Question: Can you settle this question for our coding team? Are smoking and drinking considered Social Determinants of Health? Answer: No. According to the CDC: “Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set […]
Coding Clinic Update, 2Q, 2023
Dr. Kennedy has generously allowed me to share his summary. He emphasizes that he is paraphrasing the recent advice in the spirit of “fair use” and we are responsible (and must) read the official advice directly from the Coding Clinic in light of previous Coding Clinic advice and in the context of the official ICD-10-CM conventions and guidelines. […]
HCC Transition from V24 to V28 | Webinar
Recorded July 20, 2023
CMS is transitioning risk coding from the 2020 V24 model to V28 beginning in 2024. This webinar will provide an overview of HCC coding, its purpose and methodology. We’ll describe the changes and enumerate some of the key differences in coefficients for commonly used conditions between V24 and V28. And finally, learning from OIG audits of Medicare Advantage Organizations and HCC coding, identify diagnosis codes that are frequently incorrectly reported.
Reporting the Global Surgical Package | Webinar
Event date July 17, 2025
The global surgical package provides a single payment for services normally performed before, during and after a procedure. This webinar will review both CPT and CMS rules and explain what services are included in the payment and what services may be reported separately.
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 […]
CPT® Coding for Bronchoscopy Procedures | Webinar
Recorded May 18, 2023
Guest Presenter Shannon McCall of HCPro joins us once again for a CPT® focused webinar on all things bronchoscopy! This webinar will describe coding for bronchoscopy, with and without biopsy, with ultrasound guidance, and with procedures. It includes coding by the number of lobes visualized for certain procedures. There are three case studies to illustrate the coding rules for these procedures.
Coding for Hospital Services | Webinar
Recorded April 20, 2023
First, CPT® updated their E/M code set. Then, CMS interpreted the updates and applied their own reimbursement rules to the code set. This webinar will summarize CPT® rules and CMS’s February 2023 transmittal that addresses inpatient and observation billing by the admitting and consulting physicians, admission to inpatient status following observation care, and multiple visits in a single day. The webinar will discuss when coding instruction is the same for CPT® and CMS and when it varies.
Chronic Care Management | Reference Sheet
This quick reference sheet includes clinical staff time, care planning and billing practitioner work criteria for chronic care management services. When coding for care management services services, practitioners need to distinguish between chronic care management and complex chronic care management, between who does the work, the practitioner or clinical staff, and the amount of time […]
Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442
The US Preventive Services Task Force (USPSTF) recommends screening for alcohol misuse and behavioral interventions for individuals whose screening results are positive. Medicare pays for an annual screening for alcohol misuse for all Medicare beneficiaries using HCPCS code G0442. For those who screen positive, Medicare also pays for a brief face-to-face behavioral counseling session, HCPCS […]
Coding for Hernia Repair
CPT® revised the codes and concepts used for coding for hernia repair. These are significant changes for surgical procedures that are used very frequently. At the start of the repair codes, the AMA has new language that says “The hernia repair codes in this section are categorized primarily by the type of hernia (inguinal, femoral, […]
Coding Guide – Critical Care Services
The CPT® coding rules and the CMS reimbursement rules can be confusing. This guide explains the CPT® coding rules and the CMS reimbursement rules in one place.
Principal Care Management (PCM) Services – CPT® codes 99424—99427
There are four principal care management codes 99424 and 99425 are for time spent by a physician or other qualified health care professional (someone with E/M in their scope of practice) and 99426 and 99427 for clinical staff time directed by a physician or other qualified health care professional These are time based codes used […]
Chronic Care Management
Medicare and private payers cover chronic care management services if a patient has two or more serious conditions that are expected to last at least a year. Medical offices often question the correct way to code for CCM for Medicare. CodingIntel provides the correct way to utilize CPT® 99490, 99439, 99491, 99437, 99487, and 99489. […]
Transitional Care Management
This article provides answers to frequently asked questions related to transitional care management services. It includes details about billing for TCM services including: When are CPT® 99495 & 99496 used? What are the requirements for TCM? Can We Code TCM and 99214 Together? Transitional care management for discharge Everyday Coding Q&A – Who needs to […]
Category of Code
This article is from the Category of Code section in our Everyday Coding book. It provides definitions and tips for determining whether an office encounter is a new patient, established patient, or consult, and guidelines for reporting inpatient, observation, and emergency services. Quick reference charts and key points will help you to quickly and accurately […]
As Time Goes By
One of the complexities for medical practices is using time in CPT® coding. CPT® has long had a unit of time rule that a unit of time is met when the midpoint has passed. That is, you’ve reached an hour after 31 minutes. There are many CPT® codes that follow this mid-point time rule including […]
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, medication reconciliation, etc., would their time (if documented) be able to be included in the time for the visit? Answer: No. The answer to this question is […]
2023 E/M Guidelines for Hospital, Nursing Facility, Home and Residence Services | Webinar
Recorded September 22, 2022
As expected, 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. They extended the documentation framework in place for office visits to these codes. They also deleted twenty-five codes. Coding for prolonged care services gets…
Outpatient Diabetes Self-Management Training (DSMT) Services
Medicare covers diabetes self-management training (DSMT) services are a covered benefit under Medicare when all requirements are met. This article will provide an overview of the requirements and provide answers to some commonly asked questions. It will also provide you with links to the source material for DSMT coverage in the CMS Medicare Benefit Policy […]
Coding Principles for Practice Administrators | Webinar
Recorded: July 21, 2022
Administrators managing both fee-for-service and value based payment contracts must maximize revenue and minimize risk in coding for services performed in their practices. Administrators—who aren’t coders—can accomplish this through by knowing where to find definitive answers and how to assess citations and conflicting information that is presented. This webinar will provide a framework for administrators when they are called about to mediate coding disagreements within their practices.
CPT® Coding for Obstetrical and Gynecological Procedures | Webinar
Recorded: June 23, 2022
Guest Presenter Shannon McCall of HCPro
This webinar will review obstetrical global package codes , colposcopic/hysteroscopic procedures, and FY 2023 ICD-10-CM proposed additions for OB/GYN diagnoses. Shannon will also describe when it is appropriate to unbundle pregnancy package codes, how to assign CPT® codes for abortive outcomes and more.
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