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Prolonged Services and Nursing Home Visits

Question: Prolonged Services and nursing home visits. I’m getting a “Code 99358 is a column 2 code for 99309, these codes cannot be billed together in any circumstance” error from our scrubber when we try to bill CPT® 99358 and 99309 on the same date of service. I thought these were billable with other E/M’s […]

Denial Management Strategies

Recorded October, 2017

Medical practices can decrease denials and accelerate payments by setting up work processes that use advance functions in their software systems to identify, quantify and categorize denials. The purpose is to identify patterns related to coding, enrollment, prior authorization and specific payer performance. This presentation will focus on using these systems related specifically to ICD-10, but the underlying strategy to understand the causes of denials, and reduce or prevent them in the future is applicable for all denial reasons.

HCC Diagnosis Coding: Can you Add a Code from the Past Medical History?

This post describes rules for office/outpatient coding, not facility/DRG rules. Recently a fellow coder wrote to me about risk adjusted diagnosis coding. She was responding to an article that I wrote in which I stated the conditions listed in the past medical history should not be included on the claim form by the coder. I […]

CPT® Code 99483: Cognitive Assessment and Care Plan Services

Developed in 2018, this service describes an in-depth assessment and development of care plan services for new or established patients who have signs of cognitive impairment. Notice that the use of this code requires an independent historian, stated right in the CPT description. Cognitive assessment checklist Definition of CPT® code 99483 99483: Assessment of and […]

General Behavioral Health Integration Care Management

99484 Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric […]

Selecting CPT® Rules for Excision of Skin Lesions

Many medical practices perform skin procedures.  A patient may see a dermatologist, a family physician or a surgeon when the time comes to find out, “What’s this thing growing on my arm?”  This article discusses excision of benign and malignant lesions. Shaves, biopsies, and destruction of lesions are covered in other articles. Per CPT, excision […]

Destruction of Benign or Pre-Malignant Lesions

Finding the right code for lesion destruction is not easy. The codes are distributed in the CPT® book in the integumentary, digestive, male genital system, female genital system, and eye and ocular systems. Some of the codes are selected by the method of destruction and some are not.  Some of the codes are selected based […]

Avoid These 4 Costly Errors When Coding Minor Surgical Procedures

Does your practice perform any minor or major procedures? If so, this post is for you! This post relates to the global package, and not to determining the risk of additional diagnostic testing or treatment in an E/M service. Primary care practices and urgent care centers should pay special attention to these issues and avoid […]

What’s the Difference Between B20 and Z21? Which is Right for Positive HIV Status?

In this post ICD-10-CM diagnosis coding for positive HIV status Medical practice reimbursement for individual claims based on CPT® Common HIV diagnosis codes Question:  For an HIV positive patient without symptoms, is the correct diagnosis code Z21 or B20?  What difference does it make to reimbursement? Answer:  Following ICD-10 guidelines, a patient with HIV status […]

To Credit or Not to Credit: Auditing E/M Services

Recorded September 21, 2017 When it comes to auditing E/M services, there’s black, white and a whole lot of gray. Reasonable auditors can disagree. So, how can auditors and coders accurately select a level of service? First, by thorough knowledge of the Guidelines themselves. Second, by developing a set of internal, defensible policies that address the […]

Everything You Want (And Need) to Know About E/M Services

Evaluation and Management (E/M) services account for 30% of the revenue paid by Medicare for all physician services. For many specialties, E/M codes account for 60-70% of total revenue. Maximum reimbursement depends on understanding the rules related to these services. The goal of this presentation is to teach these rules for office E/M services with […]

CMS is Seeking Comments About Updating E/M Service Definitions

I hope you’re sitting down, because there is big news! The proposed physician fee schedule rule was released in mid July and includes a section about E/M (evaluation and management services). CMS is asking for comments about changing the documentation guidelines! The current guidelines were developed in 1995 and 1997, prior to the adoption of […]

Reporting Excision of Multiple Lesions of the Same Size

Question: The doctor I work with excised two benign lesions from a patient’s arm, of the same length.  Do I add them together and report one code? Each was .5 cm.  Do I report 11400 twice or 11401 once? Answer: Report 11400 twice. Laceration repairs of the same depth and location are added together, but […]

History | 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 History is one of the three key components (history, exam, and medical decision making) of Evaluation and Management Services. […]

Screening Pelvic/Breast Exam and Pap Smear Denials | G0101 and Q0091

HCPCS codes and Q0091 We received this question from one of our members: “We have a Medicare patient for whom we provided a pelvic and a breast exam and a pap smear. We submitted it to Medicare and it got denied.  Can you tell me why?” Medicare doesn’t pay for “routine services”, but they do […]

Diagnosis Coding for Tick Bites

Question: Why is it so hard to have correct diagnosis coding for tick bites? And, how is it coded? Answer: The search function in electronic health records leads clinicians astray. And, diagnosis coding for tick bites  requires two diagnosis codes, because it is an injury. It requires a code from the injury chapter in the […]

CPT® and CMS Rules for Critical Care | What’s the Difference?

CMS and CPT count critical care time differently. For Medicare patients, the full 30 minutes of 99292 must be met in order to use the code, not the midpoint (15 minutes) of the code. For Medicare patients: Use 99291 from 30 minutes until 103 minutes. Add on code 99292 only if the time meets 104 […]

Primary Care and Post-Op Reporting | Medicare Requirements

Hey, primary care! This one’s for you too. Primary care doctors probably didn’t pay attention when the news broke that CMS is requiring reporting post op visits using code 99024 in nine states.  After all, primary care isn’t doing major surgical procedures.  However, the list includes minor procedures performed frequently in primary care and urgent […]

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In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.

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