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Spotlight on up-to-date coding

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 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 […]

Consultation Codes

First, CMS stopped recognizing consult codes in 2010. Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) were still active CPT® codes, and depending on where you are in the country, are recognized by a payer two, or many payers. In 2023, codes 99241 and 99251 are deleted. These two low level consult codes were rarely used. […]

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 […]

CMS’s 2024 Shared or Split Services Policy: Document and Report Them Correctly

In 2024, CPT® expanded its definition of split/shared services, CMS updated their requirements. Neither CMS nor CPT® made changes to this policy in 2025 or 2026. Medicare requires that both practitioners are enrolled in Medicare, and both have E/M in their scope of practice. CPT® expanded its definition of split/shared services in 2024. The service […]

G0101 Pelvic and Breast Exam

Medicare has HCPCS codes for screening services for women Both G0101 (screening breast and pelvic exam) and Q0091 (obtaining a screening pap smear) may be billed every two years for a low-risk patient and every year for high-risk patients These are not comprehensive preventive medicine services They may be billed on the day of a […]

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