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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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June 8, 2023

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.

Teaching Physician Rules – Evaluation and Management Services

CMS policy update: E/M services performed under the teaching physician rules Download this teaching physician rules quick reference sheet for a … [Read more...]

Anticoagulation Management

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...]

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...]

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...]

Skin Test for Tuberculosis (PPD)

How do we bill for placing the skin test for tuberculosis? To bill for placing the purified protein derivative (PPD) skin test for tuberculosis, use … [Read more...]

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Audit tool for Modifier 25

Reasonable coders and practitioners can and do disagree about when a separate E/M service is warranted on the day of a minor procedure. This audit tool for modifier 25 will help determine if a separate E/M service should be reported. Using it consistently will help practices be reliable in their determinations and provide support in payer audits. Sign up for our monthly newsletter to download the reference sheet.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

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Latest Intel

HCC coding: V24 versus V28

Medical practices are assessing the impact of the … Read More...

Reporting the Global Surgical Package | Webinar

Your Guide to Accurately Reporting the Global … Read More...

Coding for telehealth

Updated (again) May 17, 2023.  Will there be more … Read More...

Compliance issues in ICD-10 coding for risk based contracts and HCCs

Everyone loves to read the general guidelines at … 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. For more about Betsy visit www.betsynicoletti.com.

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