Some coders were already working from home either full time or a few days a week. Many practices and health care facilities implemented remote coding prior to the public health emergency. Now, more of you are. I call it: Telecoding for Telemedicine When we look back on this period, on our personal and professional lives, […]
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 sharing waiver for COVID-19 testing When you do, Medicare and private insurers will pay 100% of the claim, without any patient due cost sharing. The two laws that were passed require Medicare […]
Modifier CS: Cost Sharing for COVID-19 Testing and Visits Related to Testing
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Effective retroactively to 3/18/20, there is no cost sharing allowed for COVID-19 testing or for the evaluation visits related to the testing Medicare instructs us to use modifier CS on the visits and tests, and to contact your […]
Payment for Telephone Calls During the PHE: CMS Rules for Phone Calls
Telephone codes 99441–99443 were deleted from the 2025 CPT book. This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/17/2025 CMS rules for phone calls has changed during the course of the pandemic. Prior to […]
Lesion Destruction Tip Sheet
CPT® does not make it easy to locate codes for destruction of lesion(s). These codes are found in multiple chapters throughout the CPT® book, and are classified by a variety of factors (size, method of destruction, type (pre-malignant/malignant/benign), etc.) Accurate coding is essential to accurate payment. This tip sheet was created to help you quickly locate the correct CPT® code for lesion destruction.
Billing Preventive Medicine Services and Problem Visit | Quick Reference Sheet
This quick reference sheet provides guidance for billing preventive medicine services and split visits.
CMS Update on Medical Record Documentation for E/M Services
The world as we knew it Both the 1995 and 1997 evaluation and management (E/M) documentation guidelines stated that ancillary staff could record a review of systems (ROS), and past medical, family, and social history (PFSH) in a patient record. The billing physician/NP/PA needed to document that that information had been reviewed and verified. Only […]
Blood Pressure Self-Measurement 99473, 99474 | Reference Sheet
CPT ® codes 99473 and 99474 are used to report specific clinical staff and/or Physician, NP or PA work related to blood pressure self-measurement by patients. This quick reference sheet defines the work, the time required, and lists the criteria for reporting these services.
On-line Digital Services and Remote Monitoring | Webinar
Recorded February 27, 2020
New CPT ® codes for non-face-to-face services include both on-line digital evaluations and remote physiological monitoring. Hold your celebration—the digital E/M codes are not office visits through your portal and have very specific documentation requirements. The webinar will start with a brief overview of Medicare covered telehealth, and then describe these two new sets of codes, with the documentation rules and clinical examples.
Psychiatry Exam Reference Sheet 1997 Guidelines
Use the exam example below to meet the requirements of a comprehensive, using the 1997 single specialty psychiatry exam.
Non-Physician Practitioners in Nursing Facilities
Members can read more about nursing facility services here, and in Everyday Coding. Question: Can a physician assistant see patients in a nursing facility without a physician signing each encounter? How do we bill this? Can we do wellness visits in a nursing facility? Answer: A physician assistant or an advanced practice registered nurse may see […]
Coding Guide – How Physician Services are Paid
This is an essential resource for new physicians, non-physician practitioners, coders and billers and for managers who want to know just enough to manage. In addition to this billing guide, be sure to reference the helpful infographic and Betsy’s 15 minute video on the payment process.
Coding Guide – E/M Services
This coding guide describes the guidelines for evaluation and management (E/M) services reported in the office or outpatient department, consultations, ED visits, inpatient and observation hospital visits, nursing facility and home services. There are specific changes related to these categories of codes described here. The guide will also discuss how to select the level of service based on either time or medical decision-making.
E/M Services – History and Exam
History and exam for E/M services “E/M Codes that have levels of services include a medically appropriate history and/or physical examination when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified healthcare professional reporting the service. The care team may collect information and the […]
Procedure Coding for Colonoscopies
“A colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine to an anastomosis.”[1] In 2015, CPT® revised some definitions related to colonoscopy and added a decision tree to help practices select the correct CPT® code and the correct […]
New Versus established Patient Visits
There are other articles on CodingIntel about the difference between new and established patients, and the rules haven’t changed, but that doesn’t mean it is always clear. Medicare definition “Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) […]
Overview of Diagnosis Coding for Behavioral Health Services
Match diagnoses on the claim form to those listed in assessment The diagnosis codes on the claim form should match those in the note. If the assessment says “stable on medications” or “doing well,” it isn’t clear how many conditions were managed and treated In the assessment, list conditions managed, their status, and treated Note […]
Medication Management and Psychotherapy Reference Sheet
This quick reference sheet illustrates the coding and documentation requirements for medication management services with, or without psychotherapy.
Psychiatric Diagnostic Evaluation
There are two codes for psychiatric diagnostic evaluation. 90791 Psychiatric diagnostic evaluation 90792 Psychiatric diagnostic evaluation with medical services 90791 is used by psychologists, social workers and other licensed behavioral health professional and 90792 is used by psychiatrists and psychiatric nurse practitioners and physician assistants, because it includes medical services. Here is how CPT® defines […]
Psychotherapy Codes
Individual psychotherapy codes are time based codes. One set may be reported as a stand alone service, and another during the same visit as medication management. They follow the CPT®; time rule: use the code when the mid-point in the defined time is met. The CPT® book itself lists the time thresholds at the start […]
Psychotherapy for Patients in Crisis
Page down for 2024 HCPCS codes for G0017, G0018 90839 is the code for psychotherapy for crisis; first 60 minutes. 90840 is an add-on code for each additional 30 minutes of time spent with a patient who is in crisis. These codes do not have CPT® limitations on place of service. They would typically be […]
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