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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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March 25, 2023

Coding Guide – How Physician Services are Paid

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Have a new staff member or practitioner? Looking for a resource that provides an overview of how physician. services are paid? Download our guide. Medical coding in physician offices is governed by coding rules, Medicare and other third party policies and reimbursement decisions made by payers. This coding guide describes the code sets and the rules that are behind the rules to insure that medical practices submit accurate, complete and compliant claims.

Table of Contents

  • CPT®
  • HCPCS
  • Modifiers
  • NCCI
  • Multiple procedures
  • Fee calculation
  • Global surgical payment
  • Diagnosis coding

A physician sees a patient in the office or treats a patient with a fracture in the emergency department and wants to get paid for this service. That shouldn’t be too much to ask, should it?

The coding and reimbursement system in the United States is anything but simple and easy. This coding guide on medical coding in physician offices explains how all of the parts come together that result in payment for that physician.

This is an essential resource for new physicians, non-physician practitioners, coders and billers and for managers who want to know just enough to manage. In addition to this billing guide, be sure to reference the helpful infographic and Betsy’s 15 minute video on the payment process.

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Relevant Search Terms: evaluation and management services, E/M, CPT®, HCPCS, billing, coding, ICD-10, medicare, procedures, risk

Last revised March 6, 2023 - Betsy Nicoletti
Tags: Code sets and reimbursement

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, 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. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

Watch it now

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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