Questions about coverage and payment for breastfeeding and lactation counseling services come up regularly. And, payers change their policies. It is important to keep up-to-date with the commercial payers with which you have contracts. Is lactation counseling separately billable or considered part of the obstetrical package? What if the patient sees the physician and a […]
Articles
Spotlight on up-to-date coding
How Old is Your Oldest CPT® Book
My, how CPT® has grown Thank you to everyone who completed our mission critical survey: how old is your oldest CPT® book and how many pages is it? Page down: a summary chart is below. First, some of you save everything. I’d love to see your office shelves. There are coders out there who have […]
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 billing practitioner on the date of service, not just face-to-face time, and counseling does not need to dominate the visit, as it did in the 1995/1997 […]
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 perform psychotherapy at the same encounter. There are specific rules for office visit code selection for medication management done at the same encounter as psychotherapy. Watch the video below for an explanation about how […]
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 I’ve included in this article shows risk scores for a few common chronic conditions, coded two ways. One follows ICD-10 rules and results in a six-fold increase […]
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. Beginning January of 2021, when billing an office visit, select the level of visit based on medical decision making, not time. If medication management is the only service performed on that date, the clinician can […]
Coding Telehealth Visits: Place of Service
**Please see our primary telehealth article for the latest telehealth coding updates. Coding telehealth visits changes faster than the weather here in New England. The resources on the site relate to Medicare policy and CPT codes and rules. Unfortunately, they don’t address individual commercial payer policies. There are two new place of service (POS) codes […]
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 services as non-face-to-face services that are on its telehealth list During the public health emergency, CMS eased the rules related to telehealth The flexibilities remain in effect for RHCs and FQHCs for […]
Specimen Collection For COVID-19
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY 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 collection CPT had previously recommended this The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection […]
Medicare Changes Telehealth Rules, Again
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/11/2025 Medicare changes telehealth rules, again: April 30, 2020 interim final rule with comment period (IFC) https://www.cms.gov/files/document/covid-final-ifc.pdf CMS released a second IFC with policy changes during […]
E/M Services – History and Exam
History and exam for E/M services “E/M Codes that have levels of services include a medically appropriate history and/or physical examination when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified healthcare professional reporting the service. The care team may collect information and the […]
Procedure Coding for Colonoscopies
“A colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine to an anastomosis.”[1] In 2015, CPT® revised some definitions related to colonoscopy and added a decision tree to help practices select the correct CPT® code and the correct […]
New Versus established Patient Visits
There are other articles on CodingIntel about the difference between new and established patients, and the rules haven’t changed, but that doesn’t mean it is always clear. Medicare definition “Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) […]
Overview of Diagnosis Coding for Behavioral Health Services
Match diagnoses on the claim form to those listed in assessment The diagnosis codes on the claim form should match those in the note. If the assessment says “stable on medications” or “doing well,” it isn’t clear how many conditions were managed and treated In the assessment, list conditions managed, their status, and treated Note […]
Psychiatric Diagnostic Evaluation
There are two codes for psychiatric diagnostic evaluation. 90791 Psychiatric diagnostic evaluation 90792 Psychiatric diagnostic evaluation with medical services 90791 is used by psychologists, social workers and other licensed behavioral health professional and 90792 is used by psychiatrists and psychiatric nurse practitioners and physician assistants, because it includes medical services. Here is how CPT® defines […]
Psychotherapy Codes
Individual psychotherapy codes are time based codes. One set may be reported as a stand alone service, and another during the same visit as medication management. They follow the CPT®; time rule: use the code when the mid-point in the defined time is met. The CPT® book itself lists the time thresholds at the start […]
Psychotherapy for Patients in Crisis
Page down for 2024 HCPCS codes for G0017, G0018 90839 is the code for psychotherapy for crisis; first 60 minutes. 90840 is an add-on code for each additional 30 minutes of time spent with a patient who is in crisis. These codes do not have CPT® limitations on place of service. They would typically be […]
Interactive Complexity | CPT® 90785
Code 90785 is an add-on code for interactive complexity and may be added on to the diagnostic psychiatric evaluation (90791, 90792), to psychotherapy services (90833—90838), and to group psychotherapy (90853). It may not be reported with an E/M service, if no psychotherapy is performed on that day, or with psychotherapy for crisis, 90839, 90840. Code […]
Physician Specialty Codes and Claims Processing
Specialty designation is determines how claims are processed for physician and non-physician practitioners in groups It is also important in crediting data using the E/M guidelines, developed in 2021 and expanded in 2023 When physicians enroll in Medicare, they self-elect their specialty designation. In the enrollment process, there are fields to indicate primary and secondary […]
Screening for Skin Cancer
Dermatologists frequently see patients for skin checks, to examine their skin for signs of pre-malignant or malignant lesions. Some of these patients have a personal history of malignant skin neoplasms, and some do not. The appointments may be scheduled annually or bi-annually. Will insurance pay for screening for skin cancer? Medicare and private insurances are […]
Diagnosis Coding for Dermatology
Diagnosis notes for dermatology Be sure to match the diagnosis to the procedure. For example, For skin tag removal, use skin tag For treatment of warts, use warts For excision of malignant lesions, use a malignant lesion code Describe conditions in the physical exam Only use diagnosis of “inflamed” seborrheic keratosis if the exam describes […]