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 […]
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. This webinar will provide a framework for administrators when they are called on 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.
Coding and Reimbursement for Lactation Services
Questions about coverage and payment for breastfeeding and lactation counseling services come up regularly. And, payers change their policies. It is important to keep up-to-date with the commercial payers with which you have contracts. Is lactation counseling separately billable or considered part of the obstetrical package? What if the patient sees the physician and a […]
Best Practices in Revenue Cycle Management | Webinar
Recorded October 21, 2021
Guest presenter Elizabeth Woodcock
In this webinar, speaker, author, and consultant Elizabeth Woodcock provides a roadmap to optimize your practice management system, prevent denials, and strengthen cash collections.
When to Use Time to Select an E/M Service
Selecting a code for an E/M service can be done based on time or MDM (except ED visits which only use MDM) Time includes all time spent by the billing practitioner on the date of service, not just face-to-face time, and counseling does not need to dominate the visit, as it did in the 1995/1997 […]
Office Visit Code Selection for Medication Management
At some visits, psychiatrists and psychiatric NPs and PAs provide only medication management, and at some visits, they manage prescriptions and perform psychotherapy at the same encounter. There are specific rules for office visit code selection for medication management done at the same encounter as psychotherapy. Watch the video below for an explanation about how […]
HCC Diagnosis Coding Example: Diabetes, Hypertension, Chronic Kidney Disease
If a picture is worth 1000 words, what’s an example worth? An example can show in a glance what it takes paragraphs to write and explain. The one I’ve included in this article shows risk scores for a few common chronic conditions, coded two ways. One follows ICD-10 rules and results in a six-fold increase […]
HCC Coding for Medical Practices | Webinar
Recorded April 15, 2021Â
1 CEU expires 5/30/26
The rules related to HCC coding in physician practices are found in the ICD-10 book itself and in CMS guidance. Long before selecting the correct code, clinicians and coders need to understand the guidelines. This session will describe the guidelines, based on citations from these definitive sources. 1 CEU expires 5/30/26
Coding for Behavioral Health Services by Psychologists, Social Workers and Therapists
Looking for a coding resource for behavioral health therapists? It’s here. Therapists use CPT codes to describe what services they perform and ICD-10 codes to establish the medical necessity for the service. This 30 minute overview describes the coding rules for the psychiatric diagnostic evaluation, psychotherapy, psychotherapy for patients in crisis and interactive complexity.
Essential Documentation for Medication Management and Psychotherapy
When providing both medication management and psychotherapy, practitioners need to document the time spent in psychotherapy and describe the therapy. Beginning January of 2021, when billing an office visit, select the level of visit based on medical decision making, not time. If medication management is the only service performed on that date, the clinician can […]
Billing for Joint Injections | Reference Sheet
When doing a joint injection, sometimes a separate E/M service is billed on the same day, and sometimes, it’s not. This grid will help you determine when to bill for both services, and when to bill only for the joint injection.
Billing Preventive Medicine Services and Problem Visit | Quick Reference Sheet
This quick reference sheet provides guidance for billing preventive medicine services and split visits.
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.
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