Some of you have read CodingIntel’s article on coding for screening colonoscopy. The questions we get about that article are almost all related to diagnosis coding. The CPT®/HCPCS coding and the modifiers don’t raise many questions but clinicians, coders, and patients frequently ask about correct diagnosis coding and sequencing of those codes. We recently posed […]
HCC’s in Brief | The Difference Between CMS-HCC and HHS-HCC
Demographics and diagnoses Risk adjusted diagnosis coding is a model used to predict future health care costs based on demographics and diagnoses. It is most commonly used by Medicare to set rates for patients who are in Medicare Advantage plans. A Medicare Advantage plan is paid different amounts for the Medicare patients they cover. The […]
Are Start and Stop Times Required for Non Face-to-Face Prolonged Care Services?
Question: Regarding non face-to-face prolonged care, does Medicare require start and stop times, they way they do for prolonged face-to-face care? As long as the provider documents the total time spent reviewing old records is sufficient to bill this service, am I correct? (Codes 99358, 99359) Note, beginning 1/1/2023 these codes have an invalid status indicator […]
ICD-10 Coding for Suspected Cancer
Diagnosis coding for possible malignancy How would you feel if your primary care physician and your general surgeon told you-and told your insurance company on a claim form-that you had breast cancer, when you didn’t have breast cancer? You actually had atypical ductal hyperplasia, not breast cancer. Not only have they told you, the claim […]
Teaching Physician Rules | Bedside Procedures
Question: Can an attending bill for a bedside procedure that a resident did without the attending being present? If so, is this billed at 85% like a PA or NP? If a PA or NP is overseeing a bedside procedure that a resident is preforming how is this billed (no attending is present at the […]
Scoring MDM in an E/M Note
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: I have a question about scoring MDM in an E/M note. One of our coders thinks that if there […]
What Does the Decision to Perform a Minor Procedure Really Mean?
This article is updated with CPT’s March 2023 document, “Reporting CPT Modifier 25.” (citation at the end of the article) The CPT article adds specificity to what is included in typical pre and post work, which will make it more difficult to report both a procedure and an E/M service for some encounters. According to […]
Can you Screen for an Existing Condition? | Diagnosis Coding for Lab Services
Sometimes, the hardest thing about coding for preventive services isn’t the visit at all. It’s the labs. Patients come in for an annual physical and many times they believe that all of the lab work done that day or in preparation for that day will be covered as part of their preventive service. And we […]
Let’s Go to the Source! Should this Visit be Downcoded?
This article describes the use of time using the 1995/1997 guidelines. Be sure to read about the 2021 guidelines for codes 99202–99215. A physician asked me this question: “As an interventionalist, a good part of my visit is spent not only explaining patients’ conditions to them but discussing various diagnostic/therapeutic procedures, the risks and benefits […]
Can We Bill for IUD Removal and Insertion on the Same Day?
Question: Can I bill 58301 for IUD removal and bill 58300 for IUD insertion on the same day, if the provider removes and then inserts another IUD? And, can we bill an E/M with it? Answer: Yes, there is no CCI edit for those two codes. In years past, I heard that some payers denied […]
HCC Diagnosis Coding: Can you Add a Code from the Past Medical History?
This post describes rules for office/outpatient coding, not facility/DRG rules. Recently a fellow coder wrote to me about risk adjusted diagnosis coding. She was responding to an article that I wrote in which I stated the conditions listed in the past medical history should not be included on the claim form by the coder. I […]
Avoid These 4 Costly Errors When Coding Minor Surgical Procedures
Does your practice perform any minor or major procedures? If so, this post is for you! This post relates to the global package, and not to determining the risk of additional diagnostic testing or treatment in an E/M service. Primary care practices and urgent care centers should pay special attention to these issues and avoid […]
7 Sure Fire Ways to Owe the Government $4 million in Fines and Repayments | Coding Compliance
Most practices aren’t looking to pay the government any money in fines and repayment because of coding errors. Two recent OIG settlements described two practices that did just that. Most practices want to avoid this, of course, but some groups seem determined to achieve that outcome. In reviewing both of the settlements, there are some […]
Diagnosis Coding for Tick Bites
Question: Why is it so hard to have correct diagnosis coding for tick bites? And, how is it coded? Answer: The search function in electronic health records leads clinicians astray. And, diagnosis coding for tick bites requires two diagnosis codes, because it is an injury. It requires a code from the injury chapter in the […]
CPT® and CMS Rules for Critical Care | What’s the Difference?
CMS and CPT count critical care time differently. CMS issued a “technical correction” in the 2023 PFS Final Rule. They stated that it is their policy that add-on code 99292 can only be reported when critical care time is 104 minutes, not 74 minutes as stated in CPT®. CMS noted they stated this in the […]
Pessary Billing and Coding
Coding for Pessary Services Primary care practices, gynecology and urology practices often prescribe and provide pessaries. A pessary is used to treat pelvic organ prolapse and for urinary incontinence. It provides support for the vaginal walls or uterus. A physician or non-physician practitioner (NPP) must first see the patient, take a history, examine the patient […]
Billing for Multiple Surgical Procedures
When billing for multiple procedures on the same day, use this step by step procedure to determine if you should bill for more than one procedure, and if so, if you should use modifier 51 or modifier 59. It is critical to have access to National Correct Coding Initiative ((NCCI) edits in your software program. […]
Modifier 95, 93: Telemedicine
CPT® has two modifiers for telemedicine. CMS and private payers regularly change their instructions about using these modifiers and what place of service to use. As of 2024, CMS no longer requires modifier 95 on claims but rather hopes to capture modality plus place of service by use of either POS 02 or POS 10.[1] (POS […]
This Practice Paid Medicare $4.48 Million
Do you sign up for email lists and then wonder why you did it? We all do, don’t we? But, one email I always read is from the Department of Justice that links to a description of actions, settlements and indictments related to health care billing and coding A few years ago, an Orthopedic practice […]
Can I Get Paid for…My Nurse Doing Ear Lavage
The nurse flushed the patient’s ear so I could examine the TM. Free or Fee? Find out more about billing for ear lavage done by nursing staff in this brief video. Back to list Relevant Search Terms: 69209, 69210, cerumen, removal, irrigation,
Can I Get Paid for…Emergency Services in the Office
The patient called for an urgent visit that disrupted your regularly scheduled office hours. Can you get paid at a higher level for providing emergency services in the office? Back to list Relevant Search Terms: 99050, 99058, 99059, add on, codes