Medicare has very specific requirements for preventive services. What can you bill, what must you document? This article covers all the bases including tips for billing the Welcome to Medicare and Annual and Subsequent Wellness Visits. More tips for preventive medicine and split visits can be found here. See also Q&A from the Preventive Medicine […]
Home and Nursing Facility Category of Code Rules | Webinar
Recorded March 21st, 2024
This webinar will explain the rules for using Evaluation and Management (E/M) services (E/M) in home and residence locations and nursing and skilled nursing facilities. This includes CMS regulations for nursing facility services. It will discuss reporting multiple E/M services when one of the visits is in a nursing facility, and more.
Coding Multiple Procedures | Examples with Modifiers
Biopsies and lesion destruction codes are often performed at the same patient visit. This leads to questions about bundling and modifiers. There are two steps to billing these correctly and avoiding denials: Check the total RVU values Check the NCCI edits. There is a step-by-step procedure for coding multiple procedures at the end of this […]
CPT® Codes (99421-99423) – and Payment for – Online Digital Evaluation and Management (E/M) Services
Or, as I call them: message, manage, message. There are CPT codes for online digital E/M services. CPT developed a set of CPT® codes for use by physicians, physician assistants and advanced practice nurse practitioners performing brief, online E/M services via a secure platform There are also CPT® codes for use by clinicians who do […]
E/M Frequency Data for Hospitalists
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 […]
E/M Frequency Data for Family Medicine and Internal Medicine
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. The panel for family medicine physicians includes children, but the data below is Medicare data, for disabled patients of any age and people 65 and older. I opted to show internal medicine and family medicine together, because both are […]
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 […]
How Physician Services are Paid – Overview
Have a new staff member or physician who needs a primer on “how physician services are paid?” This short video is a must see! Learn how all the piece come together, from CPT® and HCPCS, to diagnosis coding and Medicare rules. All in about 15 minutes…
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 […]
How Do We Code for “Meet and Greet Visits?
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.
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 […]
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 […]
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.
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