CMS pays Medicare Advantage plans differentially based on Hierarchical Condition Category (HCCs). This coding model uses demographics and diagnoses … [Read more...]
Nicoletti Notes
This way for news!
Written for coders and medical professionals, Nicoletti Notes is a coding blog designed to keep you up-to-date with coding news and refreshers. Written by CodingIntel founder and coding expert Betsy Nicoletti.
How to improve the accuracy of your diagnosis risk scores | Dr. Edwin Knights
This reference is the companion resource for the webinar I presented in June with Edwin Knights, M.D., Improving the accuracy of your diagnosis risk … [Read more...]
ICD-10 coding for suspected cancer
Diagnosis coding for possible malignancy How would you feel if your primary care physician and your general surgeon told you—and told your insurance … [Read more...]
Reimbursement for Shingrix, the new zoster vaccine | 90750
At the end of 2017, there was news that a new vaccine for shingles, Shingrix, was significantly more effective than the older vaccine, Zostavax. The … [Read more...]
Who is responsible for coding physician services? The medical provider or the coder?
Legally, when a physician, physician assistant (PA) or nurse practitioner (NP) enroll in a Medicare, Medicaid or commercial insurance, the … [Read more...]
Are you missing the initial annual wellness visit? | G0438
After I gave a presentation at a family medicine conference a physician said to me, “What you just told me will pay for the entire cost of my coming … [Read more...]
Three things you may have missed on CodingIntel.com
Coding. Why does it keep changing? This article was out of date and has been removed. Visit our coding library to see the latest coding … [Read more...]
Medical necessity isn’t medical decision making
Have you heard of Talk Ten Tuesdays? It’s an internet radio program hosted by Chuck Buck and Dr. Erica Remer, and every week they discuss current … [Read more...]
Billing for pap smear
Clinicians often ask what codes to use when billing for a pap smear provided during a preventive medicine service or other problem-oriented E/M … [Read more...]
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 … [Read more...]
What does the decision to perform a minor procedure really mean?
I received this question recently and want to share it with you. “Since the decision to perform a minor procedure is included in the payment for the … [Read more...]
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 … [Read more...]
HCCs in Medical Practices | Risk Diagnosis Coding
What are HCCs and why do I need to know about them? Hierarchical Condition Category (HCC) is a coding system developed by Medicare to pay Medicare … [Read more...]
Let’s go to the source! Should this visit be downcoded?
This article describes the use of time using the 1995/1997 guidelines. Be sure to read about the 2021 guidelines for codes 99202--99215. A … [Read more...]
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 … [Read more...]
Avoid these 4 costly errors when coding minor surgical procedures
Does your practice perform any minor or major procedures? If so, this post is for you! Primary care practices and urgent care centers should pay … [Read more...]
A Rose by Any Other Name | EMR and Compliance
The blog post below, written in 2017, discusses the issue of copying and pasting in electronic health records. Since then, CMS has changed its stance … [Read more...]
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 … [Read more...]
Reporting a problem-oriented visit on the same day as Welcome to Medicare (G0402) or Initial and Subsequent Wellness Visit (G0438, G0439)
To do or not to do? When can you report a problem oriented visit with the Welcome to Medicare (G0402), or Initial or Subsequent (G0438, G0439) … [Read more...]
Primary care and post-op reporting | Medicare requirements
Hey, primary care! This one’s for you too. Primary care doctors probably didn’t pay attention when the news broke that CMS is requiring reporting … [Read more...]