From biopsy to localization device to mastectomy, coding for breast procedures can be challenging. This article summarizes the rules related to these services. Fine needle aspiration of a breast mass, or aspiration of a cyst Fine needle aspiration (FNA) of a breast mass is reported with codes 10021—10012. CPT® developed new codes for FNA in 2019. […]
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Spotlight on up-to-date coding
Overview of Medicare Telehealth Services
Please see the Telemedicine article for the rules and guidelines for use during the COVID-19 public health emergency. Medicare covers some services performed via real-time audio and video between a patient in an underserved area and a physician or other practitioner who is not in the same place as the patient. Requirements for Medicare telehealth […]
Repair (closure) CPT® 12001–13160
Laceration or wound repair codes are reported based on the type of repair (simple, intermediate, complex), the anatomic location, and the length The length of multiple lacerations of the same type and defined as the same anatomic location are summed and reported with a single CPT code. For multiple lacerations of either different types or […]
Describe the Exam | E/M Services for Dermatology
ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong….) However we will still need to use them when auditing notes from before 2023. This article does not apply to services performed after 1-1-2023. What do you need to document for the exam? Although exam is not a key component in 2021 for codes […]
Coding for Mohs Micrographic Surgery
Mohs surgery is performed to remove complex or ill-defined skin cancer, and the procedure includes both the surgery and histopathologic examination. Both capacities are required in order to bill for these codes, and neither part may be delegated to another individual. Let’s look at the specific guidelines for coding for Mohs Micrographic Surgery: According to […]
Other Dermatologic Procedures
This aricle reviews the codes and guidelines for these dermatologic procedures; Intralesional injections, photodynamic therapy, phototherapy, and laser treatments. Intralesional injections Intralesional injections deliver a medication directly into a specific skin lesion, allowing the medication to be delivered over a period of time. Corticosteroids are common examples. Report either code 11900 for up to 7 […]
Modifier 51 or 59? How to Know Which to Bill?
Modifier 51 and 59 are both used on second and subsequent surgical procedures, when performed on the day of a primary procedure See also Modifier 59 quick reference sheet There are two modifiers commonly used in surgical specialties when billing two or more procedures at the same encounter. Appending the correct modifier increases the likelihood […]
Shaving of Epidermal or Dermal Lesions
The chart below includes CPT® codes, and descriptions for shaving epidermal and dermal lesions. After the chart, there are important key points to keep in mind when using these codes. Code Description 11300 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less 11301    lesion diameter […]
Coding for Destruction of Malignant Lesions
The primary factors in selecting a code for destruction of malignant lesions are: Size of lesion (not defect) Location Method is not a factor in code selection Per Principles of CPT® Coding: “The destruction of malignant lesions is reported with codes 17260—17286. Similar to the codes for excision of lesions, the correct code is chosen […]
Virtual Communication: HCPCS Codes G2010, G2250, G2251, G2252; CPT® 98016
Virtual communications are not considered telehealth These HCPCS codes were developed by CMS for virtual communication They are not on CMS’s list of telehealth services and do not use real-time, interactive, audio/visual communication They do require verbal consent; a single consent can be obtained for all communications based technology services annually for Medicare patients In […]
CPT® Codes for Fine Needle Aspiration
Fine needle aspiration biopsy Material is aspirated with a fine needle and the cells are examined cytologically Core needle biopsy is performed with a larger bore needle to obtain a core sample Use code 10021 for FNA without imaging guidance, first lesion and 10004 for each additional lesions There are codes for FNA include imaging […]
Skin Biopsies
Correctly selecting and reporting skin biopsies requires an understanding of CPT® codes for skin biopsies There are codes for excision of benign and malignant lesions, and codes for shave procedures. Those are coded based on the size of the excision and location There are specific biopsy codes in other chapters, for biopsy of ears, lips, […]
Five Urban Legends About Risk-Adjusted Diagnosis Coding
Originally published on kevinmd.com When I talk to medical practices about Hierarchical Condition Category (HCCs) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends. Let’s separate fact from fiction. Don’t miss our Billing Guide on Risk-adjusted Diagnosis Coding for an in-depth look at this topic. Urban […]
HCC’s in Brief | The Difference Between CMS-HCC and HHS-HCC
Demographics and diagnoses Risk adjusted diagnosis coding is a model used to predict future health care costs based on demographics and diagnoses. It is most commonly used by Medicare to set rates for patients who are in Medicare Advantage plans. A Medicare Advantage plan is paid different amounts for the Medicare patients they cover. The […]
Intensive Behavioral Counseling for Cardiovascular Disease, HCPCS Code G0446
Medicare pays a primary care physician or other primary care practitioner in a primary care setting to annually provide one face-to-face behavioral counseling session for cardiovascular disease. Although CMS has developed a HCPCS code specifically for this service, many primary care clinicians perform this service as part of an E/M service or a wellness visit. […]
Screening for Depression | HCPCS Code G0444
G0444 Annual depression screening , 5–15 minutes According to Change Request 13710, beginning January 1, 2025, Medicare pays primary care practices to screen all Medicare patients annually for depression. The service must be provided in a primary care setting, in place of service office, outpatient hospital, independent clinic or in one of the following: 02 […]
Behavioral Counseling for Obesity, HCPCS Code G0447
G0447 face-to-face behavioral counseling for obesity, 15 minutes G0473 Face-to-face behavioral counseling for obesity, group (2-10) 30 minutes Medicare pays for ongoing face-to-face behavioral counseling for patients with a body mass index (BMI) of ≥ 30, who are alert and able to participate in counseling. The service may be performed by a physician or non-physician […]
Emergency Department Visits
Definition Emergency department (ED) services are E/M services provided to patients in the Emergency Department. Explanation These services may be billed by any specialty physician, not just Emergency Department physicians. The physician does not need to be assigned to the ED. However, these codes may only be used in a hospital-based facility that is available […]
Advance Care Planning | CPT® 99497, 99498 Video
Advance Care Planning (ACP) 99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; first 30 minutes, face- to-face with the patient, family member(s) and/or surrogate); +99498Â Â Â Â Â Â Â each […]
Exam | Documentation Guidelines for E/M Services
ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong….) However, we will still need to use them when auditing notes from before 2023. This article does not apply to services performed after 1-1-2023. Definition Exam is one of the three key components (history, exam and medical decision making) of Evaluation and Management Services. […]
Using Time to Select a Level of E/M Service
ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong….) However we will still need to use them when auditing notes from before 2023. This article does not apply to services performed after 1-1-2023. Remember, don’t use the information in this article for current services. Use these rules when billing for codes that use […]
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