Download Guide Guide updated Sept. 2025 This guide addresses CPT® coding for maternity care services. It covers coding for professional services performed by physicians and other qualified health care professionals including Certified Nurse Midwives in obstetrics, family medicine, and maternal-fetal medicine. It describes how to code for global maternity care, antepartum care only, delivery services […]
Can I Get Paid For…Removal of Sutures or Staples
For a code that reimburses at about $10, can you even remember how many times you’ve been asked that question? How do I bill for suture removal again? The answer to the second question is that there are three CPT® codes for removal of sutures or staples. Back to list
Coding for Telehealth
New telehealth codes for 2025 have an invalid status indicator from Medicare See the telemedicine section of CPT Coding Changes for 2025 for details. CPT® telephone codes 99441–99443 are deleted in the 2025 CPT book. Included in this article: Telehealth Update – March 19, 2025 Place of Service update from MLN Matters CPT® changes in […]
Performing Services that Increase Primary Care Revenue
Wellness Visits and Problem Visits at the Same Encounter Transitional Care Management Chronic Care Management Advance Care Planning HCPCS codes with low RVUs Advanced Primary Care Management Services | G0556, G0557, G0558 Post-operative Care Services Add-on Code | +G0559 CMS states it wants to increase pay to primary care physicians. And while we might quarrel […]
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 […]
CMS Adopts Codes for Caregiver Training Services (CTS)
This is information from the 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023. You can read it for yourself by downloading the pdf below. 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023 MLN Matters article Jan. 2024 – PDF These are not on the telehealth list; they are in person services […]
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 […]
Anticoagulation Management
There are a few remarkable things about coding for anticoagulation management services. First, payment for these services bolsters Medicare’s support for primary care. This monitoring is typically done by either primary care or cardiology and was considered part of the pre-and post-work for an office visit. Although there were CPT® codes for anticoagulation management prior […]
Behavioral Health and Telemedicine
In this post Overview of behavioral health services via telemedicine during the PHE Overview of behavioral health services after the PHE The Omnibus spending bill passed at the end of Dec. 2022 extended telehealth flexibilities for two years after the end of the PHE. The final MPFS 2025 extends the delay for the -in-person visit […]
Diagnosis Coding for Antepartum Care
Question: Patient seen for antepartum care but delivered at 38 weeks at a different hospital/physician group. What diagnosis codes should we use for the visits before the birth episode. Answer: The diagnosis coding for antepartum care would be specific to the patient’s condition at the time care was provided. If at the time of the […]
Diagnosis Coding for Intentional Self-Harm
Another discussion of codes that use placeholder xxxA (or xxx with another 7th character) One of the most searched terms on CodingIntel is xxxA. Experienced diagnosis coders recognize the placeholder digits “xxx” and the 7th character extender A. When we pulled the list of ICD-10-CM codes that have xxxA in them, nine related to self-harm […]
RHC and FQHC Update
Background Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) have specific rules related to coding for service in their clinics. Both submit claims on a UB claim form that shows a revenue code and also includes the specific HCPCS/CPT® codes that were performed. RHCs (generally) are paid an all-inclusive rate for services done […]
Diagnosis coding for a fall (or other injury)
More discussion of codes that use placeholder xxxA (or xxx with another 7th character). When a patient presents for an injury after a fall, practitioners may be tempted to search for the word “fall” and select the first diagnosis that they find. Perhaps, they find the code W06.xxxA “fall from a bed” or even W19.xxxA […]
Community Health Integration (CHI) Services
This article includes information primarily from the 2024 Physician Fee Schedule Final Rule, but also the 2025 OPPS Fee Schedule in order to address billing when performed at an hospital outpatient department. The effective date for the CPT® and HCPCS codes, and CMS policy was 1-1-2024. Practitioner (physician/NPP) identifies Social Determinants of Health (SDoH) needs […]
CMS Implemented G2211 in 2024
CMS releases G2211 FAQ: Finally! Eight months after implementing G2211 CMS has released a FAQ document answering questions they’ve received via email and during Open Door Forums. The link is below. Some of the document reiterates information from the Federal Register and MLN Matters article, and some is new. G2211 Visit complexity inherent to evaluation […]
“xxxA” – ICD-10-CM Placeholder Code X and 7th Character Extension
Recently, while reviewing terms people use to find CodingIntel I was surprised to find that people were searching for “xxxA.” At first, I was afraid searchers were looking for a different kind of site….or sight. But searchers were looking for information about placeholder code X and 7th character extension A. These are typically used on […]
Consultation Codes
First, CMS stopped recognizing consult codes in 2010. Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) were 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 are deleted. These two low level consult codes were rarely used. […]
Coding for Observation Services
CPT codes for observation services Beginning January 1, 2023 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, those were deleted. Use 99221–99223 for initial inpatient or observation care services and use 99231–99233 for inpatient […]
Codes for Visits in Assisted Living
Question: In 2023, how will we code for visits in assisted living? Answer: January 1st 2023, the codes for boarding home, rest home and domiciliary care are gone from the CPT® book. What are the codes for visits in assisted living in 2023 and beyond? Home and residence services (99341—99345 for new patients) and (99347—99350 […]
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 […]
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