Measuring physician productivity with work RVUs: News flash! Physicians are more interested in medicine than coding. No doctor undertook the rigors of medical school in order to be an expert coder. But, when residency ends, some physicians will find themselves looking at employment contracts in which their compensation will be determined in part by productivity. […]
Risk Coding for Medical Practices and Outpatient Services
Introduction to Risk Coding for Medical Practices and Outpatient Services Recorded May, 2022 You can find CodingIntel’s 2023 webinar at this link: https://codingintel.com/hcc-coding-changes-webinar/ Where do we find the rules for assigning diagnosis codes in medical practices? The diagnosis codes don’t just get the claim paid, they also determine the patient’s risk score and the risk […]
Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices
Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24 page guide from CodingIntel is an introduction to risk adjustment coding and the risk adjustment factor (RAF).
Coding Guide – Care Management Services
CMS has a stated goal of recognizing management services provided outside of an office visit. In particular, valuing and paying for care management and other non-face-to-face services. Sometimes, this means recognizing existing CPT® codes, and changing the status indicator from bundled to active, so that it is a covered service. Sometimes, it means working with CPT®’s chronic care management committee to develop new codes that describe management services.
CPT® Code 99483: Cognitive Assessment and Care Plan Services
Developed in 2018, this service describes an in-depth assessment and development of care plan services for new or established patients who have signs of cognitive impairment. Notice that the use of this code requires an independent historian, stated right in the CPT description. Cognitive assessment checklist Definition of CPT® code 99483 99483: Assessment of and […]
Selecting CPT® Rules for Excision of Skin Lesions
Many medical practices perform skin procedures. A patient may see a dermatologist, a family physician or a surgeon when the time comes to find out, “What’s this thing growing on my arm?” This article discusses excision of benign and malignant lesions. Shaves, biopsies, and destruction of lesions are covered in other articles. Per CPT, excision […]
What’s the Difference Between B20 and Z21? Which is Right for Positive HIV Status?
In this post ICD-10-CM diagnosis coding for positive HIV status Update to HIV coding in 2022 Medical practice reimbursement for individual claims based on CPT® Risk adjusted factor for coding medical claims HCC Model Common HIV diagnosis codes ICD-10 general guidelines Question: For an HIV positive patient without symptoms, is the correct diagnosis code Z21 […]
History | 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 History is one of the three key components (history, exam, and medical decision making) of Evaluation and Management Services. […]
Documenting Exam | Evaluation and Management Services
Lunch and Learn Exam is the second key component of evaluation and management services. This short video discusses the requirements for documenting exam, including a review of the 1995 and 1997 Exam guidelines, and what you must document for high level visits. The printable companion resource will be a helpful reference sheet for providers, coders […]
Documenting History | Evaluation and Management Services
Lunch and Learn What does a clinician need to document in the history? Is it okay to say, “non-contributory”? What if the medical assistant takes the HPI and the physician or nurse practitioner notes that it was reviewed? This short video addresses the documentation guidelines for the History component of evaluation and management services including, […]
How to Get Paid for Services in Medical Practices: Three Quick Videos for New Clinicians and Staff
An Overview of CPT® Codes, HCPCS, Diagnosis Codes & ICD-10-CM This three-part series from CodingIntel is a must see for new staff and physicians, and is a helpful review for everyone. Includes modules on How Physician Services are Paid, and the basics of CPT® codes, HCPCS, diagnosis codes and ICD-10-CM. Part 1 – How Physician […]
Wound Care | CPT® Codes for Debridement
Health care organizations have started wound care clinics to care for patients with non-healing wounds and frequently use wound care debridement codes to report the services The care of a post-op wound is done by the surgeon in the global period, and is not separately paid, unless it is on-going and must be referred to […]
Quick Coding Reference Sheet – E/M Services
This quick reference coding guide to E/M services covers consults, initial and subsequent hospital visits, and observation. This essential resource from CodingIntel includes: CPT® E&M codes for each of the above categories, documentation requirements, MDM examples, and more.
Quick Coding Reference Sheet – Psychiatry
These quick reference sheets for evaluation and management services cover inpatient and outpatient consults, and inpatient and subsequent hospital services. Specifically for psychiatry, this essential resource includes: CPT® codes for each of the above categories, documentation requirements, MDM examples, and more…
Medical Decision Making | 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 Medical decision making (MDM) is one of the three key components of evaluation and management services. (Make sure you read about […]
Modifier 24
Understanding E/M modifiers is important for both revenue and compliance. Failing to apply the correct modifier reduces revenue. Applying the wrong modifier or using it when it is not accurate is a compliance issue and puts the practice at risk for payback and disclosures. For additional information, see the article on Global Surgical Package. Modifier […]
Moderate or High MDM – General Surgery
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. Examples of Moderate MDM: Codes: Consult, 99244, Initial hospital 99222, Initial OBS 99219, 99235, ED 99284 Patient presents with a […]
Coding Guide – Global Surgery
This guide from CodingIntel explains surgery coding guidelines and the global period for procedures, and includes the contents of our original CPT® and HCPCS Modifier Guide.
Coding Guide – Newborn and Pediatrics
Neonatologists, pediatricians and family physicians who care for newborns and sick children in the hospital need to select the category of code that describes the condition of the patient. There are distinct categories of codes to describe each of these situations. There are also codes that describe services to patients who are in the process of being transferred to a higher acuity facility. This guide describes the codes to use in each situation.
Billing Admission and Subsequent Visits for Patient Having Surgery
What if I admit a patient and don’t take the patient immediately to surgery? Can I bill for the admission and subsequent visits if the patient goes to surgery later in the week? In this case it depends on when you admit the patient and when you decide to take the patient to surgery. A […]
Teaching Physician Rules and Surgical Procedures
The teaching physician rules describe a payment method by which Medicare pays an attending physician or teaching physician for services performed jointly with an intern, resident, or fellow, in an approved graduate medical education program (GME). The teaching physician’s presence and participation is required. The rules regarding participation and documentation vary by the type of […]
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