Currently, there are two sets of codes, three HCPCS codes and two CPT® codes. They aren’t defined exactly the same, and so take careful reading. The … [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.
E/M frequency data for hospitalists
Hospitalists became a recognized specialty by CMS starting in 2017, and we now have frequency E/M data for the specialty. There are probably still … [Read more...]
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 … [Read more...]
Diagnosis coding for screening colonoscopy
Some of you have read my article on coding for screening colonoscopy. The questions I get about that article are all related to diagnosis … [Read more...]
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 … [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...]
Billing for pap smear
Billing for pap smears in a physician practice can be confusing for clinicians. Pap smears can be screening services or diagnostic services … [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...]
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...]
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)
When can you report a problem oriented visit with the Welcome to Medicare (G0402), or Initial or Subsequent (G0438, G0439) Medicare Wellness … [Read more...]
G0101 Pelvic and Breast Exam
Medicare developed two HCPCS codes for screening services for women, without certain frequency time limits G0101(screening breast and pelvic exam) … [Read more...]
Every claim line tells a story | CPT® Modifiers
Some people read mystery novels, some people can read body language but medical coders can read claims. Some claim lines are simple to read. The … [Read more...]