Some of you have read my article on coding for screening colonoscopy. The questions I get about that article are all related to diagnosis coding. The … [Read more...]
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 … [Read more...]
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? … [Read more...]
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 … [Read more...]
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 … [Read more...]
Can Two Practices Split the Post-Op Office Care of a Patient?
Question: Can two practices split the post-op office care of a patient? Answer: No. Although the operative and post-operative portions of the … [Read more...]
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 … [Read more...]
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 … [Read more...]
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 … [Read more...]
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 … [Read more...]
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? … [Read more...]
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 … [Read more...]
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! Primary care practices and urgent care centers should pay … [Read more...]
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 … [Read more...]
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 … [Read more...]
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 … [Read more...]
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 … [Read more...]
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 … [Read more...]
Modifier 95, 93: Telemedicine
CPT has two modifiers for telemedicine. Modifier 95 was an existing modifier from before the public health emergency. They added modifier 93 for … [Read more...]
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 … [Read more...]
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 … [Read more...]