeon. It also used the term “under anesthesia other than local.” In CPT Changes 2023 An Insider’s View, the AMA said that […]
Transferring a Sick Baby to Another Hospital
Question: Our pediatric group practices in a community hospital, without an NICU. My pediatrician was called to attend a delivery of a newborn who was born premature and in respiratory distress. The baby needed to be stabilized and transferred to a level III neonatal intensive-care unit. The pediatrician spent 90 minutes from the time the […]
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 […]
Coding for Prolonged Services | Webinar
Recorded April 17, 2025
1 CEU expires 4/30/26
Coding for prolonged services requires practitioner education, careful documentation and coder oversight. These codes are the opposite of “set and forget.” CPT and CMS use different codes and have different time thresholds. For some services, CMS allows time spent on services done on a different date!
Coding Guide – Prolonged Services
Coding for prolonged services was never easy, and CMS’s decision to use HCPCS codes and different time thresholds complicated coding. It is hardly realistic that a physician, nurse practitioner or physician assistant can keep the rules and time thresholds clearly in their head, unless they are the rare practitioner who uses prolonged care frequently. For […]
Coding Guide – Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs)
If you are looking for a guide to coding for Rural Health Center (RHC) or Federally Qualified Health Center (FQHC) visits, here it is. Clinicians in RHCs and FQHCs use CPT® and ICD-10-CM codes to select their services, but these are submitted with HCPCS qualifying visit codes. It’s easy for clinicians in these mission driven […]
Performing Services that Increase Primary Care Revenue
Wellness Visits and Problem Visits at the Same Encounter Transitional Care Management Chronic Care Management Advance Care Planning HCPCS codes with low RVUs Advanced Primary Care Management Services | G0556, G0557, G0558 Post-operative Care Services Add-on Code | +G0559
Behavioral Health Coding Compliance
Once again, with feeling: coding for behavioral health There are two videos on this page that describe OIG audits of behavioral health services. They are evergreen. If you’re new to the field of behavioral health coding, they are cautionary tales of what not to do. Coding for Behavioral Health Compliance lessons from the OIG It’s […]
CMS Adopts Codes for Caregiver Training Services (CTS)
This is information from the 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023. You can read it for yourself by downloading the pdf below. 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023 MLN Matters article Jan. 2024 – PDF These are not on the telehealth list; they are in person services […]
Interprofessional Internet Consultations
CMS recognizes and pays for six codes for interprofessional consults codes 99446–99449, 99451, 99452 See also HCPCS codes developed in 2025 for behavioral interprofessional consults | G0546–G0551 These codes were updated in 2023. Codes 99446, 99447, 99448, 99449 and 99451 may now be performed by physicians and other qualified health care professionals. Because these codes […]
High Intensity Behavioral Counseling to Prevent Sexually Transmitted Illnesses (STI) and PrEP G0445
CMS covers counseling to prevent STI in certain circumstances. The code is G0445. G0445 – Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to- face, includes education skills training & guidance on how to change sexual behavior, performed semi-annually, 30 minutes. The patient must be referred by a primary care provider to be eligible […]
Screening for Other Sexually Transmitted Illnesses (STI)
This article covers CPT® and diagnosis codes used for screening for other sexually transmitted illnesses. It includes descriptions and screening criteria. To tell whether or not you can collect a co-pay for the testing or not can be found on the U.S. Preventive Services Task Force (USPTF) website [1]. The Affordable Care Act mandated that […]
Coding Guide – Teaching Physician Rules
The teaching physician guidelines are Medicare rules that allow for payment for services that are performed jointly between a resident and a licensed attending physician (the teaching physician). This downloadable coding guide from CodingIntel provides an explanation of teaching physician rules for E/M services and specialty specific services.
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