National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare’s coverage policies that describe medical necessity for … [Read more...]
Articles
Spotlight on up-to-date coding
Compliance Issues in ICD-10 Coding for Risk Based Contracts and HCCs
Everyone loves to read the general guidelines at the front of the ICD-10 book, right? No? Well, here's an important excerpt. "Code all documented … [Read more...]
Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442
The US Preventive Services Task Force (USPSTF) recommends screening for alcohol misuse and behavioral interventions for individuals whose screening … [Read more...]
Coding for Hernia Repair
CPT® revised the codes and concepts used for coding for hernia repair. These are significant changes for surgical procedures that are used very … [Read more...]
Principal Care Management (PCM) Services – CPT codes 99424—99427
There are four principal care management codes 99424 and 99425 are for time spent by a physician or other qualified health care professional … [Read more...]
Chronic Care Management
Medicare and private payers cover chronic care management services if a patient has two or more serious conditions that are expected to last at least … [Read more...]
Transitional Care Management
This article provides answers to frequently asked questions related to transitional care management services. It includes details about billing for … [Read more...]
Outpatient Diabetes Self-Management Training (DSMT) Services
Diabetes self-management training (DSMT) services are a covered benefit under Medicare when all requirements are met. This article will provide an … [Read more...]
Coding for Medical Nutrition Therapy Services
Medical Nutrition Therapy Services (MNT) have been a covered benefit under Medicare since the early 2000’s. This article will describe the rules … [Read more...]
Coding and Reimbursement for Lactation Services
Questions about coverage and payment for breastfeeding and lactation counseling services come up regularly. And, payers change their policies. It is … [Read more...]
When to Use Time to Select an E/M Service
Selecting a code for an E/M service can be done based on time or MDM (except ED visits which only use MDM) Time includes all time spent by the … [Read more...]
Office Visit Code Selection for Medication Management
At some visits, psychiatrists and psychiatric NPs and PAs provide only medication management, and at some visits, they manage prescriptions and … [Read more...]
HCC Diagnosis Coding Example: Diabetes, Hypertension, Chronic Kidney Disease
If a picture is worth 1000 words, what’s an example worth? An example can show in a glance what it takes paragraphs to write and explain. The one … [Read more...]
Essential Documentation for Medication Management and Psychotherapy
When providing both medication management and psychotherapy, practitioners need to document the time spent in psychotherapy and describe the therapy. … [Read more...]
Behavioral Health and Telemedicine During the PHE
In this post Overview of behavioral health services via telemedicine during the PHE Overview of behavioral health services after the PHE … [Read more...]
Is it or isn’t it a Telehealth Service?
Many payers and practices use the broad term telehealth to describe services that are not done face-to-face with a patient CMs describes telehealth … [Read more...]
Specimen Collection For COVID-19
CMS’s 4/30/2020 rule states that practices could bill 99211 for new or established patients during the public health emergency for COVID-19 specimen … [Read more...]
Medicare Changes Telehealth Rules, Again
Medicare changes telehealth rules, again: April 30, 2020 interim final rule with comment period … [Read more...]
Telemedicine in RHCs and FQHCs
In April, 2020Â CMS released guidance about paying for telehealth services in Rural Health Centers (RHCs) and Federally Qualified Health Centers … [Read more...]
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 … [Read more...]
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 … [Read more...]