Question: Can a practitioner get credit for both ordering and interpretation of a test if documented? Can you address the change from 2023 related to this? Watch this brief video, or read on for the answer. Answer: In March of 2023, CPT® issued an “Errata and Technical Corrections” which added one line to the section […]
Behavioral Health Coding Compliance
Once again, with feeling: coding for behavioral health Coding for Behavioral Health Compliance lessons from the OIG Post-discharge Telephonic Follow-up Contacts Intervention | G0544 Digital Mental Health Treatment | G0552, G0553, G0554 Safety Planning Interventions | G0560 It’s been a year (seems like a minute) since the OIG released a report on coding for behavioral […]
Interprofessional Internet Consultations
CMS recognizes and pays for six codes for interprofessional consults codes 99446–99449, 99451, 99452 See also HCPCS codes developed in 2025 for behavioral interprofessional consults | G0546–G0551 These codes were updated in 2023. Codes 99446, 99447, 99448, 99449 and 99451 may now be performed by physicians and other qualified health care professionals. Because these codes […]
How Fees are Set in the Medicare Fee Schedule
How does Medicare set its fees? This is important for other payers because commercial payers often use the values set by Medicare to calculate their fees. This overview provides information and examples to explain how fees are set in the Medicare Fee Schedule. CodingIntel members can start with the brief video introduction and companion slides, […]
CMS Implemented G2211 in 2024
Table of Contents G2211 FAQ Changes to G2211 in 2025 (with video) Not all visits Clinician’s relationship with the patient, type of problem Acute condition, seen in primary care CMS expected frequency Q&A from CodingIntel’s August 17, 2023, CMS Proposed Rule Webinar Q&A from CodingIntel’s January 22nd, 2024, Reimbursement Reality Webinar CMS releases G2211 FAQ: […]
The Second Element of MDM: Amount and/or Complexity of Data
There are three elements in medical decision-making and this article describes the second, arguably, the most complex of the three elements When selecting a level of service based on medical decision-making two of the three elements are required CPT® has developed definitions for many of the components in the MDM chart. This article describes the definitions […]
Acute, Uncomplicated vs. Acute with Systemic Symptoms
Question: When using the E/M guidelines, is the problem an acute, uncomplicated illness or an acute illness with systemic symptoms? Answer: Let’s start with the CPT definitions, from the CPT® Professional edition. Acute, uncomplicated illness Acute illness with systemic symptoms From CPT®: A recent or new short-term problem with low risk of morbidity for which […]
CMS’s 2024 Shared or Split Services Policy: Document and Report Them Correctly
In 2024, CPT® expanded its definition of split/shared services, CMS updated their requirements. Neither CMS nor CPT made changes tot his policy for 2025. CPT® expanded its definition of split/shared services in 2024, stating that the substantive portion can be determined by the practitioner who spent more than 50% of the time, or who made […]
G0101 Pelvic and Breast Exam
Medicare developed two HCPCS codes for screening services for women, without definitive frequency time limits Both G0101 (screening breast and pelvic exam) and Q0091 (obtaining a screening pap smear) may be billed every two years for a low-risk patient and every year for high-risk patients These are not comprehensive preventive medicine services They may be […]
Risk: Roads not Taken
How is risk evaluated when selecting a level of E/M service? We know that the risk from additional diagnostic testing/procedures and management is one of the three elements that determines the level of service, when MDM is used. But, how about the risk from the condition itself? This short video (I always say they’re short […]
Incident To Services – Medicare
Medicare has specific rules for billing for nurse practitioners and physician assistants and other office staff incident to a physician services in an office. This article includes: Description, explanation and codes for incident-to services Billing and coding rules Brief video overview Enrollment of non-physician practitioners (NPPs) for incident-to billing See our Medicare Incident-to and Shared […]
What is the Risk of a Referral?
Question: What level of risk is assigned when a practitioner refers a patient to a physician in another specialty? Does the complexity of the problem (eg, melanoma) make a difference? Answer: Watch this brief video for the answer. You can also download the slides here.
OIG Report on Telehealth During the PHE
What? An OIG report without doom and gloom? Fire and brimstone? Slides In February, 2024 the OIG released an audit report of telehealth E/M services performed between March 2020 and November 2020. During this nine-month period practitioners submitted claims for 19 million E/M services. Before I talk about the report though, let me congratulate everyone […]
CPT® Codes (99421-99423) – and Payment for – Online Digital Evaluation and Management (E/M) Services
Or, as I call them: message, manage, message. There are CPT codes for online digital E/M services. CPT developed a set of CPT® codes for use by physicians, physician assistants and advanced practice nurse practitioners performing brief, online E/M services via a secure platform There are also CPT® codes for use by clinicians who do […]
How Physician Services are Paid – Overview
Have a new staff member or physician who needs a primer on “how physician services are paid?” This short video is a must see! Learn how all the piece come together, from CPT® and HCPCS, to diagnosis coding and Medicare rules. All in about 15 minutes…
HCC Coding: V24 versus V28
Medical practices are assessing the impact of the change in the HCC model from V24 to V28, a phased in change that begins in 2024. CMS pays Medicare Advantage (MA) plans using Hierarchical Condition Categories (HCCs), and many private payers and ACOs use the HCC model for risk adjustment. Briefly, Medicare pays MA plans more […]
HCPCS Code G0136 for Assessment Social Determinants of Health (SDoH)
HCPCS code G0136 for an assessment of patients a practitioner suspects may have difficulty with accessing treatment and following a treatment plan due to Social Determinants of Health (SDoH) CMS established a standalone code G0136 (a HCPCS code) for the assessment of SDoH. They define SDoH into broad groups: “economic stability, education access and quality, […]
Transitional Care Management
This article provides answers to frequently asked questions related to transitional care management services. It includes details about billing for TCM services including: When are CPT® 99495 & 99496 used? What are the requirements for TCM? Can We Code TCM and 99214 Together? Transitional care management for discharge Everyday Coding Q&A – Who needs to […]
Category of Code
Learn more about selecting Category of Code in Everyday Coding. This article provides definitions and tips for determining whether an office encounter is a new patient, established patient, or consult, and guidelines for reporting inpatient, observation, and emergency services. The quick reference chart and key points will help you to quickly and accurately select the […]
As Time Goes By
One of the complexities for medical practices is using time in CPT® coding. CPT® has long had a unit of time rule that a unit of time is met when the midpoint has passed. That is, you’ve reached an hour after 31 minutes. There are many CPT® codes that follow this mid-point time rule including […]
Office Visit Code Selection for Medication Management
At some visits, psychiatrists and psychiatric NPs and PAs provide only medication management, and at some visits, they manage prescriptions and perform psychotherapy at the same encounter. There are specific rules for office visit code selection for medication management done at the same encounter as psychotherapy. Watch the video below for an explanation about how […]