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 […]
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Spotlight on up-to-date coding
Remote Therapeutic Monitoring
There are six remote therapeutic monitoring codes in the general medicine section of CPT® which may be performed by physicians, PAs and NPs and other practitioners such as psychologists, LCSWs, physical therapists and occupational therapists These codes are for non-physiologic measures and the results can be uploaded digitally or reported by the patient A physician, […]
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 […]
ICD-10-CM Conventions, Structure, and Format: Section I.A
As you read this article, it will be helpful if you have the ICD-10-CM book in front of you. You can download a pdf copy here. And even if you don’t download the entire book, download the Official Guidelines instead. There are four cooperating parties to ICD-10-CM. They publish and update the official guidelines for […]
The First Element of MDM: Number and Complexity of Problems Addressed
E/M elements for MDM There are three elements in medical decision-making and this article describes the first of three When selecting a level of service based on medical decision-making two of the three elements are required CPT® has developed definitions for many of the components in the MDM chart. The examples listed in the definitions […]
The Third Element of MDM: Risk of Complications
The third element of MDM: risk of complications and/or morbidity or mortality of patient management at the encounter Coding for E/M services There are three elements in medical decision-making and this article describes the third, the risk of complications and/or morbidity or mortality related to patient management When selecting a level of service based on […]
The Second Element of MDM: Amount and/or Complexity of Data
There are three elements in medical decision-making and this article describes the second, arguably, the most complex of the three elements When selecting a level of service based on medical decision-making two of the three elements are required CPT® has developed definitions for many of the components in the MDM chart. This article describes the definitions […]
Critical Care Services
Definition and Explanation of Critical Care Service Definition: Coding service for caring for a critically ill or injured patient Explanation: Critical care has high relative value units and payments so it’s important to know the coding rules. This article describes what can be included in the time of critical care what can’t be included, and […]
Commonly Performed Procedures in Primary Care
These reference sheets for minor procedures include common CPT® codes, descriptions, current work and non-facility RVUs, and global days for quick reference. The first chart includes codes 10060-11443, the second 11600-17111, and the third 20550-54056.
Incident To Services – Medicare
Medicare has specific rules for billing for nurse practitioners and physician assistants and other office staff incident to a physician services in an office. This article includes: Description, explanation and codes for incident-to services Billing and coding rules Brief video overview Enrollment of non-physician practitioners (NPPs) for incident-to billing See our Medicare Incident-to and Shared […]
Coding for Prolonged Services: CPT® and HCPCS Codes
Common rules: Prolonged services codes are add-on codes to the highest level E/M services in certain categories. In order to use prolonged care, the primary code must be selected based on time. This is in the CPT® and HCPCS definition of prolonged services. Prolonged services codes may only be added to the highest-level code in […]
Nursing Facility Visits
Definition Nursing facility visits are Evaluation and Management services provided in a skilled nursing facility or a long term nursing facility. Explanation Only a physician may perform an initial nursing facility service in a SNF. This includes admissions and re-admissions. In an NF, a non-physician practitioner (NPP) who is not employed by the NF may […]
Preventive Medicine Services – Medicare
Medicare has very specific requirements for preventive services. What can you bill, what must you document? This article covers all the bases including tips for billing the Welcome to Medicare and Annual and Subsequent Wellness Visits. More tips for preventive medicine and split visits can be found here. See also Q&A from the Preventive Medicine […]
Coding Multiple Procedures | Examples with Modifiers
Biopsies and lesion destruction codes are often performed at the same patient visit. This leads to questions about bundling and modifiers. There are two steps to billing these correctly and avoiding denials: Check the total RVU values Check the NCCI edits. There is a step-by-step procedure for coding multiple procedures at the end of this […]
E/M Frequency Data for Hospitalists
Hospitalists became a recognized specialty by CMS starting in 2017, and we now have frequency E/M data for the specialty. There are probably still physicians who have not switched their specialty designation. Physicians self-elect their specialty designation with Medicare and other payers. Many hospitalists are family medicine or internal medicine physicians by training, working as […]
E/M Frequency Data for Surgical Specialties
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Unfortunately, there aren’t specialty designations for breast, bariatrics, or trauma surgery, and those surgeons are usually enrolled using the category for general surgery. There are specialty designations for vascular surgery, plastic surgery, thoracic, and surgical oncology. The data below […]
E/M Frequency Data for Psychiatrists
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. This is the data for psychiatrists. The data below is from 2023 released in late 2024. Office services Psychiatry New OV 2023 99201* 0% 99202 0.59% 99203 6.82% 99204 40.09% 99205 52.50% Established office visits 2023 99211 0.83% 99212 […]
E/M Frequency Data for Infectious Disease, Pulmonary Medicine and Cardiology
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Infectious disease, pulmonary medicine and cardiology are all specialties with active inpatient services, and of course, busy office services. That’s why I’ve elected to show them together. The data below is from 2023, released in late 2024. Office services […]
Multiple E/M Services in the Same Calendar Day
The AMA has added a new subsection in the 2024 E/M section addressing how to report E/M services when there are multiple encounters in the same day. (Pages 6 and 7) According to CPT Changes 2024 An Insider’s View, the reason for this was to provide clarification for when multiple E/M services were performed on […]
Psychiatric Collaborative Care Management Services
This resource covers Psychiatric Collaborative Care Management Services 99492, 99493, 99494 and
Care Management for Behavioral Health 99484.
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