The primary factors in selecting a code for destruction of malignant lesions are: Selectd by size of lesion (not defect) Location Method is not a factor in code selection Report a code for each lesion treated Per Principles of CPT® Coding: “The destruction of malignant lesions is reported with codes 17260—17286. Similar to the codes […]
Diagnosis Coding for Biopsy Sent for Pathology
Question: What diagnosis code should you use when sending a skin biopsy to pathology? a)Â D48.5 Neoplasm of uncertain behavior of skin, or b)Â D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
Incident to and Change to Medications
Question: A CodingIntel member writes: “I am getting mixed information about incident-to and I was wondering if you could weigh in? If a NPP changes a medication dosage or medication type, but is treating the same problem, is this to be a change in treatment plan and would they bill under their NPI number. Or, […]
Virtual Communication: HCPCS Codes G2010, G2250, G2251, G2252; CPT® 98016
Virtual communications are not considered telehealth These HCPCS codes were developed by CMS for virtual communication They are not on CMS’s list of telehealth services and do not use real-time, interactive, audio/visual communication They do require verbal consent; a single consent can be obtained for all communications based technology services annually for Medicare patients In […]
CMS E/M Proposal: When Will We Hear?
Checking my crystal ball, my guess is Friday, November 2. Late afternoon. CMS releases its final rule about 60 days before it goes into effect, and this rule’s effective date is January 1, 2019. We are anxiously awaiting their decision about the fate of E/M office codes, payment reduction when modifier 25 is on a […]
CPT® Codes for Fine Needle Aspiration
Fine needle aspiration biopsy Material is aspirated with a fine needle and the cells are examined cytologically. A core needle biopsy is performed with a larger bore needle to obtain a core sample. Use code 10021 for FNA without imaging guidance, first lesion and 10004 for each additional lesions. Use codes 10005 – 10012 for […]
Skin Biopsies
Correctly selecting and reporting skin biopsies requires an understanding of CPT® codes for skin biopsies There are codes for excision of benign and malignant lesions, and codes for shave procedures. Those are coded based on the size of the excision and location There are specific biopsy codes in other chapters, for biopsy of ears, lips, […]
Exam and Time in a Visit | Documentation Requirements in E/M Services
Question: For an established patient, if I don’t document a physical exam, am I required to say that the visit was a counseling visit and document time? Answer: No. And, it would be incorrect to do so, if counseling did not dominate the visit. Established patients require two of the three key components of history, […]
Coding for Depression in the HCC System | Reference Sheet
HCC diagnosis coding for depression can be confusing. This quick reference sheet simplifes the process with an easy to follow chart. Includes a handy reference to alternate descriptions listed in some EMR’s for relevant ICD-10 codes.
Five Urban Legends About Risk-Adjusted Diagnosis Coding
Originally published on kevinmd.com When I talk to medical practices about Hierarchical Condition Category (HCCs) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends. Let’s separate fact from fiction. Don’t miss our Billing Guide on Risk-adjusted Diagnosis Coding for an in-depth look at this topic. Urban […]
Coding for Hospitalists
The information in this post applies to services provided PRIOR TO 1/1/2023 Coding for services done by hospitalists and other specialty physicians in the hospital can be confusing. After watching these videos and downloading the guides, you’ll be confident that you are selecting the right category of code and level of service. The third video […]
Behavioral Health Integration and CCM Codes | Reference Sheet
This updated quick reference sheet includes the description for Behavioral Health Integration and CCM codes codes, time requirements, reimbursement rates and more. Download the PDF – BHI and CCM Codes | Reference Sheet The CMS Final Rule released in November 2017 included new HCPCS codes for behavioral health management services, or behavioral health integration (BHI), […]
Diagnosis Coding for Screening Colonoscopy
Some of you have read CodingIntel’s article on coding for screening colonoscopy. The questions we get about that article are almost all related to diagnosis coding. The CPT®/HCPCS coding and the modifiers don’t raise many questions, but clinicians, coders, and patients frequently ask about correct diagnosis coding and sequencing of those codes. We posed these […]
What Does CMS’s Modifier 25 Proposal Mean to You? (I wish I knew)
Coding. Why does it keep changing? The article you are looking for was out of date, and we removed it. May we suggest… Using Modifier 25 | Reference Sheet Modifier 25 CMS Physician Final Rule 2019 Back to blog Relevant Search Terms: Proposed physician fee schedule rule, modifier 25, payment reduction, multiple […]
2019 CPT® changes
Recorded December 13, 2018 It’s our annual overview of new CPT® codes. Get up to speed on the new codes and 2019 CPT® coding changes. This is a broad overview of all of the changes, not an in depth exploration of any one area of the book. Have your CPT® book handy for this fast-paced […]
CMS Physician Fee Final Rule for 2019 | Webinar
Recorded November 20, 2018 The wait is over! Hear what coding and payment policies CMS is implementing for January 1, 2019 and how they will affect your practice and your revenue. The Final Rule is released in early November and this year, we’ll hear CMS’s response and decisions about the Documentation Guidelines for office services […]
Care Management in Primary Care Practices | Webinar
Recorded September 20, 2018 @ 12:00 pm (EST) Primary care practices can be reimbursed for the non-face-to-face work of caring for chronically ill patients using long-standing and new CPT® codes. However, practices must know the coding and documentation requirements before performing the services and submitting claims. This webinar will review the coding rules and provide […]
HCC’s in Brief | The Difference Between CMS-HCC and HHS-HCC
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 […]
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. […]
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