Introduction | Depression coding in HCC In fee-for-service medicine: Diagnosis coding establishes the medical necessity for a service. At times, it may be the reason for a denial, particularly for diagnostic tests or procedures. Services with national or local coverage policies often have specific diagnosis codes that are required for payment. In V28 of HCC, […]
Archives for February 2026
HCC Coding for Medical Practices | Webinar
Recorded March 19th, 2026
1 CEU expires 3/30/27
Risk adjustment coding is a hot topic for Medicare Advantage Organizations and medical practices with risk-based contracts. It’s one of the pillars of payment for Value Based Care. At this webinar, participants will learn how Hierarchical Condition Categories work based on ICD-10-CM rules.
CPT® 99459 Guidelines
Nicoletti Notes August 2025 Published on August 28th, 2025 The July 2025 CPT® Assistant had a question about whether CPT® 99459 could be used on a male patient for an examination of external male genitalia and a digital rectal exam. CPT® said no. 99459 is intended to be used with a pelvic exam to cover “the additional supplies […]
Avoid These Coding Mistakes: A Guide for Accuracy and Compliance
Nicoletti Notes October 2025 Published on October 2nd, 2025 We’ve updated CodingIntel’s Telehealth article again. We’ll keep you up-to-date with the latest Medicare rules. Medical coding is a high-stakes discipline as accuracy affects reimbursement, compliance, and the overall health of the revenue cycle. Just as a reminder, here are three frequent mistakes to watch out for—and how […]
G0136: Out With the Old, in With the New
Nicoletti Notes November 2025 Published on November 18th, 2025 CMS is changing the definition of HCPCS code G0136. They are keeping the code and the valuation of the code. The code is staying on the telehealth list. But there is a completely new definition. Between now and 12/31/2025, G0136 is for an assessment of a patient […]
E/M MLN guide
Nicoletti Notes September 2025 Published on September 9th, 2025 CMS released an updated MLN guide for Evaluation and Management Services in July and removed it in August. I’ve saved a copy, however, and you can download it from CodingIntel’s site. (link below) What’s new in the guide? This is old news. Since 1-1-2025, a practice could […]
Three Compliance Tips Every Clinic Should Know
Nicoletti Notes December 2025 Published on December 16th, 2025 Coding and billing compliance are big subjects, and small errors can lead to big consequences. Whether you’re managing a clinic, overseeing billing operations, or leading a coding team, staying vigilant is key. Here are three essential tips to help your organization stay on track and avoid […]
Time Statements for E/M Visits: What Coders and Providers Need to Know
Nicoletti Notes January 2026 Published on January 13th, 2026 Time-based coding for Evaluation and Management (E/M) services can be a powerful tool, but only when used correctly. Incomplete or vague documentation of time can lead to denials, audits, and compliance issues. Here’s a breakdown of the best and worst practices when documenting time for E/M […]
TCM Frequency
Nicoletti Notes February 2026 Published February 10th, 2026 Transitional Care Management (99495, 99496) Family practice and internal medicine providers continue to ramp up their use of transitional care management (TCM) services. As background, the TCM services comprise two codes – the “at least moderate” level of medical decision-making (MDM) code 99495 and the “high MDM” […]
E/M Frequency Data for Psychiatrists
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. This is the data for psychiatrists. The data below is from 2024 released in late 2025. Office services Psychiatry New OV 2024 99202 0.74% 99203 8.05% 99204 38.58% 99205 52.63% Established office visits 2024 99211 0.73% 99212 4.33% 99213 […]
E/M Frequency Data for Infectious Disease, Pulmonary Medicine and Cardiology
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Infectious disease, pulmonary medicine and cardiology are all specialties with active inpatient services, and of course, busy office services. That’s why I’ve elected to show them together. The data below is from 2024, released in late 2025. Office services […]
E/M Frequency Data for Surgical Specialties
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Unfortunately, there aren’t specialty designations for breast, bariatrics, or trauma surgery, and those surgeons are usually enrolled using the category for general surgery. There are specialty designations for vascular surgery, plastic surgery, thoracic, and surgical oncology. The data below […]
E/M Frequency Data for Dermatology
For dermatologists, revenue in the office is generated by procedures and office visits. Often, both are provided on the same day. See the dermatology section of our specialty page for articles about the use of modifiers 25, 51, and 59. Frequency distribution for new and established patients 2024 E/M data released at the end of […]
Cerumen Removal
There are two codes for cerumen removal 69209 Removal impacted cerumen using irrigation/lavage, unilateral 69210 Removal impacted cerumen (separate procedure), 1 or both ears Key points Document the medical necessity for cerumen removal (patient’s complaints, diminished hearing, physical exam) Document the results: was the procedure successful? Whether it is a clinical staff member or practitioner […]
Removal of a Foreign Body
Integumentary 10120 Incision and removal of foreign body, subcutaneous tissues; simple 10121 Incision and removal of foreign body, subcutaneous tissues; complicated Note that incision is required. Musculoskeletal From Principles of CPT® Coding, “If fascia is penetrated and a foreign body to be removed is within the fascia, subfascia or muscle, use an anatomic-specific code in […]
Remote Physiologic Monitoring Treatment Management Services
The remote physiological monitoring section describes providing equipment and data collection, initial set up and education on the use of the equipment, and treatment management based on the data that was measured. The codes are confusing because they are sorted/divided in confusing ways. Codes 99453, 99445 and 99454 are for the initial set up and […]
Remote Therapeutic Monitoring
There are two sets of codes in the CPT® code set for Remote Therapeutic Monitoring (RTM). The first set is for the monitoring itself, and includes codes for initial set-up and patient education and for the device supply or data transmission. The second set of codes is for treatment management services based on the data […]
Diabetes Coding in Hierarchical Condition Coding (HCC)
Diabetes is a common chronic condition, included in three distinct HCC categories Patients often have more than one chronic condition of the disease; page down for a Q&A related to how multiple conditions do–and don’t–affect the risk score CodingIntel members can download our guide to Risk Adjusted Diagnosis Coding for Medical Practices for more explanation and […]
Compliance Issues in ICD-10 Coding for Risk Based Contracts and HCCs
How to be a great HCC coder? Know ICD-10-CM Official Guidelines for Coding and Reporting During an encounter: Code conditions assessed and managed. If treatment of an acute or chronic problem is affected by an ongoing condition, note that, and add the ongoing condition to the claim form. If the condition has a manifestation or […]
Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices
Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24 page guide from CodingIntel is an introduction to risk adjustment coding and the risk adjustment factor (RAF).
Lesion Destruction Tip Sheet
CPT® does not make it easy to locate codes for destruction of lesion(s). These codes are found in multiple chapters throughout the CPT® book, and are classified by a variety of factors (size, method of destruction, type (pre-malignant/malignant/benign), etc.) Accurate coding is essential to accurate payment. This tip sheet was created to help you quickly locate the correct CPT® code for lesion destruction.