Question: Should we always wait for the pathology report before submitting a code for a biopsy? Answer: Sometimes. Wait for the pathology report only for excision of benign or malignant lesions, which are coded based on the pathology report. These codes describe excision of benign lesions in the code series 11400 to 11446 and excision […]
Improving the Accuracy of Your Diagnosis Risk Scores | Webinar
Recorded June 6, 2018 This content is no longer current. Presented by Betsy Nicoletti with guest speaker Edwin Knights, MD Edwin Knights, M.D. was the physician leader in his practice in implementing risk diagnosis coding and brings experience and strategic knowledge to this important topic. Overview: Many practices have a basic understanding of HCC risk […]
Quick Coding Reference Sheet – Home visits
Use this reference guide to select a level of service for new and established patient home visits, based on the key components or time.
Who is Responsible for Coding Physician Services? The Medical Provider or the Coder?
Legally, when a physician, physician assistant (PA) or nurse practitioner (NP) enroll in a Medicare, Medicaid or commercial insurance, the practitioner signs an agreement attesting that accurate claims will be submitted. Practitioners are responsible for claims submitted under their National Provider Identifier (NPI). CMS’s E/M guide says, When billing for a patient’s visit, choose codes […]
HCC Coding: Round Up of Chronic Conditions
This article will describe risk coding for a few common, chronic illnesses. This article isn’t comprehensive about all chronic conditions. My focus in this article is on commonly seen conditions in medical practices. If a condition is prevalent, then coding for it accurately is important in risk based diagnosis coding. Key points in coding chronic […]
Care Plan Oversight
There are two sets of codes for care plan oversight, CPT (99374–99380) and HCPCS codes (G0181, G0182). The requirements for each are different, including time thresholds and what activities may be included in the CPO time. Be sure to download the Care Plan Oversight quick reference sheet below.
Are Changes Coming to the E/M Documentation Guidelines?
Do you remember that CMS is talking about changing the documentation requirements for E/M services? If it slipped your mind in the course of your busy work weeks, you can read my article about that here. CMS E/M listening call March 21, CMS held its E/M listening session and I joined in. First you might […]
Teaching Physician Rules | Bedside Procedures
Question: Can an attending bill for a bedside procedure that a resident did without the attending being present? If so, is this billed at 85% like a PA or NP? If a PA or NP is overseeing a bedside procedure that a resident is preforming how is this billed (no attending is present at the […]
Wellness Visits and Prolonged Care | How to Use G0513 & G0514
Medicare stunned us by creating two prolonged services HCPCS codes for use with Medicare covered preventive medicine services in 2018. They may be used only with Medicare covered preventive services when the typical intraservice time for the preventive service is met, and half of the prolonged care time. CMS then released the intraservice time for […]
Medical Necessity Isn’t Medical Decision Making
Have you heard of Talk Ten Tuesdays? It’s an internet radio program hosted by Chuck Buck and Dr. Erica Remer, and every week they discuss current coding issues. They started with the implementation of ICD-10 and just kept going. I was a guest recently and discussed one of my pet peeves: equating medical necessity with […]
Can Two Practices Split the Post-Op Office Care of a Patient?
Question: Can two practices split the post-op office care of a patient? Answer: No. Although the operative and post-operative portions of the global package may be split between two groups, there isn’t any way to split the office post-op visits between two practices. CMS developed a single payment for global surgery that includes certain pre-op […]
Prolonged Services Codes for Medicare Preventive Medicine Services: G0513, G0514
Did you (or your clinician) ever have a wellness visit that took a really, truly, madly long time? And wondered what—if anything—you could bill with it? Wonder no more.
OB Coder Survey | Billing Extra Visits During Pregnancy
CPT is changing coding for maternity care in 2027. How? I don’t know. But, you can read the announcement on ACOG’s website below. https://www.acog.org/practice-management/coding/coding-library/payment-for-obstetric-services Thank you to the 63 generous coders and billers who answered my questions about billing extra OB visits during the maternity period. If we and our payers are following CPT® rules, […]
Dear Resident, Do you Understand Relative Value Units (RVUs)?
Measuring physician productivity with work Relative Value Units (RVUs) News flash! Physicians are more interested in medicine than coding. No doctor undertook the rigors of medical school in order to be an expert coder. But, when residency ends, some physicians will find themselves looking at employment contracts in which their compensation will be determined in […]
Scoring MDM in an E/M Note
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: I have a question about scoring MDM in an E/M note. One of our coders thinks that if there […]
What Does the Decision to Perform a Minor Procedure Really Mean?
This article is updated with CPT’s March 2023 document, “Reporting CPT® Modifier 25.” (citation at the end of the article). That CPT® article adds specificity to what is included in typical pre and post work, which will make it more difficult to report both a procedure and an E/M service for some encounters. According to […]
Coding Changes for 2018 | Webinar
Recorded February 15, 2018 This content has been removed as it is no longer current. Listen in on this high level overview of new CPT® and HCPCS codes for 2018! Every year, the AMA updates the CPT® code set and CMS updates the HCPCS code set. This year, some 2017 HCPCS codes were changed to […]
New CPT® Codes for 2018 | Anticoagulation Management and Education for Home INR Monitoring
CPT developed (and Medicare recognizes) two new codes for services related to home and outpatient international normalized ratio (INR) monitoring services in 2018. Here are the new codes | CPT® 93792, 93793 93792 Patient/caregiver training for initiation of home international normalized ratio (INR) monitoring under the direction of a physician or other qualified healthcare professional, […]
Can you Screen for an Existing Condition? | Diagnosis Coding for Lab Services
Sometimes, the hardest thing about coding for preventive services isn’t the visit at all. It’s the labs. Patients come in for an annual physical and believe that all of the lab work done that day or in preparation for that day will be covered as part of their preventive service. And we know what that […]
Risk Coding for Medical Practices and Outpatient Services
Introduction to Risk Coding for Medical Practices and Outpatient Services Recorded May, 2022 You can find CodingIntel’s 2023 webinar at this link: https://codingintel.com/hcc-coding-changes-webinar/ Where do we find the rules for assigning diagnosis codes in medical practices? The diagnosis codes don’t just get the claim paid, they also determine the patient’s risk score and the risk […]
Do I Need Modifier 52 for this Repair?
Question: Can you please give me your opinion on a coding case? We have a surgical oncologist that performed an excision of malignant skin lesions on the face, using code 11621. A plastic surgeon (in the OR at the same time) performs immediate reconstructive closure. It was an intermediate repair using 12051. It is my […]
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