Question: What’s the accurate level of service for a patient who presents with a sore throat, has a positive strep test, and is put on antibiotics? Answer: The September 2025 CPT® Assistant posed this question and said the level of service was 99213. Let’s look at this in grid form to see why. You need […]
Monthly Coding Q&A
Our newsletter subscribers and our members have a coding question and answer delivered to their inbox monthly. Some topics are perennial and timeless, asked by new clinicians and team members all the time. Some answer questions about new rules and services. Do you want to receive our monthly Q&A? Sign up here.
Does 99459 Require a Chaperone?
Question: The E/M session of the CPT® symposium this year was in question-and-answer format. One of the questions was, “Is a chaperone required to use add-on code 99459?” Answer: Their answer: no. Some consultants stated that in order to use code 99459 with an office visit, consult, or certain preventive medicine services, a chaperone was […]
Crediting Independent Interpretation
Question: Can a practitioner get credit for both ordering and interpretation of a test if documented? Can you address the change from 2023 related to this? Watch this brief video, or read on for the answer. Answer: In March of 2023, CPT® issued an “Errata and Technical Corrections” which added one line to the section […]
Teaching Physician Rules – Moonlighting
Question: Resident is moonlighting in an urgent care setting. The resident is licensed but not enrolled with insurance companies. Can we follow the Teaching Physician rules for this resident and bill for services jointly performed between an attending and the resident? Answer: For Medicare, no, not based on my reading of the applicable statutes. “Moonlighting” specifically refers to […]
Visits in the Maternity Package
Question: How many visits are included in the payment for the maternity care package? Answer: The global maternity package includes approximately 13 routine antepartum visits for an uncomplicated pregnancy: monthly visits up to 28 weeks, biweekly visits to 36 weeks, and weekly visits until delivery. Fewer than four prenatal visits do not qualify for global reimbursement and […]
Advance Care Planning Q&A
Does your practice provide Advance Care Planning (ACP) services? If so, read on and watch the video below. Advance Care Planning is reported with two CPT® codes from 2015. CMS gave it a status indicator of Invalid in 2015, but in 2016 changed that to an active status and began reimbursing for the service. But, […]
Transferring a Sick Baby to Another Hospital
Question: Our pediatric group practices in a community hospital, without an NICU. My pediatrician was called to attend a delivery of a newborn who was born premature and in respiratory distress. The baby needed to be stabilized and transferred to a level III neonatal intensive-care unit. The pediatrician spent 90 minutes from the time the […]
Codes for Visits in Assisted Living
Question: In 2023, how will we code for visits in assisted living? Answer: January 1st 2023, the codes for boarding home, rest home and domiciliary care are gone from the CPT® book. What are the codes for visits in assisted living in 2023 and beyond? Home and residence services (99341—99345 for new patients) and (99347—99350 […]
Acute, Uncomplicated vs. Acute with Systemic Symptoms
Question: When using the E/M guidelines, is the problem an acute, uncomplicated illness or an acute illness with systemic symptoms? Answer: Let’s start with the CPT definitions, from the CPT® Professional edition. Acute, uncomplicated illness Acute illness with systemic symptoms From CPT®: A recent or new short-term problem with low risk of morbidity for which […]
What is the Risk of a Referral?
Question: What level of risk is assigned when a practitioner refers a patient to a physician in another specialty? Does the complexity of the problem (eg, melanoma) make a difference? Answer: Watch this brief video for the answer. You can also download the slides here.
Age and Wellness Visits | Eligibility for Welcome to Medicare
Who can perform the AWV Knowing which Medicare wellness visit to bill Eligibility requirements for the Welcome to Medicare visit 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 to this conference.” I don’t always […]
Medicare Advantage Plan Network Issues
Question: My sister is thinking of enrolling in a Medicare Advantage plan. In our practice, we have issues with pre-authorizations and denials. I’ve warned her about network issues. Is there anything else I should tell her? Answer: I’m so glad you asked. I’ve had this conversation with my own family and friends. Medigap plans If […]
Compliance Issues in ICD-10 Coding for Risk Based Contracts and HCCs
Everyone loves to read the general guidelines at the front of the ICD-10 book, right? No? Well, here’s an important excerpt. “Code all documented conditions, which coexist at the time of the visit that require or affect patient care or treatment. (Do not code conditions, which no longer exist).” Most of the articles I’ve written […]
Can We Bill a New Patient Visit for Preventive and E/M Services on the Same Day?
See our on-demand webinar, Preventive medicine and Medicare wellness visits with an E/M. Question: Our physician saw a patient and did a preventive medicine service and addressed an acute, significant problem. The patient was new to us. Should we bill both as new patient visits? Answer: The last time I saw this addressed by CPT® […]
Non-Physician Practitioners in Nursing Facilities
Members can read more about nursing facility services here, and in Everyday Coding. Question: Can a physician assistant see patients in a nursing facility without a physician signing each encounter? How do we bill this? Can we do wellness visits in a nursing facility? Answer: A physician assistant or an advanced practice registered nurse may see […]
Diagnosis Coding for Biopsy Sent for Pathology
Question: What diagnosis code should you use when sending a skin biopsy to pathology? a) D48.5 Neoplasm of uncertain behavior of skin, or b) D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin