Coding for Destruction of Malignant Lesions

The primary factors in selecting a code for destruction of malignant lesions are: Size of lesion (not defect) Location Method is not a factor in code selection Per Principles of CPT® Coding: “The destruction of malignant lesions is reported with codes 17260—17286. Similar to the codes for excision of lesions, the correct code is chosen […]

Virtual Communication: HCPCS Codes G2010, G2250, G2251, G2252; CPT® 98016

Virtual communications are not considered telehealth These HCPCS codes were developed by CMS for virtual communication They are not on CMS’s list of telehealth services and do not use real-time, interactive, audio/visual communication They do require verbal consent; a single consent can be obtained for all communications based technology services annually for Medicare patients In […]

CPT® Codes for Fine Needle Aspiration

Fine needle aspiration biopsy Material is aspirated with a fine needle and the cells are examined cytologically Core needle biopsy is performed with a larger bore needle to obtain a core sample Use code 10021 for FNA without imaging guidance, first lesion and 10004 for each additional lesions There are codes for FNA include imaging […]

Skin Biopsies

Correctly selecting and reporting skin biopsies requires an understanding of CPT® codes for skin biopsies There are codes for excision of benign and malignant lesions, and codes for shave procedures.  Those are coded based on the size of the excision and location There are specific biopsy codes in other chapters, for biopsy of ears, lips, […]

Coding Guide – Behavioral Health Services

The coding for psychiatric and psychotherapy services changed in 2013 and although that was years ago many psychiatrists, psychiatric nurse practitioners (NPs), and psychiatric physician assistants (PAs) are still adjusting to the change. This guide will answer questions about how to code for behavioral health services including: initial evaluations, re-evaluations, medication management, and psychotherapy.

Behavioral Counseling for Obesity, HCPCS Code G0447

G0447 face-to-face behavioral counseling for obesity, 15 minutes G0473 Face-to-face behavioral counseling for obesity, group (2-10) 30 minutes Medicare pays for ongoing face-to-face behavioral counseling for patients with a body mass index (BMI) of ≥ 30, who are alert and able to participate in counseling. The service may be performed by a physician or non-physician […]

Coding Guide – Minor Surgical Procedures

This guide includes definitions of minor procedures used frequently in primary care and urgent care. And, even more important, instructions for billing the services. No minor procedure guide would be complete without a discussion of modifier 25. It is also the reference for CodingIntel’s minor procedures webinar which you can watch here.

Emergency Department Visits

Definition Emergency department (ED) services are E/M services provided to patients in the Emergency Department. Explanation These services may be billed by any specialty physician, not just Emergency Department physicians. The physician does not need to be assigned to the ED. However, these codes may only be used in a hospital-based facility that is available […]

Advance Care Planning | CPT® 99497, 99498

Advance Care Planning (ACP) 99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; first 30 minutes, face- to-face with the patient, family member(s) and/or surrogate); +99498              each […]

Exam | Documentation Guidelines for E/M Services

ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong….) However, we will still need to use them when auditing notes from before 2023. This article does not apply to services performed after 1-1-2023. Definition Exam is one of the three key components (history, exam and medical decision making) of Evaluation and Management Services. […]

Using Time to Select a Level of E/M Service

ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong….) However we will still need to use them when auditing notes from before 2023.  This article does not apply to services performed after 1-1-2023. Remember, don’t use the information in this article for current services. Use these rules when billing for codes that use […]

Diagnosis Coding | Not Just for Claims Anymore

Physician claims are paid based on the fee schedule associated with the CPT® or HCPCS code that is submitted. Diagnosis coding can be a reason for a denial.  Physicians use CPT® or HCPCS codes to tell the payer what was done (colonoscopy, office visit) and modifiers to describe special circumstances (assistant at surgery, bilateral procedure.) […]

Diabetes Coding in Hierarchical Condition Coding (HCC)

Diabetes is a common chronic condition, included in three distinct HCC categories Patients often have more than one chronic condition of the disease; page down for a Q&A related to how multiple conditions do–and don’t–affect the risk score CodingIntel members can download our guide to Risk adjusted diagnosis coding for medical practices for more explanation and […]

Depression Coding and Hierarchical Condition Coding (HCC)

Introduction | Depression coding in HCC In fee-for-service medicine: Diagnosis coding establishes the medical necessity for a service. At times, it may be the reason for a denial, particularly for diagnostic tests or procedures.  Services with national or local coverage policies often have specific diagnosis codes that are required for payment. In risk based contracts […]

HCC Coding: Round Up of Chronic Conditions

I saw on twitter recently that COPD was the third leading cause of death in the U.S. If it was on twitter, it must be true, right? This article will describe risk coding for a few common, chronic illnesses. There are articles about depression, diabetes, compliance and other topics also on the site.  This article […]

Don’t forget Care Plan Oversight

There are two sets of codes for care plan oversight, CPT (99374–99380) and HCPCS codes (G0181, G0182). The requirements for each are different, including time thresholds and what activities may be included in the CPO time. Be sure to download the Care Plan Oversight quick reference sheet below.

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In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.

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