Question: I understand from your article about prolonged services in 2021 that CMS won’t pay for prolonged code 99417 and instead developed a HCPCS code for the service. (G2212) Do you have any recommendations about how to manage this in the office? Answer: Although in general, I believe most clinicians can code for most of […]
E/M Auditing Webinar: Using the Updated AMA Guidelines
Recorded June 16th, 2021
The AMA issued technical corrections related to the 2021 E/M guidelines for new and established office visit codes 99202—99215. The most significant changes were how data is credited and a clarification on minor and major procedures. During this webinar, we’ll audit three notes that include crediting data and procedure risk.
Office Visit Code Selection for Medication Management
Medication management performed by psychiatrists, psychiatric nurse practitioners and physician assistants is billed with Evaluation and Management codes. This could be any type of E/M service, a nursing facility service or home visit, but is most typically billed as an office/outpatient visit for an established patient, using codes 99212-99215. Members can download the medication management […]
HCC Diagnosis Coding Example: Diabetes, Hypertension, Chronic Kidney Disease
If a picture is worth 1000 words, what’s an example worth? An example can show in a glance what it takes paragraphs to write and explain. The one I’ve included in this article shows risk scores for a few common chronic conditions, coded two ways. One follows ICD-10 rules and results in a six-fold increase […]
How Medical Practice Services are Paid | Webinar
Recorded May 20, 2021
The coding and reimbursement system is anything but simple. This webinar will explain how services are paid in fee-for-service medicine, and the use of CPT codes, HCPCS codes, ICD-10-CM codes, bundling, and payer policies. It is a broad overview aimed at describing “who makes up these rules” and where to look for definitive, citation-based answers.
Coding for Behavioral Health Services by Psychologists, Social Workers and Therapists
Looking for a coding resource for behavioral health therapists? It’s here. This video was recorded before CMS added Marriage and Family Therapists and Mental Health Counselors to enroll in Medicare. These professions aren’t noted but the are updated on the slide. Therapists use CPT® codes to describe what services they perform and ICD-10 codes to […]
Defining Problems Using the E/M Guidelines
The first element of MDM is the number and complexity of problems addressed CodingIntel’s members-only webinars on auditing E/M services include poll questions, and looking at the poll results during our webinars, I think there is some confusion about the definition of problems. Some people selected self-limited problems for cases in which the patient had […]
Essential Documentation for Medication Management and Psychotherapy
When providing both medication management and psychotherapy, practitioners need to document the time spent in psychotherapy and describe the therapy. Beginning January of 2021, when billing an office visit, select the level of visit based on medical decision making, not time. If medication management is the only service performed on that date, the clinician can […]
Insights: Changes in Level of Service Using Office Visit Guidelines
The American Medical Association (AMA) changed the definitions for codes 99202–99215, effective 1/1/2021 Medical practices are struggling to accurately apply these new definitions to office visits There are significant shifts in the level of service calculated from 2020 to 2021 Both the AMA and CMS said that they didn’t anticipate that levels of service would […]
Office Visit Fees in 2021
2022 Conversion Factor – $34.6062 CMS released the updated conversion factor for 2021, and it is $34.89. This represents about a 7.7% increase from the conversion factor released in the final rule, but is still a decrease from 2020. The RVU values for office and outpatient codes 99202—99215 were changed from 2020 to 2021. Many […]
Billing for Joint Injections | Reference Sheet
When doing a joint injection, sometimes a separate E/M service is billed on the same day, and sometimes, it’s not. This grid will help you determine when to bill for both services, and when to bill only for the joint injection.
Documenting and Coding Observation Services in 2021
For Medicare patients in observation, the consulting physician uses new and established patient visit codes. Only the admitting physician can use initial and subsequent observation codes for Medicare patients in observation. Some commercial payers still recognize outpatient consults, and allow a consulting physician to bill subsequent observation codes. But Medicare does not. Questions about what […]
99072 – CPT® Code for Supplies, Equipment and Staff Time During the Public Health Emergency
The AMA released a CPT® code for use in non-facility settings for the expense related to supplies, equipment and staff time and activities for visits performed during the PHE due to respiratory-transmitted infectious disease, effective Sept 8, 2020 Some commercial payers are recognizing the paying a small amount for this code. • 99072 Additional supplies, […]
Can We Code TCM and 99214 Together?
Question: Can we code TCM and 99214 together? Answer: No, not if you mean on the same calendar date. On the day of the E/M service that is related to the TCM/discharge, use code 99495 or 99496. These TCM codes include the value of the first E/M service performed after the discharge. You don’t bill […]
Medicare “Audio-Only” Telehealth Services
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/11/2025 CMS issued multiple waivers and two interim final rules to support health care organizations and patients during the public health emergency in spring 2020 Medicare […]
Coding Telehealth Visits: Place of Service
**This content has moved*** See our primary telehealth article for the latest telehealth coding updates.
Is it or isn’t it a Telehealth Service?
Many payers and practices use the broad term telehealth to describe services that are not done face-to-face with a patient CMs describes telehealth services as non-face-to-face services that are on its telehealth list During the public health emergency, CMS eased the rules related to telehealth The flexibilities remain in effect for RHCs and FQHCs for […]
Specimen Collection For COVID-19
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY CMS’s 4/30/2020 rule states that practices could bill 99211 for new or established patients during the public health emergency for COVID-19 specimen collection CPT had previously recommended this The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection […]
Medicare Changes Telehealth Rules, Again
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/11/2025 Medicare changes telehealth rules, again: April 30, 2020 interim final rule with comment period (IFC) https://www.cms.gov/files/document/covid-final-ifc.pdf CMS released a second IFC with policy changes during […]
Telemedicine in RHCs and FQHCs
The 2025 Physician Fee Schedule Final Rule, released in Nov. 2024 continues to allow RHCs and FHQCs to perform telehealth through all of 2025. RHC and FQHC Update In April, 2020 CMS released guidance about paying for telehealth services in Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs). These payments were authorized by […]
Why and When to Use Modifier CS
Question: Why and when should we use modifier CS? Answer: Use modifier CS on visits related to testing for COVID-19. Modifier CS: cost sharing waiver for COVID-19 testing When you do, Medicare and private insurers will pay 100% of the claim, without any patient due cost sharing. The two laws that were passed require Medicare […]
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