ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong….) However, we will still need to use them when auditing notes from before 2023. This article does not apply to services performed after 1-1-2023. Definition Medical decision making (MDM) is one of the three key components of evaluation and management services. (Make sure you read about […]
Archives for November 2016
Global Surgical Package: An Overview
Need a quick summary of the global surgical package and frequently used modifiers? This article from CodingIntel will ensure that your medical practice gets paid correctly for services that are performed. This article includes Definition of the global surgical package Explanation of global surgery billing Explanation of “separate procedure” Global surgery billing and coding rules […]
Modifier 24
Understanding E/M modifiers is important for both revenue and compliance. Failing to apply the correct modifier reduces revenue. Applying the wrong modifier or using it when it is not accurate is a compliance issue and puts the practice at risk for payback and disclosures. For additional information, see the article on Global Surgical Package. Modifier […]
Moderate or High MDM – General Surgery
ARCHIVE The 1995/1997 Documentation Guidelines are gone beginning 1-1-2023. (Ding dong….) However, we will still need to use them when auditing notes from before 2023. This article does not apply to services performed after 1-1-2023. Examples of Moderate MDM: Codes: Consult, 99244, Initial hospital 99222, Initial OBS 99219, 99235, ED 99284 Patient presents with a […]
Coding Guide – Global Surgery
This guide from CodingIntel explains surgery coding guidelines and the global period for procedures, and includes the contents of our original CPT® and HCPCS Modifier Guide.
Billing Admission and Subsequent Visits for Patient Having Surgery
What if I admit a patient and don’t take the patient immediately to surgery? Can I bill for the admission and subsequent visits if the patient goes to surgery later in the week? In this case, it depends on when you admit the patient and when the final decision for surgery is made. A major […]
Teaching Physician Rules and Surgical Procedures
The teaching physician rules describe a payment method by which Medicare pays an attending physician or teaching physician for services performed jointly with an intern, resident, or fellow, in an approved graduate medical education program (GME). The teaching physician’s presence and participation is required. The rules regarding participation and documentation vary by the type of […]
Teaching Physician Rules – Use Modifier GC
Coding. Why does it keep changing? The information you are looking for has moved. Please see the following resources for up-to-date information on the new teaching physician rules and modifier GC: Teaching Physician Rules-Surgical Procedures Teaching Physician Rules – Evaluation and Management Services Revised, Betsy Nicoletti 5/4/19
Laceration Repair
Wound repair is classified as Simple, Intermediate or Complex Simple: 12001—12021 Intermediate: 12031—12057 Complex: 13100–13160 Simple repair: Use when the wound to superficial involving primarily epidermis, dermis or subcutaneous tissue Simple one layer closure Includes local anesthesia, and chemical or electro cauterization of wants not closed Download the minor surgical services billing guide for RVU […]
Three Key Components of E/M Services
There are three key components to evaluation and management services. History, Exam and Medical decision making. Each component has specific rules and documentation requirements. This downloadable article includes definitions, codes, billing guidelines, helpful reference charts and more for each of the three components. COURSE E/M auditing in depth is one of three courses offered by CodingIntel. […]
Reporting Screening Colonoscopy
What is the difference between a screening and diagnostic colonoscopy, and how are they coded? What if a screening colonoscopy was scheduled, but a diagnostic or therapeutic colonoscopy was performed? What you need to know about reporting for colonoscopy procedures in about 10 minutes. See also: Diagnosis coding for screening colonoscopy Procedure Coding for Colonoscopies […]
Why You Shouldn’t Automatically Bill an E/M with Every Procedure
Should you bill just a procedure? Or an E/M service with it? Medicare provides a breakdown by CPT® code of the pre-evaluation, pre-operative, intraoperative, and post-operative times included in each code. Find out more in this 5 minute video. After watching, check out this article for additional information. And download the time file referred to […]
Certification for Home Health Services
There are two HCPCS codes that physician, nurse practitioners, clinical nurse specialists and physician assistants can use to report developing a plan for a Medicare patient who requires home health services. The CARES Act passed in March 2020 permanently allows nurse practitioners, clinical nurse specialists and physician assistants to certify and re-certify Medicare covered home […]
Not all Unspecified Codes are Created Equal
What kind of unspecified codes can a practice still use? Which ones need to be avoided? Quick, five minute guidance in this video about unspecified codes in ICD-10. Relevant Search Terms:diagnosis codes, NCD, LCD, procedures, labs, diagnostic testing
Quick Coding Reference Sheet – General Surgery
This quick reference sheet is packed with useful information. It covers consults, initial and subsequent hospital visits, and observation. Specifically for general surgery, it includes: CPT® codes for each of the above categories, documentation requirements, MDM examples, and more…
Critical Care
Critical care has high relative value units and payments so it’s important to know the coding rules. This video describes when and how to bill for critical care services including: the components of critical care, what can be included in the time of critical care and what can’t be included, and the time thresholds for […]
Excision of Soft Tissue, Lipoma Removal
This chart is a quick reference for soft tissue excision. It includes anatomic location and size for subcutaneous and subfacial excisions.
Excision of Benign or Malignant Lesions
This article reviews codes and guidelines for excision of skin lesions. For more information about minor procedures, see additional resources at the bottom of this page. This article includes: CPT® Codes for Excision Excision of Benign Lesions Excision of Malignant Lesions Excision of Soft Tumors Reporting Excision of Multiple Lesions of the Same Size Coding […]
Secrets of the Medicare Fee Schedule
The Medicare Fee Schedule is much more than Relative Value Units! It is the source of global days and status indicators. It tells if a service can be paid bilaterally, if an assistant at surgery is allowed and the break down of the professional and technical component for tests. What you need to know about […]
Explaining E/M Modifiers: 24, 25, 57
These evaluation and management modifiers indicate to a payer that the service provided was not part of the global surgical package. What are the criteria for using these modifiers? This video covers what you need to know about modifiers 24, 25 and 57 in about 15 minutes… Members can also download the modifier 25 audit […]
Billing for New Patients, Established Patients and Consults
Select the correct category of code: should it be a new patient, an established patient or a consult? This video includes CPT® and Medicare definitions, insurance considerations and documentation guidelines for each…