Question: Regarding non face-to-face prolonged care, does Medicare require start and stop times, they way they do for prolonged face-to-face care? As long as the provider documents the total time spent reviewing old records is sufficient to bill this service, am I correct? (Codes 99358, 99359)Â Note, beginning 1/1/2023 these codes have an invalid status indicator […]
Coding Guide – Behavioral Health Services
The coding for psychiatric and psychotherapy services changed in 2013 and although that was years ago many psychiatrists, psychiatric nurse practitioners (NPs), and psychiatric physician assistants (PAs) are still adjusting to the change. This guide will answer questions about how to code for behavioral health services including: initial evaluations, re-evaluations, medication management, and psychotherapy.
Coding Guide – CPT® and HCPCS Code Modifiers
Table of Contents Modifier introduction Initial evaluation – minor procedure E/M service same day Initial evaluation – major procedure Post-operative care CPT® modifiers Assistant at, co-surgery, team surgery HCPCS modifiers List of modifiers included Using CPT® and HCPCS code modifiers correctly is critical to ensure accurate and timely payment. Some modifiers bypass the claims editing […]
Coding Guide – Medicare Incident-to and Shared Services
This in depth guide reviews the requirements for billing Medicare Incident-to and shared services including: when/where these services can be billed, which provider number to use, and documentation requirements.
CMS Proposed Changes in the 2019 Physician Fee Schedule Rule | Webinar
Recorded August 16, 2018 Some Fee Schedule rules are almost boring, but not this year! CMS is proposing significant changes to the payment of and documentation for new and established patient visits. This will be a sea change for most groups, particularly groups that use RVUs for physician compensation or that have coders coding all […]
Coding Guide – Preventive Medicine Services
Coding for preventive medicine services should be easy, but it’s not. It’s complicated by frequency issues, Medicare rules and the always difficult issue of when to bill a problem oriented E/M service on the same day. This guide includes coding and billing guidelines for preventive medicine services.
CMS Proposes Significant Changes to E/M Requirements
Coding. Why does is keep changing? This post was out of date and has been removed. For information about E/M requirements, see these resources: E/M in 2019: A look ahead Everyday Coding for Medical Practices Documenting History Documenting Exam Or Browse the resource library by topic, keyword, or code Back to blog
Changes in HCC Diagnosis Coding from V22 to V23: What You Need to Know
CMS pays Medicare Advantage plans differentially based on Hierarchical Condition Category (HCCs). This coding model uses demographics and diagnoses to predict future health care costs for Medicare beneficiaries enrolled in a Medicare Advantage plan. Each year, Medicare announces what the rates will be and indicates any coding changes in the HCC model. Between 2017 in […]
Screening for Depression | HCPCS Code G0444
G0444 Annual depression screening , 5–15 minutes According to Change Request 13710, beginning January 1, 2025, Medicare pays primary care practices to screen all Medicare patients annually for depression. The service must be provided in a primary care setting, using one of the following place of service codes: 02 Telehealth provided other than in patient’s […]
Behavioral Counseling for Obesity, HCPCS Code G0447
G0447 face-to-face behavioral counseling for obesity, 15 minutes G0473 Face-to-face behavioral counseling for obesity, group (2-10) 30 minutes Medicare pays for ongoing face-to-face behavioral counseling for patients with a body mass index (BMI) of ≥ 30, who are alert and able to participate in counseling. The service may be performed by a physician or non-physician […]
Coding Guide – Minor Surgical Procedures
This guide includes definitions of minor procedures used frequently in primary care and urgent care. And, even more important, instructions for billing the services. No minor procedure guide would be complete without a discussion of modifier 25. It is also the reference for CodingIntel’s minor procedures webinar which you can watch here.
How to Improve the Accuracy of Your Diagnosis Risk Scores | Dr. Edwin Knights
This reference is the companion resource for the webinar I presented in June with Edwin Knights, M.D., Improving the accuracy of your diagnosis risk scores. Members login to watch the webinar on-demand. Not a member? Learn how you can access the webinar. The handout includes: A quick comparison of fee-for-service vs. risk-adjusted diagnosis coding Explanation of risk […]
Are Subsequent Hospital or Office Visits Prior to Surgery Billable?
Question: Are the surgeon’s subsequent hospital visits or office visits between their original consult and the final visit prior to surgery billable? This is not referring to a pre-op H&P or an extra visit to answer more questions from the patient and family members after the decision for surgery. Here’s the scenario. A surgeon evaluates a […]
Coding for Minor Surgical Procedures | Webinar
Recorded June 19, 2018 The handout for this webinar has been updated with RVUs for 2019. For more about minor procedures, watch Coding for Skin Procedures in Dermatology, Family Practice, and Urgent Care, available on demand. Medical practitioners often find it easier to do a minor procedure than to select the right code for a minor procedure. […]
Emergency Department Visits
Definition Emergency department (ED) services are E/M services provided to patients in the Emergency Department. Explanation These services may be billed by any specialty physician, not just Emergency Department physicians. The physician does not need to be assigned to the ED. However, these codes may only be used in a hospital-based facility that is available […]
Advance Care Planning | CPT® 99497, 99498
Advance Care Planning CPT® Codes Overview Medical practices perform countless tasks every day for which there is no payment. CMS continually states that it wants to support non-procedural and in the past decade has added payment for some non-face-to-face services, including Care Plan Oversight, Transitional Care Management and Chronic Care Management. CPT® Codes 99497 & […]
Exam | Documentation Guidelines for E/M Services
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. Definition Exam is one of the three key components (history, exam and medical decision making) of Evaluation and Management Services. […]
Time Based Rules | Behavioral Health Services
Psychiatrists, psychiatric NPs and psychiatric PAs provide medication management using E/M codes and psychotherapy services. There are specific rules for performing both on a calendar day. Be sure to review the behavioral health coding guide for more specific information. When a CPT® code is defined by time, the clinician must document time in the medical […]
Using Time to Select a Level of E/M Service
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. Remember, don’t use the information in this article for current services. Use these rules when billing for codes that use […]
Diagnosis Coding | Not Just for Claims Anymore
Physician claims are paid based on the fee schedule associated with the CPT® or HCPCS code that is submitted. Diagnosis coding can be a reason for a denial. Physicians use CPT® or HCPCS codes to tell the payer what was done (colonoscopy, office visit) and modifiers to describe special circumstances (assistant at surgery, bilateral procedure.) […]
Reimbursement for Shingrix, the New Zoster Vaccine | 90750
At the end of 2017, there was news that a new vaccine for shingles, Shingrix, was significantly more effective than the older vaccine, Zostavax. The new vaccine was recommended in place of the old, and for patients who had already received the older vaccine. An article in The New York Times summarized the benefits. The […]
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