Demographics and diagnoses Risk adjusted diagnosis coding is a model used to predict future health care costs based on demographics and diagnoses. It is most commonly used by Medicare to set rates for patients who are in Medicare Advantage plans. A Medicare Advantage plan is paid different amounts for the Medicare patients they cover. The […]
Archives for August 2018
Critical Care Services Rule | Two Physicians Billing for Same Time Period
Question: Where does it say in CPT® that two physicians can’t bill for the same period of time when performing critical care? Answer: It doesn’t. This is a Medicare rule. There are two significant differences in critical care coding rules between CPT® and CMS. (Wouldn’t our lives be easier if they were the same?) The […]
Fee-for-Service Medicine | The Rumors of My Death Have Been Greatly Exaggerated!
Let me start with apologies for stealing Mark Twain’s words!  And, a quick search will show I’m not the only one to apply these words to fee-for-service medicine. Be sure to take a look at Five urban legends about risk-adjusted diagnosis coding after reading this post. Volume to value For years, we’ve been reading about […]
Intensive Behavioral Counseling for Cardiovascular Disease, HCPCS Code G0446
Medicare pays a primary care physician or other primary care practitioner in a primary care setting to annually provide one face-to-face behavioral counseling session for cardiovascular disease. Although CMS has developed a HCPCS code specifically for this service, many primary care clinicians perform this service as part of an E/M service or a wellness visit. […]