Question: How much detail do I need to include in documentation for Advance Care Planning? Answer: Document the discussion in enough detail that someone reading the note knows what was discussed. Is that a circular argument? Here’s the example that I give. If a surgeon performs an appendectomy, we wouldn’t bill for the service if […]
HCC Transition from V24 to V28 | Webinar
Recorded July 20, 2023
CMS is transitioning risk coding from the 2020 V24 model to V28 beginning in 2024. This webinar will provide an overview of HCC coding, its purpose and methodology. We’ll describe the changes and enumerate some of the key differences in coefficients for commonly used conditions between V24 and V28. And finally, learning from OIG audits of Medicare Advantage Organizations and HCC coding, identify diagnosis codes that are frequently incorrectly reported.
Compliance Issues in ICD-10 Coding for Risk Based Contracts and HCCs
Everyone loves to read the general guidelines at the front of the ICD-10 book, right? No? Well, here’s an important excerpt. “Code all documented conditions, which coexist at the time of the visit that require or affect patient care or treatment. (Do not code conditions, which no longer exist).” Most of the articles I’ve written […]
CPT® Coding for Bronchoscopy Procedures | Webinar
Recorded May 18, 2023
Guest Presenter Shannon McCall of HCPro joins us once again for a CPT® focused webinar on all things bronchoscopy! This webinar will describe coding for bronchoscopy, with and without biopsy, with ultrasound guidance, and with procedures. It includes coding by the number of lobes visualized for certain procedures. There are three case studies to illustrate the coding rules for these procedures.
Coding for Hospital Services | Webinar
Recorded April 20, 2023
First, CPT® updated their E/M code set. Then, CMS interpreted the updates and applied their own reimbursement rules to the code set. This webinar will summarize CPT® rules and CMS’s February 2023 transmittal that addresses inpatient and observation billing by the admitting and consulting physicians, admission to inpatient status following observation care, and multiple visits in a single day. The webinar will discuss when coding instruction is the same for CPT® and CMS and when it varies.
CMS Split/Shared Services Rules | Reference Sheet
Download Reference Sheet Split/shared services are evaluation and management services (E/M) services performed jointly between a physician and a non-physician practitioner (NPP), also called advanced practice nurses or physician assistants. CMS pays services performed by physicians at 100% of the physician fee schedule amount and services performed by NPPs at 85% of the fee schedule […]
Chronic Care Management | Reference Sheet
This quick reference sheet includes clinical staff time, care planning and billing practitioner work criteria for chronic care management services. When coding for care management services services, practitioners need to distinguish between chronic care management and complex chronic care management, between who does the work, the practitioner or clinical staff, and the amount of time […]
Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442
Information about these services, and other screening/preventive care is found on the CMS website CMS MLN Medicare Preventive Services Educational Tool. The reference is now MLN006559. The page was updated in 2025 to include: Added crisis support contact information Added information for safety planning for patients at risk for suicide Added information for follow-up contacts […]
Are You Missing the Initial Annual Wellness Visit? | G0438
Knowing which Medicare wellness visit to bill Eligibility requirements for the Welcome to Medicare visit After I gave a presentation at a family medicine conference a physician said to me, “What you just told me will pay for the entire cost of my coming to this conference.” I don’t always hear that after I give […]
Coding for Hernia Repair
CPT® revised the codes and concepts used for coding for hernia repair. These are significant changes for surgical procedures that are used very frequently. At the start of the repair codes, the AMA has new language that says “The hernia repair codes in this section are categorized primarily by the type of hernia (inguinal, femoral, […]
Coding Guide – Critical Care Services
The CPT® coding rules and the CMS reimbursement rules can be confusing. This guide explains the CPT® coding rules and the CMS reimbursement rules in one place.
CMS Teaching Physician Rules Update | Webinar
Recorded February 16, 2023
The teaching physician rules provide payment to an attending physician for services performed jointly by an attending and a resident. The required participation and documentation of the attending varies for E/M services, critical care, psychiatry and procedures. This webinar will review the basics of the CMS rules and the specific participation and documentation requirements for each type of service. The presentation will also include a description of the waivers in place during the PHE.
Principal Care Management (PCM) Services – CPT® codes 99424—99427
There are four principal care management codes 99424 and 99425 are for time spent by a physician or other qualified health care professional (someone with E/M in their scope of practice) and 99426 and 99427 for clinical staff time directed by a physician or other qualified health care professional These are time based codes used […]
Chronic Care Management
Medicare and private payers cover chronic care management services if a patient has two or more serious conditions that are expected to last at least a year. Medical offices often question the correct way to code for CCM for Medicare. CodingIntel provides the correct way to utilize CPT® 99490, 99439, 99491, 99437, 99487, and 99489. […]
Transitional Care Management
This article provides answers to frequently asked questions related to transitional care management services. It includes details about billing for TCM services including: When are CPT® 99495 & 99496 used? What are the requirements for TCM? Can We Code TCM and 99214 Together? Transitional care management for discharge Everyday Coding Q&A – Who needs to […]
Category of Code
Learn more about selecting Category of Code in Everyday Coding. This article provides definitions and tips for determining whether an office encounter is a new patient, established patient, or consult, and guidelines for reporting inpatient, observation, and emergency services. The quick reference chart and key points will help you to quickly and accurately select the […]
Shared Visits – Medicare and CPT
Medicare has specific rules for billing for nurse practitioners and physician assistants using shared services. These rules are explained in this article. CodingIntel members can also download the Medicare Incident-to and Shared Services Coding Guide and split/shared quick reference sheet Definition Shared or split services are Evaluation and Management (E/M) services performed jointly between a […]
Audit Tool for Modifier 25 | Reference Sheet
Download Reference Sheet Reasonable coders and practitioners can and do disagree about when a separate E/M service is warranted on the day of a minor procedure. This audit tool for modifier 25 will help determine if a separate E/M service should be reported. Using it consistently will help practices be reliable in their determinations and […]
Coding Hospitalist Services | Webinar
Recorded November 17, 2022
Understand changes to the 2023 E/M code set for hospital services, including inpatient, observation, and emergency department encounters. The American Medical Association is extending the 2021 framework for office visits to the remainder of E/M services selected by key components or time. In the process, they have consolidated hospital and observation coding, and changed the guidelines related to reporting these services. The medical decision-making grid has additions that directly…
As Time Goes By
One of the complexities for medical practices is using time in CPT® coding. CPT® has long had a unit of time rule that a unit of time is met when the midpoint has passed. That is, you’ve reached an hour after 31 minutes. There are many CPT® codes that follow this mid-point time rule including […]
Clinical Staff Time
Question: I believe that I know the answer to this question but am hoping you know the source, as I can’t find it—if a nurse helps with ROS, medication reconciliation, etc., would their time (if documented) be able to be included in the time for the visit?
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