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CodingIntel

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

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February 5, 2023

Everyday Coding Q&A

 
When meeting with coders and clinicians, the same issues and concerns arise year after year. We've translated those into a searchable Everyday Coding Q&A.
 
 
 

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 … [Read more...]

Clinical staff time

Question: I believe that I know the answer to this question but am hoping you know the source, as I can't find it -- if a nurse helps with ROS, … [Read more...]

Acute, uncomplicated vs. acute with systemic symptoms

Question: When using the E/M guidelines, is the problem an  an acute, uncomplicated illness or an acute illness with systemic … [Read more...]

Does a practitioner need to document time for a telehealth visit?

Question:  Does a practitioner need to document time for a telehealth visit? What if it is audio only? Answer: First: For a telehealth visit, … [Read more...]

Coding for ultrasound guidance

Question: Can you do an article on coding ultrasound guided musculoskeletal procedures and point of care (POC) ultrasound coding and documentation … [Read more...]

Should we begin using the new CPT modifier -93

Question: Should we begin using the new CPT® modifier -93? Answer: I recommend a wait and see approach.  Here’s the definition from the AMA, … [Read more...]

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 … [Read more...]

Does HCPCS code G0444 require a full 15 minutes?

Question Does HCPCS code G0444 require a full 15 minutes, or can you use it if 8 minutes are documented? Answer The reason for this question … [Read more...]

FAQ: Scoring elements in the E/M guidelines

Scoring MDM elements can be challenging for E/M services This post includes questions related to: Major/Minor procedure Data Elements (with … [Read more...]

Why and when to use Modifier CS

Question: Why and when should we use modifier CS? Answer: Use modifier CS on visits related to testing for COVID-19. Modifier CS: cost … [Read more...]

Non-physician practitioners in nursing facilities

Find additional information about nursing facility services in Betsy's signature resource Everyday Coding. Question: Can a physician assistant … [Read more...]

Can we bill an E/M service with a scheduled endoscopy?

Question: Can we charge an E/M service when we do a scheduled endoscopy to account for the cost of nursing staff, supplies, pre- and post- care of … [Read more...]

Counting conditions in the HPI and assessment

ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong....) However, we will still need to use them when auditing … [Read more...]

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 … [Read more...]

Drug therapy requiring intensive monitoring for toxicity

Question: When auditing MDM, is there a list of drugs that are considered “drug therapy requiring intensive monitoring for … [Read more...]

What is an interval history?

ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong....) However, we will still need to use them when auditing … [Read more...]

Initial hospital service codes and established patients

Question: We are having a disagreement in our coding department. Our cardiologist sees an inpatient at the hospital, but it’s a patient she knows … [Read more...]

ROS requirements for preventive services OB/GYN

Question: What are the review of system requirements when an annual physical (99381-99387, 99391-99397) is performed/billed by an OBGYN … [Read more...]

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)  … [Read more...]

Are start and stop times required for non face-to-face prolonged care services?

Question: Regarding non face-to-face prolonged care, does Medicare require start and stop times, they way they do for prolonged face-to-face care? … [Read more...]

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2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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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

Removal of sutures or staples

There are three codes for removal of sutures or … Read More...

Coding for Hernia Repair

CPT® revised the codes and concepts used for … Read More...

Coding Guide – Critical Care Services

Critical care is a complex service provided to a … Read More...

CMS Teaching Physician Rules Update | Webinar

Let's review the teaching physician … 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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