CPT® codes for patients at home in a residence: New patient: 99341, 99342, 99344, 99345 Established patient: 99347−99350 These codes are used to report services in a patient’s home or in a residence. “Home may be defined as a private residence, temporary lodging, or short -term accommodation (eg, hotel, campground, hostel, or cruise ship).” These […]
E/M Services
For many practices, E/M services are what you do the most. Knowing what type of service to bill, what level of service and the rules related to the visit will decrease denials and payment delays. Here you'll find an overview, MDM and rule changes, resources organized just like your CPT book, and a bonus section with E/M frequency data.
E/M Frequency Data for Infectious Disease, Pulmonary Medicine and Cardiology
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Infectious disease, pulmonary medicine and cardiology are all specialties with active inpatient services, and of course, busy office services. That’s why I’ve elected to show them together. The data below is from 2024, released in late 2025. Office services […]
E/M Frequency Data for Psychiatrists
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. This is the data for psychiatrists. The data below is from 2024 released in late 2025. Office services Psychiatry New OV 2024 99202 0.74% 99203 8.05% 99204 38.58% 99205 52.63% Established office visits 2024 99211 0.73% 99212 4.33% 99213 […]
E/M Frequency Data for Surgical Specialties
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Unfortunately, there aren’t specialty designations for breast, bariatrics, or trauma surgery, and those surgeons are usually enrolled using the category for general surgery. There are specialty designations for vascular surgery, plastic surgery, thoracic, and surgical oncology. The data below […]
E/M Frequency Data for Dermatology
For dermatologists, revenue in the office is generated by procedures and office visits. Often, both are provided on the same day. See the dermatology section of our specialty page for articles about the use of modifiers 25, 51, and 59. Frequency distribution for new and established patients 2024 E/M data released at the end of […]
Critical Care for General Surgery and Trauma Surgeons
Critical care provided as a stand-alone service is based on the seriousness of the patient, the types of intervention, and time spent in direct patient care. Critical care provided by a surgeon to a patient in a global period for procedures with a 10- or 90-day global period, must also follow the rules for critical […]
Clinical Staff Time
Question: : If a nurse helps with ROS, medication reconciliation, etc., would their time (if documented) be able to be included in the time for the visit?
Coding for Observation Services
CPT® Codes for Observation Services There are two sets of codes used for both inpatient status and observation level of care. Coding for observation services no longer has a distinct set of CPT® codes as those were deleted. The “observation care code” applies to Hospital Inpatient or Observation Care Services Codes: 99221–99223 for initial inpatient […]
Consultation Codes
CMS stopped recognizing consult codes in 2010. Outpatient consultations (99242—99245) and inpatient consultations (99252—99255) are still active CPT® codes, and depending on where you are in the country, are recognized by a payer two, or many payers. In 2023, codes 99241 and 99251 were deleted. These two low level consult codes were rarely used. There […]
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 or CMS. Some MACs or third parties may have lists. Here’s the definition:
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 […]
E/M Office Visit Scenarios
It can be difficult to translate the E/M rules into patient scenarios that ring true and are applicable to every day clinical encounters. The guidelines seem great in theory, but how does a clinician, coder, or auditor apply them to select the correct level of service? Here are examples based on MDM, not time, that […]
When to Use Time to Select an E/M Service
Selecting a code for an E/M service can be based on time or medical decision making (MDM) (except ED visits which must be selected based on MDM) Time includes all time spent by the billing practitioner on the date of service, not just face-to-face time, and counseling does not need to dominate the visit, as […]
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.
Crediting Independent Interpretation
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 […]
Anatomy of an Audit™: Risk of Patient Management | Webinar
Recorded September 11th, 2025
1 CEU expires 9/30/26
Guest presenters Pam D’Apuzzo and Debra Rossi of VMG Health
The risk of additional diagnostic testing and management is distinct from the risk of the condition itself. Risk also includes the decision to forgo treatment, but what is the best way to document that?
Anatomy of an Audit™: Amount and Complexity of Data | Webinar
Recorded July 10th, 2025
1 CEU expires 7/30/26
Guest presenters Pam D’Apuzzo and Debra Rossi of VMG Health
Crediting data elements and explaining rules about crediting data elements is complicated. Pam and Deb will describe these and optimal documentation practices, including practical, citation-based advice and recommendations for auditors.
Anatomy of an Audit™: Complexity of Problem Addressed | Webinar
Recorded May 22nd, 2025
1 CEU expires 5/30/26
Guest presenters Pam D’Apuzzo and Debra Rossi of VMG Health
Combining CPT® guidance and audit experience, this session addresses definitions and documentation for the first element of medical decision making, the number and complexity of problems addressed. It includes guidance for all problem levels in the E/M grid.
Coding and Auditing Critical Care Notes | Webinar
Recorded May 8th, 2025
1 CEU expires 5/30/26
This webinar will review CPT® guidance for reporting critical care, including the condition of the patient, the interventions, and time spent. The webinar will discuss what services may be reported separately from critical care.
The Ins and Outs of Assessing RISK within the MDM Component | Webinar
Recorded April 24, 2025
1 CEU expires 4/30/26
Guest presenter Seth Canterbury
When the method for selecting the level of E/M services was changed for 2021 (office visits) and 2023 (other visits), the concept of “risk” underwent significant revision. No longer was this concept confined to just one element/subcomponent of MDM.
Transferring a Sick Baby to Another Hospital
Question: Our pediatric group practices in a community hospital, without an NICU. My pediatrician was called to attend a delivery of a newborn who was born premature and in respiratory distress. The baby needed to be stabilized and transferred to a level III neonatal intensive-care unit. The pediatrician spent 90 minutes from the time the […]