May 23, 2025
Event date June 26th, 2025
Guest presenter Darren Goodwin, CPC, CPMA, CPCO
This presentation provides a focused overview of Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT) services. It outlines key coverage criteria, provider qualifications, and documentation requirements necessary for accurate claims submission and compliance.
Event date June 19th, 2025
Guest presenter Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O
This webinar will focus on selected CPT® modifiers that tend to be problematic for coders and claims processing. The instructor will focus on the application of modifier-22 and -52 including commonalities and differences as stated by the AMA as well as supportive citations from the Medicare Claims Processing Manual.
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 […]
Recorded May 22nd, 2025
Guest presenters Pam D’Apuzzo, CPC, ACS-EM, ACS-MS, CPMA and Debra Rossi, CCS, CCS-P, CPC, CPMA of VMG Health
Combining CPT® guidance and extensive audit experience, this session will address definitions and documentation related to acute and chronic conditions, stable or with exacerbation/progression or side-effect, how an undiagnosed new problem with an uncertain outcome differs from an acute, uncomplicated condition, and have examples of an illness with systemic symptoms and “high” in the number and complexity of problems addressed.
Recorded May 8th, 2025
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.
Medical Nutrition Therapy Services (MNT) have been a covered benefit under Medicare since the early 2000’s. This article will describe the rules related to coding for medical nutrition therapy services for Medicare patients. This article also addresses common questions about coverage under the Medicare benefit with brief answers and links to the source documents for […]
For a code that reimburses at about $10, can you even remember how many times you’ve been asked that question? How do I bill for suture removal again? The answer to the second question is that there are three CPT® codes for removal of sutures or staples. Back to list
New telehealth codes for 2025 have an invalid status indicator from Medicare See the telemedicine section of CPT Coding Changes for 2025 for details. CPT® telephone codes 99441–99443 are deleted in the 2025 CPT book. Included in this article: Telehealth Update – March 19, 2025 Place of Service update from MLN Matters CPT® changes in […]
Recorded April 24, 2025
Guest presenter Seth Canterbury, CPC, CPC-I
When the method for selecting the level of E/M services was changed for 2021 (office visits) and 2023 (other visits), the concept of “risk” underwent significant revision. No longer was this concept confined to just one element/subcomponent of MDM.
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 […]
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 2023 E/M data released at the end of […]
Recorded April 17, 2025
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!
CMS developed new HCPCS codes for primary care practitioners who provide care management services and communications-technology based services on a monthly basis. These are an alternative to other care management codes, and acknowledge that much of the work caring for patients occurs outside of regular office visits. These Advanced Primary Care Management (APCM) codes are […]
Prolonged services codes function as add-on codes to the highest-level Evaluation and Management (E/M) services in certain categories. To use prolonged care, providers must select the primary code based on time, which is explicitly stated in both the CPT® and HCPCS definitions of prolonged services. For billing purposes, the full 15 minutes of prolonged services […]
RHCs and FQHCs are paid an all-inclusive rate (AIR) or national prospective payment system (PPS) rate for any service that is defined as a visit to their facility. A visit may be with a physician, non-physician practitioner (NPP), psychologist or social worker. There are some differences in RHC and FQHC rules, but in general, a […]
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 […]
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 CMS states it wants to increase pay to primary care physicians. And while we might quarrel […]
Once again, with feeling: coding for behavioral health Coding for Behavioral Health Compliance lessons from the OIG Post-discharge Telephonic Follow-up Contacts Intervention | G0544 Digital Mental Health Treatment | G0552, G0553, G0554 Safety Planning Interventions | G0560 It’s been a year (seems like a minute) since the OIG released a report on coding for behavioral […]
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 […]
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 […]
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 […]
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