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
This article is from the Category of Code section in our Everyday Coding book. It 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. Quick reference charts and key points will help you to quickly and accurately […]
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? Answer: No. The answer to this question is […]
2023 E/M Guidelines for Hospital, Nursing Facility, Home and Residence Services | Webinar
Recorded September 22, 2022
As expected, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. They extended the documentation framework in place for office visits to these codes. They also deleted twenty-five codes. Coding for prolonged care services gets…
2023 CPT® E/M Changes
Ready to learn about the 2023 CPT® E/M changes? There is a significant update to the Evaluation and Management (E/M) section of the CPT® book. There are 25 codes that are going away. There are revisions to the introductory guidelines related to five different categories of codes. Prolonged services are getting yet another overhaul. This […]
Outpatient Diabetes Self-Management Training (DSMT) Services
Medicare covers diabetes self-management training (DSMT) services are a covered benefit under Medicare when all requirements are met. This article will provide an overview of the requirements and provide answers to some commonly asked questions. It will also provide you with links to the source material for DSMT coverage in the CMS Medicare Benefit Policy […]
Coding Principles for Practice Administrators | Webinar
Recorded: July 21, 2022
Administrators managing both fee-for-service and value based payment contracts must maximize revenue and minimize risk in coding for services performed in their practices. Administrators—who aren’t coders—can accomplish this through by knowing where to find definitive answers and how to assess citations and conflicting information that is presented. This webinar will provide a framework for administrators when they are called about to mediate coding disagreements within their practices.
CPT® Coding for Obstetrical and Gynecological Procedures | Webinar
Recorded: June 23, 2022
Guest Presenter Shannon McCall of HCPro
This webinar will review obstetrical global package codes , colposcopic/hysteroscopic procedures, and FY 2023 ICD-10-CM proposed additions for OB/GYN diagnoses. Shannon will also describe when it is appropriate to unbundle pregnancy package codes, how to assign CPT® codes for abortive outcomes and more.
Payment Denials for Unspecified Codes
From the day coders got their first glimpse at ICD-10 codes, the question went out in the land: “Will payers deny unspecified codes?” Recently, a client told me that she was seeing an increase in denials for unspecified codes from payers and I wanted to gather more information about that. Thank you to the 140 […]
Does a Practitioner Need to Document Time for a Telehealth Visit?
Question: Does a practitioner need to document time for a telehealth visit? What if it is audio only? Answer: First: For a telehealth visit, always document if it is with video or audio only. Documenting “telehealth visit” or “telemedicine visit” doesn’t differentiate this. Second: If you are using office visit codes (99202—99215), you can select […]
E/M Auditing | Webinar
Recorded April 21, 2022
In this webinar, Betsy audits three E/M notes, one primary care note, one medical specialty note, one surgical specialty note. Using the sample notes, this webinar reviews the three elements of medical decision making. Poll questions, allow participants to think about their assessment of the components of each note and compare their assessment with their peers.
Modifier Update
Recorded February 17, 2022
CMS released four new modifiers at the end of 2022, and CPT released one. These include modifiers for split/shared services, critical care in the post op period, audio-only telehealth services and physician supervision via audio/visual communication. It’s a lot of change for medical practices and coders. This webinar will describe the rules for using these services, based on CMS transmittals released mid-January. There will be a brief discussion of the new place of service code 10 and CMS’s policy about it.
When to Use CPT® Modifier -93
CodingIntel has a more complete article about modifiers 93 and 95, so be sure to read that. This is a brief Q&A, and doesn’t contain all you need to know. Modifier 95, 93: Telemedicine Question: In 2022, the question was, “should we begin using the new CPT® modifier -93?” Now, the question is, when should […]
Coding and Reimbursement for Lactation Services
Questions about coverage and payment for breastfeeding and lactation counseling services come up regularly. And, payers change their policies. It is important to keep up-to-date with the commercial payers with which you have contracts. Is lactation counseling separately billable or considered part of the obstetrical package? What if the patient sees the physician and a […]
New Vaccination Codes for 2022
The 2022 CPT® book had some new vaccination codes and some vaccination codes that practices have been using in 2021. These include codes for the serum and administration of COVID-19 vaccines, which came out during the past year and now are incorporated into CPT®, and a few new codes. The 2023 CPT® book includes added […]
How Old is Your Oldest CPT® Book
My, how CPT® has grown Thank you to everyone who completed our mission critical survey: how old is your oldest CPT® book and how many pages is it? Page down: a summary chart is below. First, some of you save everything. I’d love to see your office shelves. There are coders out there who have […]
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