Articles

Spotlight on up-to-date coding

History | Documentation Guidelines for E/M Services

This article relates to the 1995/1997 documentation guidelines, and not to office/outpatient codes 99202--99215 in 2021. Definition History is … [Read more...]

CPT^® and CMS rules for critical care | What’s the difference?

There are some significant differences in critical care rules as described in CPT® and in the Medicare Claims Processing Manual.1 This makes it … [Read more...]

Co-surgery, Team surgery, Assistant at surgery

Modifiers for co-surgery, team surgery and assistant at surgery CPT® has specific modifiers for co-surgery, team surgery and assistant at surgery. … [Read more...]

Collaboration of Care Model for Behavioral Health Integration (CoCM.BHI)

Definition HCPCS codes that describe collaboration of care services in primary care practices for patients with behavioral health … [Read more...]

Care Management for Behavioral Health Conditions

Care Management for Behavioral Health Conditions Overview CMS developed HCPCS G0507 code for care management performed by clinical staff for … [Read more...]

Modifier 95: telemedicine

During the public health emergency (PHE), CMS and private payers relaxed the restrictions on telehealth. These changes are intended to be temporary. … [Read more...]

Wound Care | CPT^® Codes for Debridement

Health care organizations have started wound care clinics to care for patients with non-healing wounds The care of a post-op wound is done by the … [Read more...]

What is a Coverage Policy?

National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare’s coverage policies that describe medical necessity for … [Read more...]

Medical Decision Making | Documentation Guidelines for E/M Services

This article relates to the 1995/1997 documentation guidelines, and not to office/outpatient codes 99202--99215 in … [Read more...]

Global Surgical Package: an overview

Need a quick summary of the global surgical package and frequently used modifiers? This article from CodingIntel will ensure that your medical … [Read more...]

Nursing Facility Visits

Definition Nursing facility visits are Evaluation and Management services provided in a skilled nursing facility or a long term nursing … [Read more...]

Modifier 24 and 25

This summary of the rules regarding modifier 24 and 25 is a must read; it includes specific examples of when to report both an E/M and a procedure and … [Read more...]

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 … [Read more...]

Moderate or High MDM – General Surgery

Accurately select the level of medical decision making, using the 1995 and 1997 Documentation Guidelines. This article provides examples of moderate … [Read more...]

Billing Admission and Subsequent Visits for Patient Having Surgery

What if I Admit a Patient and Don't Take the patient Immediately to Surgery? Can I bill for the admission and subsequent visits if the patient … [Read more...]

Teaching physician rules and surgical procedures

The teaching physician rules describe a payment method by which Medicare pays an attending physician or teaching physician for services performed … [Read more...]

Teaching Physician – Primary Care Exception

CMS updated the teaching physician rules in 2019, and this article reflects the change. On April 26, 2019 CMS released Transmittal 4283. The … [Read more...]

Laceration Repair

Wound repair is classified as Simple, Intermediate or … [Read more...]

How Fees are Set in the Medicare Fee Schedule

How does Medicare set its fees? This is important, as well, because commercial payers often use the values set by Medicare to calculate their fees. … [Read more...]

Certification for Home Health Services

There are two HCPCS codes for certification and re-certification of Medicare covered home health services The CARES Act of March 2020 allows nurse … [Read more...]