This article covers CPT® and diagnosis codes used for screening for other sexually transmitted illnesses. It includes descriptions and screening criteria. To tell whether or not you can collect a co-pay for the testing or not can be found on the U.S. Preventive Services Task Force (USPTF) website [1]. The Affordable Care Act mandated that […]
Coding Guide – Teaching Physician Rules
The teaching physician guidelines are Medicare rules that allow for payment for services that are performed jointly between a resident and a licensed attending physician (the teaching physician). This downloadable coding guide from CodingIntel provides an explanation of teaching physician rules for E/M services and specialty specific services.
Anticoagulation Management
There are a few remarkable things about coding for anticoagulation management services. First, payment for these services bolsters Medicare’s support for primary care. This monitoring is typically done by either primary care or cardiology and was considered part of the pre-and post-work for an office visit. Although there were CPT® codes for anticoagulation management prior […]
Billing Medical Practice Services for Patients on Hospice
Overview of Hospice Care Additional Services (non-Hospice Organization) Medicare beneficiaries who have a terminal illness with a life expectancy of six months or less can elect to have their end-of-life care provided by a hospice organization (the “hospice”). Medicare then pays hospice to provide all the care that the patient needs that is related to […]
Teaching Physician Rules | Quick Reference Guide
This quick reference guide breaks down who must document what for which services as outlined in Medicare’s teaching physician rules.
Select HCPCS codes from 2025 and 2024 | Webinar
Recorded March 20th, 2025
CMS continues to develop new HCPCS codes to describe services that promote their healthcare agenda, and are not in the CPT® code set. This webinar will address a select few of the newer services from this year and last year.
Behavioral Health and Telemedicine
In this post Overview of behavioral health services via telemedicine during the PHE Overview of behavioral health services after the PHE The Omnibus spending bill passed at the end of Dec. 2022 extended telehealth flexibilities for two years after the end of the PHE. The final MPFS 2025 extends the delay for the -in-person visit […]
Diagnosis Coding for Antepartum Care
Question: Patient seen for antepartum care but delivered at 38 weeks at a different hospital/physician group. What diagnosis codes should we use for the visits before the birth episode. Answer: The diagnosis coding for antepartum care would be specific to the patient’s condition at the time care was provided. If at the time of the […]
Aftercare and Follow-Up: ICD-10-CM Coding
Aftercare visit codes are assigned in situations in which the initial treatment of a disease has been performed but the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. ICD-10 makes two important points about the use of aftercare codes in the final chapter. The aftercare […]
Overview of FQHC and RHC Coding | Webinar
Recorded February 20th, 2025
Federally Qualified Health Centers (FQHCs) operate in rural and urban areas, and provide services to Medicare, Medicaid patients and privately insured patients. Rural Health Centers operate in rural areas and also provide services to Medicare, Medicaid and privately insured patients.
Diagnosis Coding for Intentional Self-Harm
Another discussion of codes that use placeholder xxxA (or xxx with another 7th character) One of the most searched terms on CodingIntel is xxxA. Experienced diagnosis coders recognize the placeholder digits “xxx” and the 7th character extender A. When we pulled the list of ICD-10-CM codes that have xxxA in them, nine related to self-harm […]
Anatomy of an Audit™
Recorded February 4th, 2025
Evaluation & Management E/M Services: Guest presenters Pam D’Apuzzo, CPC, ACS-EM, ACS-MS, CPMA and Debra Rossi, CCS, CCS-P, CPC, CPMA of VMG Health
Surgical Procedures & Diagnostic Tests: Guest presenter Pam Warren, MHA, COC, CPC, Fellow
Auditing an individual record is one part of conducting an internal or external audit. Anatomy of an audit will look at the entire audit process including: identifying the type and purpose of the audit, necessary research, record selection, utilization of appropriate audit tools, and reporting and response.
National Coverage Determination: PrEP for HIV Prevention | HCPCS Code G0011
Physicians and qualified health professionals (QHP) can gain reimbursement for up to eight counseling sessions per year for HIV risk assessment, risk reduction and medication adherence, according to a recently issued national coverage determination (NCD). Background On September 30, CMS issued a NCD 210.15, Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention, which shifts […]
Everyday Coding for Medical Practices
Everyday Coding is Betsy’s signature course. We’ve gathered all the components here in one convenient spot. You can work through them one at a time, select just the ones you need, or customize training for your physicians and staff.
RHC and FQHC Update
Background Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) have specific rules related to coding for service in their clinics. Both submit claims on a UB claim form that shows a revenue code and also includes the specific HCPCS/CPT® codes that were performed. RHCs (generally) are paid an all-inclusive rate for services done […]
Diagnosis coding for a fall (or other injury)
More discussion of codes that use placeholder xxxA (or xxx with another 7th character). When a patient presents for an injury after a fall, practitioners may be tempted to search for the word “fall” and select the first diagnosis that they find. Perhaps, they find the code W06.xxxA “fall from a bed” or even W19.xxxA […]
How Fees are Set in the Medicare Fee Schedule
How does Medicare set its fees? This is important for other payers because commercial payers often use the values set by Medicare to calculate their fees. This overview provides information and examples to explain how fees are set in the Medicare Fee Schedule. CodingIntel members can start with the brief video introduction and companion slides, […]
Community Health Integration (CHI) Services
This article includes information primarily from the 2024 Physician Fee Schedule Final Rule, but also the 2025 OPPS Fee Schedule in order to address billing when performed at an hospital outpatient department. The effective date for the CPT® and HCPCS codes, and CMS policy was 1-1-2024. Practitioner (physician/NPP) identifies Social Determinants of Health (SDoH) needs […]
Care Plan Oversight | Coding reference sheet
There are two sets of codes for care plan oversight, CPT® (99374–99380) and HCPCS codes (G0181, G0182). The requirements for each are different, including time thresholds and what activities may be included in the CPO time. RVUs are assigned by Medicare for these CPT® codes. Some have a bundled indicator and some invalid, which means […]
Advanced Primary Care Management Codes | Webinar
Recorded January 16th, 2025
CMS developed three HCPCS codes effective 1-1-2025 to pay primary care practices to manage the care of patients over time. CMS continues to believe that practices incur significant expense for the care that happens in between office visits.
Physician Fee Schedule Final Rule for Calendar Year 2025
2025 conversion factor $32.3465 (updated 11/19/2024) Coverage of new HCPCS codes On November 1, CMS released the final 2025 Medicare physician fee schedule. The rule contains dozens of new HCPCS codes that will take effect Jan. 1, 2025. From cardiovascular disease assessment and caregiver training services to a suite of behavioral health services, the new […]
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