Individual psychotherapy codes are time based codes. One set may be reported as a stand alone service, and another during the same visit as medication management. They follow the CPT®; time rule: use the code when the mid-point in the defined time is met. The CPT®book itself lists the time thresholds at the start of […]
Psychotherapy for Patients in Crisis
90839 Psychotherapy for crisis; first 60 minutes. +90840 each additional 30 minutes 90839 is the code for psychotherapy for crisis; first 60 minutes. 90840 is an add-on code for each additional 30 minutes of time spent with a patient who is in crisis. These codes do not have CPT® limitations on place of […]
Counting Conditions in the HPI and Assessment
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: When counting the chronic conditions for the history of the present illness (HPI) can the status of the condition […]
What is an Interval History?
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: What does it mean when it says a code requires an “interval” history? This question related to the 1995/1997 […]
Physician Specialty Codes and Claims Processing
Specialty designation is determines how claims are processed for physician and non-physician practitioners in groups It is also important in crediting data using the E/M guidelines, developed in 2021 and expanded in 2023 When physicians enroll in Medicare, they self-elect their specialty designation. In the enrollment process, there are fields to indicate primary and secondary […]
Everyday Dermatology Coding
Everyday Dermatology Coding is a 52 page guide to coding dermatology services. This in-depth coding resource covers the following topics specific to dermatology: E/M MDM table, Dermatology E/M frequency, Common Dermatology procedures, modifiers and more.
Screening for Skin Cancer
Dermatologists frequently see patients for skin checks, to examine their skin for signs of pre-malignant or malignant lesions. Some of these patients have a personal history of malignant skin neoplasms, and some do not. The appointments may be scheduled annually or bi-annually. Will insurance pay for screening for skin cancer? Medicare and private insurances are […]
Diagnosis Coding for Dermatology
Diagnosis notes for dermatology Be sure to match the diagnosis to the procedure. For example, For skin tag removal, use skin tag For treatment of warts, use warts For excision of malignant lesions, use a malignant lesion code Describe conditions in the physical exam Only use diagnosis of “inflamed” seborrheic keratosis if the exam describes […]
Coding for Breast Procedures: Biopsy, Localization Devices, and Surgery
From biopsy to localization device to mastectomy, coding for breast procedures can be challenging. This article summarizes the rules related to these services. Fine needle aspiration of a breast mass, or aspiration of a cyst Fine needle aspiration (FNA) of a breast mass is reported with codes 10021—10012. CPT® developed new codes for FNA in 2019. […]
Screening Codes Guide – G0442, G0443, G0444, G0446, G0447
Medicare pays for some screening services for its beneficiaries, using HCPCS codes. These screening codes are time-based HCPCS codes with relatively low wRVU values and payment. This coding guide includes an explanation of the guidelines for each of these codes, and information about bundling, diagnosis coding, specialty and site of service restrictions, and much more.
Pre-operative Clearance in Primary Care
Primary care practices are frequently asked to do preoperative evaluations or clearances on their own patients by a surgeon. Although a routine history and physical mandated by the hospital is included in the surgical payment, patients may need an evaluation by their primary care clinician, a cardiologist, pulmonologist, or other practitioner prior to surgery. These […]
Repair (closure) CPT® 12001–13160
Laceration or wound repair codes are reported based on the type of repair (simple, intermediate, complex), the anatomic location, and the length The length of multiple lacerations of the same type and defined as the same anatomic location are summed and reported with a single CPT® code. For multiple lacerations of either different types or […]
Describe the Exam | E/M Services for Dermatology
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. What do you need to document for the exam? Although exam is not a key component in 2021 for codes […]
Coding for Mohs Micrographic Surgery
Mohs surgery is performed to remove complex or ill-defined skin cancer, and the procedure includes both the surgery and histopathologic examination. Both capacities are required in order to bill for these codes, and neither part may be delegated to another individual. Let’s look at the specific guidelines for coding for Mohs Micrographic Surgery: According to […]
Modifier 51 or 59? How to Know Which to Bill?
Modifier 51 and 59 are both used on second and subsequent surgical procedures, when performed on the day of a primary procedure See also Modifier 59 quick reference sheet There are two modifiers commonly used in surgical specialties when billing two or more procedures at the same encounter. Appending the correct modifier increases the likelihood […]
Shaving of Epidermal or Dermal Lesions
The chart below includes CPT® codes, and descriptions for shaving epidermal and dermal lesions. After the chart, there are important key points to keep in mind when using these codes. Code Description 11300 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less 11301 lesion diameter […]
Other Dermatologic Procedures
This aricle reviews the codes and guidelines for these dermatologic procedures; Intralesional injections, photodynamic therapy, phototherapy, and laser treatments. Intralesional injections Intralesional injections deliver a medication directly into a specific skin lesion, allowing the medication to be delivered over a period of time. Corticosteroids are common examples. Report either code 11900 for up to 7 […]
Quick Coding Reference Sheet – Hospitalists
This quick coding reference sheet is a must have when coding E/M services for hospitalists. It covers consults, initial and subsequent hospital visits, and observation.
Quick Coding Reference Sheet – Dermatology
This dermatology specific E/M reference sheet includes 1997 single specialty skin exam and medical decision making examples relevant to your specialty. A must have reference for physicians and staff coding for dermatology services!
Diagnosis Coding for Biopsy Sent for Pathology
Question: What diagnosis code should you use when sending a skin biopsy to pathology? a) D48.5 Neoplasm of uncertain behavior of skin, or b) D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
Coding for Destruction of Malignant Lesions
The primary factors in selecting a code for destruction of malignant lesions are: Selectd by size of lesion (not defect) Location Method is not a factor in code selection Report a code for each lesion treated Per Principles of CPT® Coding: “The destruction of malignant lesions is reported with codes 17260—17286. Similar to the codes […]
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