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Spotlight on up-to-date coding

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 2023 E/M data released at the end of […]

Wellness Visits and Care Management in Rural Health Centers and Federally Qualified Health Centers (RHCs and FQHCs)

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 […]

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

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 […]

Billing Medical Practice Services for Patients on Hospice

Overview of Hospice Care Additional Services (non-Hospice Organization) Medicare beneficiaries who have a terminal illness with a life expectancy of six months or less can elect to have their end-of-life care provided by a hospice organization (the “hospice”). Medicare then pays hospice to provide all the care that the patient needs that is related to […]

Aftercare and Follow-Up: ICD-10-CM Coding

Aftercare visit codes are assigned in situations in which the initial treatment of a disease has been performed but the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. ICD-10 makes two important points about the use of aftercare codes in the final chapter. The aftercare […]

National Coverage Determination: PrEP for HIV Prevention | HCPCS Code G0011

Physicians and qualified health professionals (QHP) can gain reimbursement for up to eight counseling sessions per year for HIV risk assessment, risk reduction and medication adherence, according to a recently issued national coverage determination (NCD). Background On September 30, CMS issued a NCD 210.15, Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention, which shifts […]

How Fees are Set in the Medicare Fee Schedule

How does Medicare set its fees? This is important for other payers because commercial payers often use the values set by Medicare to calculate their fees. This overview provides information and examples to explain how fees are set in the Medicare Fee Schedule. CodingIntel members can start with the brief video introduction and companion slides, […]

CPT^® Coding Changes

Updates to the CPT® Manual: 2025 Edition The 2025 edition of the CPT® Manual confirms hundreds of code changes that take effect Jan. 1, 2025, including 270 new codes and 112 deleted codes. The 2025 Manual also revises nearly 40 codes. In this roundup of some of the significant changes to the 2025 CPT code […]

ICD-10-CM Chapter Specific Guidelines – Chapters 17–20

The ICD-10-CM Official Guidelines for Coding and Reporting sets the precedent of rules that all diagnostic coders must abide by. Section I.C. covers the chapter-specific guidelines. These offer detailed information about various conditions that require more thorough reporting guidance than the general guidelines provide. Reading the guidelines in their entirety is incredibly important, but this […]

ICD-10-CM Chapter Specific Guidelines – Chapters 14–16

ICD-10-CM Chapter Specific Guidelines – Chapters 11–13

Smoking Cessation, Substance Use Counseling, Screening, and Intervention Coding, 99406-99609

Although the use of tobacco products is on the decline in the United States, the consumption of alcohol and other addictive substances remains a common preventable problem. As a result, the American Medical Association’s (AMA’s) CPT Editorial Panel included a spotlight on reporting tobacco, alcohol, and substance use cessation, counseling, screening, and intervention codes in […]

ICD-10-CM Chapter Specific Guidelines – Chapters 7–10

Section I.C of the ICD-10-CM Official Guidelines for Coding and Reporting, titled “Chapter Specific Guidelines,” contains 22 chapters. These chapters offer detailed guidance on specific codes and code ranges in the ICD-10-CM manual. This article is part of a series that will delve into each of the chapters in Section I.C to delineate coding protocols […]

ICD-10-CM Chapter Specific Guidelines – Chapters 4–6

ICD-10-CM Chapter Specific Guidelines – Chapters 1–3

FAQ: Scoring Elements in the E/M Guidelines

Scoring MDM elements can be challenging for E/M services This post includes questions related to: Major/Minor procedure Data Elements (with link to additional resources) General questions about the guidelines Using time (with link to additional resources) Social determinants of health Major or minor procedure? Question: I have a question about how to determine if a […]

Consent for Communication Technology-Based Services (CTBS)

Both CPT and CMS have developed codes for non-face-to-face communication-based technology services in recent years. In addition to care management services, these include interprofessional consults, remote physiologic and therapeutic monitoring, and on-line digital E/M services In the 2020 Physician Fee Schedule Final Rule, CMS clarified the type of patient consent that is required to perform […]

Remote Physiologic Monitoring Treatment Management Services

This is an overview of coding for Digitally Stored Data Services/Remote Physiologic Monitoring in the E/M section of the CPT book. There are more detailed articles for the individual codes on CodingIntel. Put the code in the search box to find them. Medical practices can use these devices to monitor a patient’s health metrics, assess […]

Blood Pressure Self-Measurement: Education, Training and Analysis | CPT Codes 99473, 99474

There are two CPT codes specifically for blood pressure self-measurement and management. The first is for patient education and calibration of a home blood pressure device The second is for reviewing data collected by the patient at home, with a report and communication back to the patient 99473 Self-measured blood pressure using a device validated […]

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