Question: Can you settle this question for our coding team? Are smoking and drinking considered Social Determinants of … [Read more...]
Coding Clinic Update, 2Q, 2023
Dr. Kennedy has generously allowed me to share his summary. He emphasizes that he is paraphrasing the recent advice in the spirit of “fair use” and we … [Read more...]
Compliance Issues in ICD-10 Coding for Risk Based Contracts and HCCs
Everyone loves to read the general guidelines at the front of the ICD-10 book, right? No? Well, here's an important excerpt. "Code all documented … [Read more...]
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 … [Read more...]
Removal of Sutures or Staples
There are three codes for removal of sutures or staples. How to bill for suture removal is a question that comes up frequently. And the answer to the … [Read more...]
Coding for Prolonged Services: CPT and HCPCS Codes
Common rules: Prolonged services codes are add-on codes to E/M services. In order to use prolonged care, the primary code must be selected … [Read more...]
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 … [Read more...]
Audit Tool for Modifier 25 | Reference Sheet
Download Reference Sheet Reasonable coders and practitioners can and do disagree about when a separate E/M service is warranted on the day of a … [Read more...]
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 … [Read more...]
Clinical Staff Time
Question: I believe that I know the answer to this question but am hoping you know the source, as I can't find it—if a nurse helps with ROS, … [Read more...]
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 … [Read more...]
2023 CPT® E/M Changes
Ready to learn about the 2023 CPT® E/M changes? There is a significant update to the Evaluation and Management (E/M) section of the CPT® book. There … [Read more...]
Payment Denials for Unspecified Codes
From the day coders got their first glimpse at ICD-10 codes, the question went out in the land: “Will payers deny unspecified codes?” Recently, a … [Read more...]
Behavioral Health Coding Compliance
Once again, with feeling: coding for behavioral health It's been a year (seems like a minute) since the OIG released a report on coding for … [Read more...]
Acute, Uncomplicated vs. Acute with Systemic Symptoms
Question: When using the E/M guidelines, is the problem an an acute, uncomplicated illness or an acute illness with systemic … [Read more...]
Does a Practitioner Need to Document Time for a Telehealth Visit?
Question: Does a practitioner need to document time for a telehealth visit? What if it is audio only? Answer: First: For a telehealth visit, … [Read more...]
Should We Begin Using the New CPT Modifier -93
Question: Should we begin using the new CPT® modifier -93? Answer: I recommend a wait and see approach. Here’s the definition from the AMA, … [Read more...]
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? … [Read more...]
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 … [Read more...]
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 … [Read more...]
Consultation Codes
First, CMS stopped recognizing consult codes in 2010. Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) were still … [Read more...]