Hospitalists became a recognized specialty by CMS starting in 2017, and we now have frequency E/M data for the specialty. There are probably still physicians who have not switched their specialty designation. Physicians self-elect their specialty designation with Medicare and other payers. Many hospitalists are family medicine or internal medicine physicians by training, working as […]
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Spotlight on up-to-date coding
Multiple E/M Services in the Same Calendar Day
The AMA added a new subsection in the 2024 E/M section addressing how to report E/M services when there are multiple encounters in the same day. (Pages 6 and 7) According to CPT® Changes 2024 An Insider’s View, the reason for this was to provide clarification for when multiple E/M services were performed on the […]
Teaching Physician – Primary Care Exception
CMS updated the teaching physician rules in 2019, and this article reflects the change. On April 26, 2019 CMS released Transmittal 4283. The transmittal primarily addresses E/M services, but also amends the section of the manual related to the primary care exception. The changes to the primary care section were mostly wording updates. Those rules […]
Two Visits for the Price of One? | Multiple Medical Visits on the Same Day
Patients often schedule two medical appointments on the same day with physicians of different specialties. It’s convenient for them. It saves travel time. It may mean the patient or a family member only needs to take one day off work. Can a multi-specialty practice be paid for two visits, when the physicians/non-physician practitioners (NPPs) practice […]
What is a Coverage Policy?
National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare coverage policies that describe medical necessity for certain services. Individual Medicare Administrative Contractors develop LCDs. These policies describe the service and covered indications. They can also include what professionals may perform the service. Some describe conservative treatments that must be tried before the procedure […]
HCPCS Code G0136 Update
CMS is changing the definition of HCPCS code G0136. They are keeping the code, and the valuation of the code. The code is staying on the telehealth list. But there is a completely new definition. Between now and 12/31/2025, G0136 is for an assessment of a patient in the areas of social determinants of health […]
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 […]
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 […]
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 […]
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 […]
Coding and Reimbursement for Lactation Services
Questions about coverage and payment for breastfeeding and lactation counseling services come up regularly. And, payers change their policies. It is important to keep up-to-date with the commercial payers with which you have contracts. Is lactation counseling separately billable or considered part of the obstetrical package? What if the patient sees the physician and a […]
How Old is Your Oldest CPT® Book
My, how CPT® has grown Thank you to everyone who completed our mission critical survey: how old is your oldest CPT® book and how many pages is it? Page down: a summary chart is below. First, some of you save everything. I’d love to see your office shelves. There are coders out there who have […]
Office Visit Code Selection for Medication Management
Medication management performed by psychiatrists, psychiatric nurse practitioners and physician assistants is billed with Evaluation and Management codes. This could be any type of E/M service, a nursing facility service or home visit, but is most typically billed as an office/outpatient visit for an established patient, using codes 99212-99215. Members can download the medication management […]
Essential Documentation for Medication Management and Psychotherapy
When providing both medication management and psychotherapy, practitioners need to document the time spent in psychotherapy and describe the therapy. Beginning January of 2021, when billing an office visit, select the level of visit based on medical decision making, not time. If medication management is the only service performed on that date, the clinician can […]
Specimen Collection For COVID-19
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY CMS’s 4/30/2020 rule states that practices could bill 99211 for new or established patients during the public health emergency for COVID-19 specimen collection CPT had previously recommended this The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection […]
Medicare Changes Telehealth Rules, Again
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/11/2025 Medicare changes telehealth rules, again: April 30, 2020 interim final rule with comment period (IFC) https://www.cms.gov/files/document/covid-final-ifc.pdf CMS released a second IFC with policy changes during […]
E/M Services – History and Exam
History and exam for E/M services “E/M Codes that have levels of services include a medically appropriate history and/or physical examination when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified healthcare professional reporting the service. The care team may collect information and the […]
Procedure Coding for Diagnostic and Therapeutic Colonoscopies
“A colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine to an anastomosis.”[1] CPT® definitions Proctosigmoidoscopy is the examination of the rectum and may include examination of a portion of the sigmoid colon. Sigmoidoscopy is the examination of […]
New Versus Established Patient Visits
There are other articles on CodingIntel about the difference between new and established patients, and the rules haven’t changed, but that doesn’t mean it is always clear. This article is here to try and clarify any remaining questions you have about the differences. Medicare definition “Interpret the phrase “new patient” to mean a patient who […]