This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Effective retroactively to 3/18/20, there is no cost sharing allowed for COVID-19 testing or for the evaluation visits related to the testing Medicare instructs us to use modifier CS on the visits and tests, and to contact your […]
Payment for Telephone Calls During the PHE: CMS Rules for Phone Calls
Telephone codes 99441–99443 were deleted from the 2025 CPT book. 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  It is for HISTORICAL REFERENCE ONLY.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 2/17/2025 CMS rules for phone calls has changed during the course of the pandemic. Prior to the […]
Telemedicine | Webinar
Recorded July 15th, 2020
The coding and reimbursement rules for telehealth changed fast in March. Congress passed a law relaxing certain telemedicine restrictions during the period of a government state of emergency. This webinar will describe the new telehealth Medicare rules. Join us to learn about CPT coding for telehealth, diagnosis coding, and the type of communication that can be used for telehealth services.
APRN and PA Students and Medical Record Documentation
Question We have students from a nurse practitioner program rotate through our practice. Can we use their notes the same way as medical student notes? Answer As of January 1, 2020, yes. The quotes below are excerpts from the 2020 Physician Fee Schedule Final Rule. Here’s the cliff notes: A physician, APRN or PA can […]
Medical Record Documentation | Webinar
Recorded April 23, 2020
This webinar will review CMS’s changed policy for teaching physician rules and E/M services. Each medical group will need to decide for itself whether to implement these changes, with the understanding that they apply to fee-for-service Medicare only.
CMS Update on Medical Record Documentation for E/M Services
The world as we knew it Both the 1995 and 1997 evaluation and management (E/M) documentation guidelines stated that ancillary staff could record a review of systems (ROS), and past medical, family, and social history (PFSH) in a patient record. The billing physician/NP/PA needed to document that that information had been reviewed and verified. Only […]
On-line Digital Services and Remote Monitoring | Webinar
Recorded February 27, 2020
New CPT ® codes for non-face-to-face services include both on-line digital evaluations and remote physiological monitoring. Hold your celebration—the digital E/M codes are not office visits through your portal and have very specific documentation requirements. The webinar will start with a brief overview of Medicare covered telehealth, and then describe these two new sets of codes, with the documentation rules and clinical examples.
Psychiatry Exam Reference Sheet 1997 Guidelines
Use the exam example below to meet the requirements of a comprehensive, using the 1997 single specialty psychiatry exam.
Chronic Care Management, Add-on Code G2058
CMS developed this HCPCS code to report additional non-face-to-face staff time performing non-complex care management services Use this code only with CPT code 99490 This 20-minute time-based code may only be reported twice in a calendar month The existing code for clinical staff non-complex chronic care management is CPT code 99490, Â defined as 20 minutes […]
Can We Give a Flu Shot if the Doctor isn’t in the Office?
Question: Do we need to have a physician in the office when our clinical staff gives flu shots? Answer: No. CMS allows flu shots to be given without a physician order and without physician supervision. From MLN Matters: Remember the following regarding the influenza vaccine:Â Medicare allows one influenza (flu) vaccination per year; Medicare does […]
What are the Requirements for Billing a TCM Visit?
Question: In order to bill a TCM visit, is anything else needed besides the phone call and E/M visit? (Codes 99495 and 99496) Answer: Yes, I’m so glad you asked. Let’s go to CPT®. “TCM is comprised of one face-to-face visit within the specified timeframes, in combination with non-face-to- face services that may be performed […]
Coding Guide – How Physician Services are Paid
This is an essential resource for new physicians, non-physician practitioners, coders and billers and for managers who want to know just enough to manage. In addition to this billing guide, be sure to reference the helpful infographic and Betsy’s 15 minute video on the payment process.
Coding Guide – E/M Services
This coding guide describes the guidelines for evaluation and management (E/M) services reported in the office or outpatient department, consultations, ED visits, inpatient and observation hospital visits, nursing facility and home services. There are specific changes related to these categories of codes described here. The guide will also discuss how to select the level of service based on either time or medical decision-making.
Scoring Medical Decision Making for Office Visits in 2021
Recorded October 31, 2019 This content is no longer current Let’s compare the current medical decision-making rules with the CPT changed rules for 2021 for codes 99202—99215. The existing rules and the revised rules are similar enough to be confusing, and different enough to require practice. For October’s webinar, we will look at the MDM […]
Can We Bill an E/M Service with a Scheduled Endoscopy?
Question: Can we charge an E/M service when we do a scheduled endoscopy to account for the cost of nursing staff, supplies, pre- and post- care of the patient in the suite? We use place of service office, and I know we can’t charge a facility fee. Many of our commercial payers pay the same […]
An Overview of the Revised MDM
Medical Decision Making: selecting the correct level of service for codes 99202—99215:  E/M codes 99202—99215 have a changed definition of MDM The new MDM chart is similar to the current table of risk, but with significant changes, particularly in data Finally! Definitions of key terms in MDM The AMA is working on changing the documentation […]
E/M Changes in 2021 for 99202-99215 | Overview
It’s here! New definitions for codes 99202–99215 Clinicians can select new and established patient visit based on time or medical decision making (MDM) New guidelines for using time for 99202—99215, and revised definitions for MDM The American Medical Association (AMA) CPT® panel changed the definitions, and CMS is in agreement with these. The changes below […]
E/M Services – History and Exam
History and exam for E/M services “E/M Codes that have levels of services include a medically appropriate history and/or physical examination when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified healthcare professional reporting the service. The care team may collect information and the […]
Time: Using Time for Office Visits
Using time to select a level of service for office visit codes 99202—99215 Total practitioner time on the date of service can be used to select one of these codes. Counseling and/or coordination of care no longer needs to dominate the service. See also When to use time to select an office visit code using the […]
New E/M Rules Effective Date and Payer Policies
Question: When can we start using the new E/M rules for new and established patient visits? And, are all payers going to follow them? Answer: The revised definitions for codes 99202—99215 are effective until January 1 2021. These new definitions are now in the 2021 CPT book. CMS and the AMA have joined hands (figuratively […]
CMS 2020 Proposed Rule Updates
CMS rescinds bundled payments for 2021 and accepts CPT® revisions for new and established patients Proposes new HCPCS codes for care management Outlines proposals to further ease burden of documentation As I work my way through the proposed rule, I’ll add new content at the top of this blog post. The 2020 proposed physician fee […]
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