Commonly Performed Procedures in Primary Care

These reference sheets for minor procedures include common CPT® codes, descriptions, current work and non-facility RVUs, and global days for quick reference. The first chart includes codes 10060-11443, the second 11600-17111, and the third 20550-54056.

Incident To Services – Medicare

Medicare has specific rules for billing for nurse practitioners and physician assistants and other office staff incident to a physician services in an office.  This article includes: Description, explanation and codes for incident-to services Billing and coding rules Brief video overview Enrollment of non-physician practitioners (NPPs) for incident-to billing See our Medicare Incident-to and Shared […]

Coding for Prolonged Services: CPT® and HCPCS Codes

Common rules: Prolonged services codes are add-on codes to the highest level E/M services in certain categories. In order to use prolonged care, the primary code must be selected based on time. This is in the CPT® and HCPCS definition of prolonged services. Prolonged services codes may only be added to the highest-level code in […]

Nursing Facility Visits

Definition Nursing facility visits are Evaluation and Management services provided in a skilled nursing facility or a long term nursing facility. Explanation Only a physician may perform an initial nursing facility service in a SNF. This includes admissions and re-admissions. In an NF, a non-physician practitioner (NPP) who is not employed by the NF may […]

Preventive Medicine Services – Medicare

Medicare has very specific requirements for preventive services. What can you bill, what must you document? This article covers all the bases including tips for billing the Welcome to Medicare and Annual and Subsequent Wellness Visits.  More tips for preventive medicine and split visits can be found here. See also Q&A from the Preventive Medicine […]

Shared Services: CPT® and CMS Rules | Webinar

Recorded May 16th, 2024

Shared services are E/M services jointly performed by a physician and non-physician practitioner in a facility setting. The service is reported under the National Provider Identifier (NPI) of the practitioner who performs the substantive portion of the service. The substantive portion of the service can be determined by time or medical decision making (MDM).

Modifier 25

Use of Modifier 25 may be applicable when an E/M service is provided on the same day as a procedure, a  preventive medicine service, or other medical service or procedure. Use this quick reference sheet to determine when to use modifier 25, and which code to append it to.

Using Modifier 33 | Quick Reference

Modifier 33 is used to identify certain screening and preventive services. This quick reference sheet addresses: when to use modifier 33, why to use it, screening colorectal cancer test, and planned screening colorectal test that converts to a diagnostic or therapeutic service.

Using Modifier 59 | Quick Reference

Modifier 59 is referred to by CMS as the modifier of last resort. It is often used when modifier 51 is the more accurate modifier. This quick reference sheet explains when, why and how to use it.

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.  

Remote Monitoring 99453, 99454 | Reference Sheet

CPT codes 99453 99454 are used to report remote monitoring device set up, supply and recording. This resource answers the questions: who does the work, what is being monitored, how is it done, and what does the practice do.

Preventive Medicine, Wellness Visits and Problem-Oriented Visits | Webinar

Recorded April 18th, 2024

Two for the price of one? Or, double-billing? There are varying opinions about when the documentation supports adding a problem-oriented visit to a CPT® preventive service or a Medicare wellness visit. This webinar provides a framework for determining if documentation shows the additional work that was done. We’ll review the examples from the CPT® Assistant for guidance (including using time) and discuss what to do about copy/paste.

OIG Report on Telehealth During the PHE

What? An OIG report without doom and gloom? Fire and brimstone? Slides In February, 2024 the OIG released an audit report of telehealth E/M services performed between March 2020 and November 2020. During this nine-month period practitioners submitted claims for 19 million E/M services. Before I talk about the report though, let me congratulate everyone […]

Home and Nursing Facility Category of Code Rules | Webinar

Recorded March 21st, 2024

This webinar will explain the rules for using Evaluation and Management (E/M) services (E/M) in home and residence locations and nursing and skilled nursing facilities. This includes CMS regulations for nursing facility services. It will discuss reporting multiple E/M services when one of the visits is in a nursing facility. It will describe the correct category of code for…

Coding Multiple Procedures | Examples with Modifiers

Biopsies and lesion destruction codes are often performed at the same patient visit. This leads to questions about bundling and modifiers. There are two steps to billing these correctly and avoiding denials: Check the total RVU values Check the NCCI edits. There is a step-by-step procedure for coding multiple procedures at the end of this […]

E&M: Key up the Focus to Complexity and Risk

Recorded February 15. 2024

Guest Presenter Shannon O. DeConda, CPC, CEMC, CEMA, CPMA, CRTT

Prior to the new E&M guidelines, AMA CPT did not reference medical necessity. The Claims Process Manual was our main point of reference for the statement Medical necessity is the overarching determining factor. While 2021 Documentation Guidelines uses 2 key components of time and MDM, the guidelines came armed with references of medical necessity littered throughout inferring that maybe it’s NOT always just 2 of the 3 key components.

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 physicians who have not switched their specialty designation.  Physicians self-elect their specialty designation with Medicare and other payers. Many hospitalists are family medicine or internal medicine physicians by training, working as […]

E/M Frequency Data for Surgical Specialties

CMS releases E/M frequency data annually.  A physician self-elects their specialty designation when enrolling with Medicare. Unfortunately, there aren’t specialty designations for breast,  bariatrics, or trauma surgery, and those surgeons are usually enrolled using the category for general surgery. There are specialty designations for vascular surgery, plastic surgery, thoracic, and surgical oncology. The data below […]

E/M Frequency Data for Family Medicine and Internal Medicine

CMS releases E/M frequency data annually.  A physician self-elects their specialty designation when enrolling with Medicare. The panel for family medicine physicians includes children, but the data below is Medicare data, for disabled patients of any age and people 65 and older. I opted to show internal medicine and family medicine together, because both are […]

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.

Copyright © 2025, CodingIntel
A division of Medical Practice Consulting, LLC
Privacy Policy