Question: What code can I use when a patient presents to establish care, and doesn’t have any symptoms or problems? Answer: First, code or no code, isn’t this a great position for the patient to be in? Establishing care without a care in the world? (Medically at least.)
E/M Services: High Volume, High Risk | Webinar
Recorded October 19, 2023
According to CMS, E/M services comprise 40% of allowed charges in the physician fee schedule, 20% office visits and 20% other E/M services. Medicare’s expense is medical practice revenue, with the income from some primary care practices comprising 70% or more of total charges. To protect the organization, compliance professionals can focus on four components of E/M.
Is ChatGPT Coming to Coding?
Question: What’s all this I hear about ChatGPT? Is it coming to coding? Answer: All right, I wrote that question myself. I’ve been thinking about this topic. Alicia Gallegos wrote an article for CodingIntel about the topic. But, I wanted to see for myself how it could interpret coding rules, so I asked ChatGPT questions […]
A Conversation with Two Auditors: Lessons Learned about MDM | Webinar
Recorded September 28, 2023
Guest Presenters Pam D’Apuzzo and Debra Rossi of VMG Health
Medical practices can prepare for audits, improve documentation and decrease compliance risk by sharpening their focus on high-risk areas, high volume services, identifying confusing areas of MDM. Then, develop consistent guidelines from appropriate resources.
Coding Matters™
Health care coding news matters to coders, billers administrators and practitioners in medical practices. Often, there’s new beyond new codes or new policies and keeping up-to-date with that news can inform decisions that practices make. CodingIntel’s Coding Matters® page will help you be in the know about government regulation, compliance actions, third-party policies and the […]
CMS Finalizing Principal Illness Navigation (PIN) Services
This is information from the 2024 Physician Fee Schedule Final Rule https://public-inspection.federalregister.gov/2023-24184.pdf CMS developed four HCPCS codes for Principal Illness Navigation. This service is intended to help patients with serious conditions navigate their health care treatment. PIN services are incident-to services so may only be performed in a non-facility setting Informed consent is required-the patient must […]
Medicare Coverage for Marriage and Family Therapists and Mental Health Counselors
In the Consolidated Appropriations Act, 2023 Congress mandated that Medicare provide coverage and payment for the services of health professionals who are Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs). The effective date of coverage was January 1, 2024. And of course, these professionals must enroll in Medicare in order to provide the […]
What are Social Determinants of Health?
Question: Can you settle this question for our coding team? Are smoking and drinking considered Social Determinants of Health? Answer: No. According to the CDC: “Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set […]
Documentation for Advance Care Planning
Question: How much detail do I need to include in documentation for Advance Care Planning? Answer: Document the discussion in enough detail that someone reading the note knows what was discussed. Is that a circular argument? Here’s the example that I give. If a surgeon performs an appendectomy, we wouldn’t bill for the service if […]
HCC Transition from V24 to V28 | Webinar
Recorded July 20, 2023
CMS is transitioning risk coding from the 2020 V24 model to V28 beginning in 2024. This webinar will provide an overview of HCC coding, its purpose and methodology. We’ll describe the changes and enumerate some of the key differences in coefficients for commonly used conditions between V24 and V28. And finally, learning from OIG audits of Medicare Advantage Organizations and HCC coding, identify diagnosis codes that are frequently incorrectly reported.
CPT® Coding for Bronchoscopy Procedures | Webinar
Recorded May 18, 2023
Guest Presenter Shannon McCall of HCPro joins us once again for a CPT® focused webinar on all things bronchoscopy! This webinar will describe coding for bronchoscopy, with and without biopsy, with ultrasound guidance, and with procedures. It includes coding by the number of lobes visualized for certain procedures. There are three case studies to illustrate the coding rules for these procedures.
Coding for Hospital Services | Webinar
Recorded April 20, 2023
First, CPT® updated their E/M code set. Then, CMS interpreted the updates and applied their own reimbursement rules to the code set. This webinar will summarize CPT® rules and CMS’s February 2023 transmittal that addresses inpatient and observation billing by the admitting and consulting physicians, admission to inpatient status following observation care, and multiple visits in a single day. The webinar will discuss when coding instruction is the same for CPT® and CMS and when it varies.
Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442
Information about these services, and other screening/preventive care is found on the CMS website CMS MLN Medicare Preventive Services Educational Tool. The reference is now MLN006559. The page was updated in 2025 to include: Added crisis support contact information Added information for safety planning for patients at risk for suicide Added information for follow-up contacts […]
Are You Missing the Initial Annual Wellness Visit? | G0438
Knowing which Medicare wellness visit to bill Eligibility requirements for the Welcome to Medicare visit After I gave a presentation at a family medicine conference a physician said to me, “What you just told me will pay for the entire cost of my coming to this conference.” I don’t always hear that after I give […]
Coding for Hernia Repair
In 2023, CPT® revised the codes and concepts used for coding hernia repair. These represent significant changes for surgical procedures that are some of the most frequently performed surgical procedures. At the start of the repair codes, the American Medical Association (AMA) created new language that says “The hernia repair codes in this section are categorized […]
Coding Guide – Critical Care Services
The CPT® coding rules and the CMS reimbursement rules can be confusing. This guide explains the CPT® coding rules and the CMS reimbursement rules in one place.
CMS Teaching Physician Rules Update | Webinar
Recorded February 16, 2023
The teaching physician rules provide payment to an attending physician for services performed jointly by an attending and a resident. The required participation and documentation of the attending varies for E/M services, critical care, psychiatry and procedures. This webinar will review the basics of the CMS rules and the specific participation and documentation requirements for each type of service. The presentation will also include a description of the waivers in place during the PHE.
Principal Care Management (PCM) Services – CPT® codes 99424—99427
There are two sets of CPT® codes for Principal Care Management 99424 and 99425 are for time spent by a physician or other qualified health care professional (someone with E/M in their scope of practice) and 99426 and 99427 for clinical staff time directed by a physician or other qualified health care professional These are […]
Chronic Care Management
Medicare and private payers cover chronic care management services if a patient has two or more serious conditions that are expected to last at least a year. See also Principal Care Management And, download our Care Management Coding Guide and CCM Quick Reference Sheet Use of CPT® codes 99490, 99439, 99487, 99489, 99491 and HCPCS […]
Transitional Care Management
This article provides answers to frequently asked questions related to transitional care management services. It includes details about billing for TCM services including: When are CPT® 99495 & 99496 used? What are the requirements for TCM? Can We Code TCM and 99214 Together? Transitional care management for discharge Everyday Coding Q&A – Who needs to […]
Category of Code
Learn more about selecting Category of Code in Everyday Coding, updated annually. This article provides definitions and tips for determining whether an office encounter involves a new patient, an established patient, or a consult, and the guidelines for reporting inpatient, observation, and emergency services. The quick reference chart and key points will help you to quickly […]
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