This reference is the companion resource for the webinar I presented in June with Edwin Knights, M.D., Improving the accuracy of your diagnosis risk scores. Members login to watch the webinar on-demand. Not a member? Learn how you can access the webinar. The handout includes: A quick comparison of fee-for-service vs. risk-adjusted diagnosis coding Explanation of risk […]
Archives for June 2018
Are Subsequent Hospital or Office Visits Prior to Surgery Billable?
Question: Are the surgeon’s subsequent hospital visits or office visits between their original consult and the final visit prior to surgery billable? This is not referring to a pre-op H&P or an extra visit to answer more questions from the patient and family members after the decision for surgery. Here’s the scenario. A surgeon evaluates a […]
Coding for Minor Surgical Procedures | Webinar
Recorded June 19, 2018 The handout for this webinar has been updated with RVUs for 2019. For more about minor procedures, watch Coding for Skin Procedures in Dermatology, Family Practice, and Urgent Care, available on demand. Medical practitioners often find it easier to do a minor procedure than to select the right code for a minor procedure. […]
Emergency Department Visits
Definition Emergency department (ED) services are E/M services provided to patients in the Emergency Department. Explanation These services may be billed by any specialty physician, not just Emergency Department physicians. The physician does not need to be assigned to the ED. However, these codes may only be used in a hospital-based facility that is available […]
Advance Care Planning | CPT® 99497, 99498
Advance Care Planning CPT® Codes Overview Medical practices perform countless tasks every day for which there is no payment. CMS continually states that it wants to support non-procedural and in the past decade has added payment for some non-face-to-face services, including Care Plan Oversight, Transitional Care Management and Chronic Care Management. CPT® Codes 99497 & […]
Exam | Documentation Guidelines for E/M Services
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 Exam is one of the three key components (history, exam and medical decision making) of Evaluation and Management Services. […]
Time Based Rules | Behavioral Health Services
Psychiatrists, psychiatric NPs and psychiatric PAs provide medication management using E/M codes and psychotherapy services. There are specific rules for performing both on a calendar day. Be sure to review the behavioral health coding guide for more specific information. When a CPT® code is defined by time, the clinician must document time in the medical […]
Using Time to Select a Level of E/M Service
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. Remember, don’t use the information in this article for current services. Use these rules when billing for codes that use […]
Diagnosis Coding | Not Just for Claims Anymore
Physician claims are paid based on the fee schedule associated with the CPT® or HCPCS code that is submitted. Diagnosis coding can be a reason for a denial. Physicians use CPT® or HCPCS codes to tell the payer what was done (colonoscopy, office visit) and modifiers to describe special circumstances (assistant at surgery, bilateral procedure.) […]