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 […]
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Written for coders and medical professionals, these articles are designed to help you stay current, with important coding updates, trends in coding, coder surveys and 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 physician asked me this question: “As an interventionalist, a good part of my visit is spent not only explaining patients’ conditions to them but discussing various diagnostic/therapeutic procedures, the risks and benefits […]
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 […]
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! This post relates to the global package, and not to determining the risk of additional diagnostic testing or treatment in an E/M service. Primary care practices and urgent care centers should pay special attention to these issues and avoid […]
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 […]
Reporting a Problem-Oriented Visit on the Same Day as Welcome to Medicare (G0402) or Initial and Subsequent Wellness Visit (G0438, G0439)
I continue to hear that some consultants and coders don’t agree with reporting a problem oriented visit with welcome to Medicare or wellness visit The 2024 Physician Fee Schedule Final Rule commented on this What does CMS say about adding an E/M service to a Welcome to Medicare visit or annual wellness visit? About the […]
Pessary Billing and Coding
Coding for Pessary Services Primary care practices, gynecology and urology practices often prescribe and provide pessaries. Â 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 […]
Billing for Multiple Surgical Procedures
When billing for multiple procedures on the same day, use this step by step procedure to determine if you should bill for more than one procedure, and if so, if you should use modifier 51 or modifier 59. It is critical to have access to National Correct Coding Initiative ((NCCI) edits in your software program. […]
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 […]
This Practice Paid Medicare $4.48 Million
Do you sign up for email lists and then wonder why you did it? We all do, don’t we? But, one email I always read is from the Department of Justice that links to a description of actions, settlements and indictments related to health care billing and coding A few years ago, an Orthopedic practice […]
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 & […]
Pecked By a Parrot. Oh No, Not Again!
When we first implemented ICD-10, we all had a lot of fun with the ICD-10-CM external cause codes. But, do we need to use them? The answer to that is no according to the official guidelines and yes if your payers require them. Here is what the official ICD-10-CM guidelines say, “There is no national […]
Prescription Drug Management and Medical Decision Making (MDM)
Whether selecting a level of service for an E/M encounter, the question arises about what counts as prescription drug management. In both sets of guidelines, it appears in the moderate medical decision making (MDM) row. The question arises, should we credit prescription drug management for new prescriptions, medication adjustments, and renewals? My answer has always […]
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 […]
No Chart Left Behind: Deadline to Complete Medical Records
Years ago, I worked with a physician who was chronically behind in dictating his notes. The charts were crammed into boxes by date, lining the walls of his office. Sometimes, they flowed over into the hallway or into the break room. This caused major inconveniences when a patient called for a lab result or returned […]