CodingIntel has a more complete article about modifiers 93 and 95, so be sure to read that. This is a brief Q&A, and doesn’t contain all you need to know. Modifier 95, 93: Telemedicine Question: In 2022, the question was, “should we begin using the new CPT® modifier -93?” Now, the question is, when should […]
How Old is Your Oldest CPT® Book
My, how CPT® has grown Thank you to everyone who completed our mission critical survey: how old is your oldest CPT® book and how many pages is it? Page down: a summary chart is below. First, some of you save everything. I’d love to see your office shelves. There are coders out there who have […]
Why Not Bill All 99213 Visits in an FQHC?
Why not bill all 99213 visits in an FQHC? (Hint: it’s a good way of telling everyone that they were pretty easy visits.) Practitioners who work in Federally Qualified Health Centers (FQHCs) can get in the habit of billing all level three office visits, understanding that an FQHC is paid under the Prospective Payment System […]
Can We Bill a New Patient Visit for Preventive and E/M Services on the Same Day?
See our on-demand webinar, Preventive medicine and Medicare wellness visits with an E/M. Question: Our physician saw a patient and did a preventive medicine service and addressed an acute, significant problem. The patient was new to us. Should we bill both as new patient visits? Answer: The last time I saw this addressed by CPT® […]
Medicare “Audio-Only” Telehealth Services
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/11/2025 CMS issued multiple waivers and two interim final rules to support health care organizations and patients during the public health emergency in spring 2020 Medicare […]
Coding Telehealth Visits: Place of Service
**Just a reminder, as of Jan 1, 2025 telehealth for Medicare is extended until March 31, 2025. Congress needs to act by then. Coding telehealth visits changes faster than the weather here in New England. The resources on the site relate to Medicare policy and CPT codes and rules. Unfortunately, they don’t address individual commercial […]
Specimen Collection For COVID-19
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY CMS’s 4/30/2020 rule states that practices could bill 99211 for new or established patients during the public health emergency for COVID-19 specimen collection CPT had previously recommended this The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection […]
Telecoding for Telemedicine
Some coders were already working from home either full time or a few days a week. Many practices and health care facilities implemented remote coding prior to the public health emergency. Now, more of you are. I call it: Telecoding for Telemedicine When we look back on this period, on our personal and professional lives, […]
Why and When to Use Modifier CS
Question: Why and when should we use modifier CS? Answer: Use modifier CS on visits related to testing for COVID-19. Modifier CS: cost sharing waiver for COVID-19 testing When you do, Medicare and private insurers will pay 100% of the claim, without any patient due cost sharing. The two laws that were passed require Medicare […]
Modifier CS: Cost Sharing for COVID-19 Testing and Visits Related to Testing
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Effective retroactively to 3/18/20, there is no cost sharing allowed for COVID-19 testing or for the evaluation visits related to the testing Medicare instructs us to use modifier CS on the visits and tests, and to contact your […]
Payment for Telephone Calls During the PHE: CMS Rules for Phone Calls
Telephone codes 99441–99443 were deleted from the 2025 CPT book. This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/17/2025 CMS rules for phone calls has changed during the course of the pandemic. Prior to […]
Lesion Destruction Tip Sheet
CPT® does not make it easy to locate codes for destruction of lesion(s). These codes are found in multiple chapters throughout the CPT® book, and are classified by a variety of factors (size, method of destruction, type (pre-malignant/malignant/benign), etc.) Accurate coding is essential to accurate payment. This tip sheet was created to help you quickly locate the correct CPT® code for lesion destruction.
CMS Update on Medical Record Documentation for E/M Services
The world as we knew it Both the 1995 and 1997 evaluation and management (E/M) documentation guidelines stated that ancillary staff could record a review of systems (ROS), and past medical, family, and social history (PFSH) in a patient record. The billing physician/NP/PA needed to document that that information had been reviewed and verified. Only […]
Non-Physician Practitioners in Nursing Facilities
Members can read more about nursing facility services here, and in Everyday Coding. Question: Can a physician assistant see patients in a nursing facility without a physician signing each encounter? How do we bill this? Can we do wellness visits in a nursing facility? Answer: A physician assistant or an advanced practice registered nurse may see […]
New Versus established Patient Visits
There are other articles on CodingIntel about the difference between new and established patients, and the rules haven’t changed, but that doesn’t mean it is always clear. Medicare definition “Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) […]
Counting Conditions in the HPI and Assessment
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. Question: When counting the chronic conditions for the history of the present illness (HPI) can the status of the condition […]
Drug Therapy Requiring Intensive Monitoring for Toxicity
Question: When auditing MDM, is there a list of drugs that are considered “drug therapy requiring intensive monitoring for toxicity?” Answer: Not from the AMA. Here’s the definition: “Drug therapy requiring intensive monitoring for toxicity: A drug that requires intensive monitoring is a therapeutic agent that has the potential to cause serious morbidity or death. […]
What is an Interval History?
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. Question: What does it mean when it says a code requires an “interval” history? This question related to the 1995/1997 […]
Initial Hospital Service Codes and Established Patients
Question: We are having a disagreement in our coding department. Our cardiologist sees an inpatient at the hospital, but it’s a patient she knows from the office. Should she bill an initial hospital service code or a subsequent hospital service code when she sees this patient, who she knows and has seen many times? Answer: […]
Diagnosis Coding for Biopsy Sent for Pathology
Question: What diagnosis code should you use when sending a skin biopsy to pathology? a) D48.5 Neoplasm of uncertain behavior of skin, or b) D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin Answer: The answer is b! Use an unspecified code when a specific diagnosis code is not known at the […]
Five Urban Legends About Risk-Adjusted Diagnosis Coding
Originally published on kevinmd.com When I talk to medical practices about Hierarchical Condition Category (HCCs) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends. Let’s separate fact from fiction. Don’t miss our Billing Guide on Risk-adjusted Diagnosis Coding for an in-depth look at this topic. Urban […]