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May 20, 2025

Coding Guides

These coding guides are your path to accurate coding!

 

 

Coding Guide – Advanced Primary Care Management

CMS developed new HCPCS codes for primary care practitioners who provide care management services and communications-technology based services on a monthly basis. These are an alternative to other care management codes, and acknowledge that much of the work caring for patients occurs outside of regular office visits. These Advanced Primary Care Management (APCM) codes are […]

Coding Guide – Prolonged Services

Prolonged services codes function as add-on codes to the highest-level Evaluation and Management (E/M) services in certain categories. To use prolonged care, providers must select the primary code based on time, which is explicitly stated in both the CPT® and HCPCS definitions of prolonged services. For billing purposes, the full 15 minutes of prolonged services […]

Coding Guide – Federally Qualified Health Centers

If you are looking for a guide to coding for Rural Health Center (RHC) or Federally Qualified Health Center (FQHC) visits, here it is. Clinicians in RHCs and FQHCs use CPT® and ICD-10-CM codes to select their services, but these are submitted with HCPCS qualifying visit codes. It’s easy for clinicians in these mission driven […]

Coding Guide – Teaching Physician Rules

The teaching physician guidelines are Medicare rules that allow for payment for services that are performed jointly between a resident and a licensed attending physician (the teaching physician). This downloadable coding guide from CodingIntel provides an explanation of teaching physician rules for E/M services and specialty specific services.

Everyday Coding for Medical Practices

Everyday Coding is Betsy’s signature course. We’ve gathered all the components here in one convenient spot. You can work through them one at a time, select just the ones you need, or customize training for your physicians and staff.

Compliance Guide

You may have heard about the “Seven Elements for an Effective Compliance Plan.” In fact, if you enter that term in a popular web browser “about 575,000” results appear within seconds. Fortunately, compliance and enforcement agencies endorse the elements and provide great examples on what to do – without having to delve much into those […]

Coding Guide – Critical Care Services

The CPT® coding rules and the CMS reimbursement rules can be confusing. This guide explains the CPT® coding rules and the CMS reimbursement rules in one place.

Coding Guide – How Physician Services are Paid

This is an essential resource for new physicians, non-physician practitioners, coders and billers and for managers who want to know just enough to manage. In addition to this billing guide, be sure to reference the helpful infographic and Betsy’s 15 minute video on the payment process.

Coding Guide – E/M Services

This coding guide describes the guidelines for evaluation and management (E/M) services reported in the office or outpatient department, consultations, ED visits, inpatient and observation hospital visits, nursing facility and home services. There are specific changes related to these categories of codes described here. The guide will also discuss how to select the level of service based on either time or medical decision-making.

Everyday Dermatology Coding

Everyday Dermatology Coding is a 52 page guide to coding dermatology services.

Screening Codes Guide – G0442, G0443, G0444, G0446, G0447

Medicare pays for some screening services for its beneficiaries, using HCPCS codes. These screening codes are time-based HCPCS codes with relatively low wRVU values and payment. This coding guide includes an explanation of the guidelines for each of these codes, and information about bundling, diagnosis coding, specialty and site of service restrictions, and much more.

Coding Guide – Behavioral Health Services

The coding for psychiatric and psychotherapy services changed in 2013 and although that was years ago many psychiatrists, psychiatric nurse practitioners (NPs), and psychiatric physician assistants (PAs) are still adjusting to the change. This guide will answer questions about how to code for behavioral health services including: initial evaluations, re-evaluations, medication management, and psychotherapy.

Coding Guide – Medicare Incident-to and Shared Services

This in depth guide reviews the requirements for billing Medicare Incident-to and shared services including: when/where these services can be billed, which provider number to use, and documentation requirements.

Coding Guide – Preventive Medicine Services

Coding for preventive medicine services should be easy, but it’s not.  It’s complicated by frequency issues, Medicare rules and the always difficult issue of when to bill a problem oriented E/M service on the same day. This guide includes coding and billing guidelines for preventive medicine services.

Coding Guide – Minor Surgical Procedures

This guide includes definitions of minor procedures used frequently in primary care and urgent care. And, even more important, instructions for billing the services. No minor procedure guide would be complete without a discussion of modifier 25. It is also the reference for CodingIntel’s minor procedures webinar which you can watch here.

Coding Guide – Care Management Services

CMS has a stated goal of recognizing management services provided outside of an office visit. In particular, valuing and paying for care management and other non-face-to-face services. Sometimes, this means recognizing existing CPT® codes, and changing the status indicator from bundled to active, so that it is a covered service. Sometimes, it means working with CPT®’s chronic care management committee to develop new codes that describe management services.

Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices

Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24 page guide from CodingIntel is an introduction to risk adjustment coding and the risk adjustment factor (RAF).

Coding Guide – Newborn and Pediatrics

Neonatologists, pediatricians and family physicians who care for newborns and sick children in the hospital need to select the category of code that describes the condition of the patient. There are distinct categories of codes to describe each of these situations. There are also codes that describe services to patients who are in the process of being transferred to a higher acuity facility. This guide describes the codes to use in each situation.

Coding Guide – Global Surgery

This guide from CodingIntel explains surgery coding guidelines and the global period for procedures, and includes the contents of our original CPT® and HCPCS Modifier Guide.

Annual CPT® Changes Webinar

CodingIntel welcomes back Shannon McCall of HCPro for this review of changes that will go into effect January 1st, 2025. Exclusively for members.

Join now

Compliance for Medical Practices

Exclusively for members, this two module concentration includes guidance for developing an audit workplan, and how to locate source citations for common healthcare compliance scenarios.

Join today!

IRE Inpatient Determinations: Case Studiesoding for Prolonged Services | Webinar

Exclusively for members, this case-study focused webinar describes important ICD-10-CM Guidelines that establish the rules for these decisions.

Join today!

Latest Intel

Fueling Compliance: Cracking the Code on DSMT & MNT | Webinar

Overview … Read More...

Problematic Modifiers – 22, -52, -58, -78, -79 | Webinar

Overview … Read More...

Behavioral Health Screening and Testing

This article will review the codes and guidelines … Read More...

Anatomy of an Audit™: Complexity of Problem Addressed | Webinar

Overview … Read More...

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.

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