Some of you have read CodingIntel’s article on coding for screening colonoscopy. The questions we get about that article are almost all related to diagnosis coding. The CPT®/HCPCS coding and the modifiers don’t raise many questions but clinicians, coders, and patients frequently ask about correct diagnosis coding and sequencing of those codes. We recently posed […]
Complimentary articles from our library
CodingIntel is a library of coding resources for medical professionals, practitioners and the revenue cycle team. Here’s a small sampling of our most read articles about CPT® and E/M, CMS, compliance, and HCC and diagnosis coding. If this is what you’re looking for, become a member today.
OB Coder Survey | Billing Extra Visits During Pregnancy
Thank you to the 63 generous coders and billers who answered my questions about billing extra OB visits during the maternity period. If we and our payers are following CPT® rules, these extra visits caring for a pregnant patient are separately billable. The editorial comments at the start of the Maternity Care and Delivery section […]
Can you Screen for an Existing Condition? | Diagnosis Coding for Lab Services
Sometimes, the hardest thing about coding for preventive services isn’t the visit at all. It’s the labs. Patients come in for an annual physical and many times they believe that all of the lab work done that day or in preparation for that day will be covered as part of their preventive service. And we […]
HCC Diagnosis Coding: Can you Add a Code from the Past Medical History?
This post describes rules for office/outpatient coding, not facility/DRG rules. Recently a fellow coder wrote to me about risk adjusted diagnosis coding. She was responding to an article that I wrote in which I stated the conditions listed in the past medical history should not be included on the claim form by the coder. I […]
7 Sure Fire Ways to Owe the Government $4 million in Fines and Repayments | Coding Compliance
Most practices aren’t looking to pay the government any money in fines and repayment because of coding errors. Two recent OIG settlements described two practices that did just that. Most practices want to avoid this, of course, but some groups seem determined to achieve that outcome. In reviewing both of the settlements, there are some […]
CPT® and CMS Rules for Critical Care | What’s the Difference?
CMS and CPT count critical care time differently. CMS issued a “technical correction” in the 2023 PFS Final Rule. They stated that it is their policy that add-on code 99292 can only be reported when critical care time is 104 minutes, not 74 minutes as stated in CPT®. CMS noted they stated this in the […]
Pessary Billing and Coding
Coding for Pessary Services Primary care practices, gynecology and urology practices often prescribe and provide pessaries. A pessary is used to treat pelvic organ prolapse and for urinary incontinence. It provides support for the vaginal walls or uterus. A physician or non-physician practitioner (NPP) must first see the patient, take a history, examine the patient […]
Modifier 95, 93: Telemedicine
CPT® has two modifiers for telemedicine. CMS and private payers regularly change their instructions about using these modifiers and what place of service to use. Modifier 95 is for use with real-time, audio/visual visits. Modifier 93 is for audio-only telehealth services Modifier 93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-only Telecommunication […]
Overview of Advance Care Planning
Advance Care Planning CPT® Codes Overview Medical practices perform countless tasks every day for which there is no payment. CMS continually states that it wants to support non-procedural and in the past decade has added payment for some non-face-to-face services, including Care Plan Oversight, Transitional Care Management and Chronic Care Management. CPT® Codes 99497 & […]
Coding for Screening Colonoscopy
An Overview of Colonoscopy Coding Guidelines The ACA, which was passed in 2010, did a great many things, but this is what is relevant for colonoscopies: insurers must cover preventive services, like screenings and vaccines, without charging co-pays, deductibles, or coinsurance to encourage early detection and preventive care. A screening colonoscopy should have no patient […]