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. 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.
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
Medical practices face new risks and opportunities as changes to the healthcare marketplace ignite the pressure to strengthen revenue cycle management (RCM). In this webinar, speaker, author, and consultant Elizabeth Woodcock provides a roadmap to optimize your practice management system, prevent denials, and strengthen cash collections. Find out about initiatives you can implement immediately.
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, 2021
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.
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.
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.
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
Do you want to be ready for the E/M changes in 2023? Download this guide for an explanation of changes to E/M services: office, consultations, hospital, ED, nursing facility and home. 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 […]
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