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.
Billing Physician Services for Hospice Patients | Reference Sheet
Medical practices find the hospice modifiers confusing, and confusion leads to denials and payment delays. Use the decision trees below to help you determine if the service is separately billable once a patient has elected hospice and if so, how to bill it.
Dear Resident, Do you Understand Relative Value Units (RVUs)?
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 […]
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