CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. This is the data for psychiatrists. The data below is from 2023 released in late 2024. Office services Psychiatry New OV 2023 99201* 0% 99202 0.59% 99203 6.82% 99204 40.09% 99205 52.50% Established office visits 2023 99211 0.83% 99212 […]
E/M Frequency Data for Infectious Disease, Pulmonary Medicine and Cardiology
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Infectious disease, pulmonary medicine and cardiology are all specialties with active inpatient services, and of course, busy office services. That’s why I’ve elected to show them together. The data below is from 2023, released in late 2024. Office services […]
Multiple E/M Services in the Same Calendar Day
The AMA has added a new subsection in the 2024 E/M section addressing how to report E/M services when there are multiple encounters in the same day. (Pages 6 and 7) According to CPT Changes 2024 An Insider’s View, the reason for this was to provide clarification for when multiple E/M services were performed on […]
Psychiatric Collaborative Care Management Services
This resource covers Psychiatric Collaborative Care Management Services 99492, 99493, 99494 and
Care Management for Behavioral Health 99484.
Teaching Physician – Primary Care Exception
CMS updated the teaching physician rules in 2019, and this article reflects the change. On April 26, 2019 CMS released Transmittal 4283. The transmittal primarily addresses E/M services, but also amends the section of the manual related to the primary care exception. The changes to the primary care section were mostly wording updates. Those rules […]
2025 RVU table with national fee amounts
Looking for 2025 work RVUs? Wondering how much a new code pays? Look no farther. You can download the 2025 CMS national RVU table below. It does not include payment variations after the geographic practice cost indices have been applied. We’ve hidden some columns (which you can unhide) so that you see the code, short […]
How Physician Services are Paid – Overview
Have a new staff member or physician who needs a primer on “how physician services are paid?” This short video is a must see! Learn how all the piece come together, from CPT® and HCPCS, to diagnosis coding and Medicare rules. All in about 15 minutes…
Two Visits for the Price of One? | Multiple Medical Visits on the Same Day
Patients often schedule two medical appointments on the same day with physicians of different specialties. It’s convenient for them. It saves travel time. It may mean the patient or a family member only needs to take one day off work. Can a multi-specialty practice be paid for two visits, when the physicians/non-physician practitioners (NPPs) practice […]
HCC Coding: V24 versus V28
Medical practices are assessing the impact of the change in the HCC model from V24 to V28, a phased in change that begins in 2024. CMS pays Medicare Advantage (MA) plans using Hierarchical Condition Categories (HCCs), and many private payers and ACOs use the HCC model for risk adjustment. Briefly, Medicare pays MA plans more […]
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 […]
Facility versus Non-Facility in the Physician Fee Schedule
Understanding facility versus non-facility in the physician fee schedule explains the RVU and payment differences that practices receive when performing the same service in different settings. The Medicare Physician Fee Schedule has values for some CPT® codes that include both a facility and a non-facility fee. When CMS develops the fee schedule, each code has […]
What is a Coverage Policy?
National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare’s coverage policies that describe medical necessity for certain services. Private payers publish their own coverage policies on their Web sites. When services are denied due to medical necessity, no pre-authorization, failing to try less expensive or invasive treatments, this is a good indication there […]
HCPCS Code G0136 for Assessment Social Determinants of Health (SDoH)
HCPCS code G0136 for an assessment of patients a practitioner suspects may have difficulty with accessing treatment and following a treatment plan due to Social Determinants of Health (SDoH0 CMS established a standalone code G0136 (a HCPCS code) for the assessment of SDoH. They define SDoH into broad groups: “economic stability, education access and quality, […]
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 […]
How Do We Code for “Meet and Greet Visits?
Question: What code can I use when a patient presents to establish care, and doesn’t have any symptoms or problems? Answer: First, code or no code, isn’t this a great position for the patient to be in? Establishing care without a care in the world? (Medically at least.) There isn’t a CPT code for “meet […]
E/M Services: High Volume, High Risk | Webinar
Recorded October 19, 2023
According to CMS, E/M services comprise 40% of allowed charges in the physician fee schedule, 20% office visits and 20% other E/M services. Medicare’s expense is medical practice revenue, with the income from some primary care practices comprising 70% or more of total charges. To protect the organization, compliance professionals can focus on four components of E/M:
Is ChatGPT Coming to Coding?
Question: What’s all this I hear about ChatGPT? Is it coming to coding? Answer: All right, I wrote that question myself. I’ve been thinking about this topic. Alicia Gallegos wrote an article for CodingIntel about the topic. But, I wanted to see for myself how it could interpret coding rules, so I asked ChatGPT questions […]
A Conversation with Two Auditors: Lessons Learned about MDM | Webinar
Recorded September 28, 2023
Medical practices can prepare for audits, improve documentation and decrease compliance risk by sharpening their focus on high-risk areas, high volume services, and/or identifying confusing areas of MDM and developing and following consistent guidelines from appropriate resources. Join Pam D’Apuzzo, CPC, ACS-EM, ACS-MS, CPMA and Debra Rossi, CCS, CCS-P, CPC, CPMA of VMG Health and me for a lively and informative discussion.
Coding Matters™
Health care coding news matters to coders, billers administrators and practitioners in medical practices. Often, there’s new beyond new codes or new policies and keeping up-to-date with that news can inform decisions that practices make. CodingIntel’s Coding Matters® page will help you be in the know about government regulation, compliance actions, third-party policies and the […]
CMS Finalizing Principal Illness Navigation (PIN) Services
This is information from the 2024 Physician Fee Schedule Final Rule https://public-inspection.federalregister.gov/2023-24184.pdf CMS developed four HCPCS codes for Principal Illness Navigation. This service is intended to help patients with serious conditions navigate their health care treatment. PIN services are incident-to services so may only be performed in a non-facility setting Informed consent is required-the patient must […]
Medicare Coverage for Marriage and Family Therapists and Mental Health Counselors
In the Consolidated Appropriations Act, 2023 Congress mandated that Medicare provide coverage and payment for the services of health professionals who are Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs). The effective date of coverage is January 1, 2024. And of course, these professionals must enroll in Medicare in order to provide the […]
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