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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 […]

E/M Frequency Data for Psychiatrists

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 […]

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 […]

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…

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:

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.

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.

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. […]

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