CMS released an NCD for ABPM on July 2, 2019. CMS has expanded the coverage for ABPM by allowing it for a greater range of BP measurements. Of course, there are limits or there wouldn’t be an updated coverage determination. Neither the CPT® nor the ICD-10 coding has changed, only the eligibility, expanding the covered […]
Procedure Coding for Diagnostic and Therapeutic Colonoscopies
“A colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine to an anastomosis.”[1] CPT® definitions Proctosigmoidoscopy is the examination of the rectum and may include examination of a portion of the sigmoid colon. Sigmoidoscopy is the examination of […]
New Versus Established Patient Visits
There are other articles on CodingIntel about the difference between new and established patients, and the rules haven’t changed, but that doesn’t mean it is always clear. This article is here to try and clarify any remaining questions you have about the differences. Medicare definition “Interpret the phrase “new patient” to mean a patient who […]
Psychotherapy Codes
Individual psychotherapy codes are time based codes. One set may be reported as a stand alone service, and another during the same visit as medication management. They follow the CPT®; time rule: use the code when the mid-point in the defined time is met. The CPT®book itself lists the time thresholds at the start of […]
Psychotherapy for Patients in Crisis
90839 Psychotherapy for crisis; first 60 minutes. +90840 each additional 30 minutes 90839 is the code for psychotherapy for crisis; first 60 minutes. 90840 is an add-on code for each additional 30 minutes of time spent with a patient who is in crisis. These codes do not have CPT® limitations on place of […]
Family and Group Therapy Codes
Group therapy Group psychotherapy is reported with code 90853. This is not a time-based code: one unit of service should be reported for each group member according to CPT®. Group therapy typically lasts 45 to 50 minutes, and some payers set a limit at 12 participants. Many payers require that the number of members in […]
Overview of Diagnosis Coding for Behavioral Health Services
Match diagnoses on the claim form to those listed in assessment The diagnosis codes on the claim form should match those in the note. If the assessment says “stable on medications” or “doing well,” it isn’t clear how many conditions were managed and treated In the assessment, list conditions managed, their status, and treated Note […]
Psychiatric Diagnostic Evaluation
There are two codes for psychiatric diagnostic evaluation. 90791 Psychiatric diagnostic evaluation 90792 Psychiatric diagnostic evaluation with medical services 90791 is used by psychologists, social workers and other licensed behavioral health professional and 90792 is used by psychiatrists and psychiatric nurse practitioners and physician assistants, because it includes medical services. Here is how CPT® defines […]
Counting Conditions in the HPI and Assessment
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. Question: When counting the chronic conditions for the history of the present illness (HPI) can the status of the condition […]
Teaching Physician Rules – Evaluation and Management Services
CMS policy update: E/M services performed under the teaching physician rules Download this teaching physician rules quick reference sheet for a summary of the rules. The CMS rules got a major update with the April 26, 2019 Transmittal 4823. A transmittal is a communication from CMS to the Medicare Administrative Contractors. It is followed by […]
Teaching Physician Rules – Psychiatric Services
In psychiatry if reporting time-based psychotherapy services, the time of the attending physician is the time used to select the code. For psychiatry services that are not time based, the requirement for the presence of the physician may be met if the attending uses a one way mirror or video (not audio) equipment. This concurrent […]
Coding Inpatient Pediatric Services | Webinar
Recorded May 23, 2019
Pediatricians and family physicians who care for newborn and older children in an inpatient setting need to select the correct category of code based on the condition of the patient. For newborns, this varies from caring for healthy newborns, to neonates who require inpatient care, intensive care or critical care. It is important to select the codes that reflect the condition of the patient, whether providing 24-hour care or stabilizing and transferring the patient. This webinar will explain the use of these codes, using clinical examples from CPT® Changes: An Insider’s View from 2008, 2009 and 2013.
What is an Interval History?
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. Question: What does it mean when it says a code requires an “interval” history? This question related to the 1995/1997 […]
Analysis of 2018 CERT Report: Use These Findings to Educate and Audit High Risk Codes
Recorded April 25, 2019
This webinar will analyze errors for Part B payments and identify the types of services with the highest error rates and the reasons identified in the CERT report. The most common type of error is insufficient documentation, followed by incorrect coding. Some types of procedures, however, were denied for medical necessity.
Physician Specialty Codes and Claims Processing
Specialty designation is determines how claims are processed for physician and non-physician practitioners in groups It is also important in crediting data using the E/M guidelines, developed in 2021 and expanded in 2023 When physicians enroll in Medicare, they self-elect their specialty designation. In the enrollment process, there are fields to indicate primary and secondary […]
Everyday Dermatology Coding
Everyday Dermatology Coding is a 52 page guide to coding dermatology services. This in-depth coding resource covers the following topics specific to dermatology: E/M MDM table, Dermatology E/M frequency, Common Dermatology procedures, modifiers and more.
Initial Hospital Service Codes and Established Patients
Question: We are having a disagreement in our coding department. Our cardiologist sees an inpatient at the hospital, but it’s a patient she knows from the office. Should she bill an initial hospital service code or a subsequent hospital service code when she sees this patient, who she knows and has seen many times? Answer: […]
Screening for Skin Cancer
Dermatologists frequently see patients for skin checks, to examine their skin for signs of pre-malignant or malignant lesions. Some of these patients have a personal history of malignant skin neoplasms, and some do not. The appointments may be scheduled annually or bi-annually. Will insurance pay for screening for skin cancer? Medicare and private insurances are […]
Diagnosis Coding for Dermatology
Diagnosis notes for dermatology Be sure to match the diagnosis to the procedure. For example, For skin tag removal, use skin tag For treatment of warts, use warts For excision of malignant lesions, use a malignant lesion code Describe conditions in the physical exam Only use diagnosis of “inflamed” seborrheic keratosis if the exam describes […]
Coding for Breast Procedures: Biopsy, Localization Devices, and Surgery
From biopsy to localization device to mastectomy, coding for breast procedures can be challenging. This article summarizes the rules related to these services. Fine needle aspiration of a breast mass, or aspiration of a cyst Fine needle aspiration (FNA) of a breast mass is reported with codes 10021—10012. CPT® developed new codes for FNA in 2019. […]
Chronic Care Management Services (CCM), CPT® 99491: new code in 2019
CPT® has added 99491 to the section of chronic care management codes. The other code in this section is 99490 and there are two codes in the complex chronic care management section, 99487 and 99498. This article will discuss CPT® 99491. For in-depth information about existing codes, read our feature about chronic care management here on […]
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