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.

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...]

Fee-for-service medicine | The rumors of my death have been greatly exaggerated!

Let me start with apologies for stealing Mark Twain’s words! And, a quick search will show I'm not the only one to apply these words to … [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

Pap smears can be screening services or diagnostic services Performing a pelvic exam is part of a preventive medicine service or problem oriented … [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...]