These quick reference sheets for evaluation and management services cover inpatient and outpatient consults, and inpatient and subsequent hospital services. Specifically for psychiatry, this essential resource includes: CPT® codes for each of the above categories, documentation requirements, MDM examples, and more…
This Practice Paid Medicare $4.48 Million
Do you sign up for email lists and then wonder why you did it? We all do, don’t we? But, one email I always read is from the Department of Justice that links to a description of actions, settlements and indictments related to health care billing and coding A few years ago, an Orthopedic practice […]
Modifier 57
Decision for Surgery. An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service. The payment for major surgery includes E/M services provided on the day of and the day before a major surgical procedure, unless it […]
Medical Decision Making | 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 Medical decision making (MDM) is one of the three key components of evaluation and management services. (Make sure you read about […]
Modifier 24
Understanding E/M modifiers is important for both revenue and compliance. Failing to apply the correct modifier reduces revenue. Applying the wrong modifier or using it when it is not accurate is a compliance issue and puts the practice at risk for payback and disclosures. For additional information, see the article on Global Surgical Package. Modifier […]
Moderate or High MDM – General Surgery
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. Examples of Moderate MDM: Codes: Consult, 99244, Initial hospital 99222, Initial OBS 99219, 99235, ED 99284 Patient presents with a […]
Coding Guide – Global Surgery
This guide from CodingIntel explains surgery coding guidelines and the global period for procedures, and includes the contents of our original CPT® and HCPCS Modifier Guide.
Teaching Physician Rules and Surgical Procedures
The teaching physician rules describe a payment method by which Medicare pays an attending physician or teaching physician for services performed jointly with an intern, resident, or fellow, in an approved graduate medical education program (GME). The teaching physician’s presence and participation is required. The rules regarding participation and documentation vary by the type of […]
Certification for Home Health Services
There are two HCPCS codes that physician, nurse practitioners, clinical nurse specialists and physician assistants can use to report developing a plan for a Medicare patient who requires home health services. The CARES Act passed in March 2020 permanently allows nurse practitioners, clinical nurse specialists and physician assistants to certify and re-certify Medicare covered home […]
Quick Coding Reference Sheet – General Surgery
This quick reference sheet is packed with useful information. It covers consults, initial and subsequent hospital visits, and observation. Specifically for general surgery, it includes: CPT® codes for each of the above categories, documentation requirements, MDM examples, and more…
Excision of Soft Tissue, Lipoma Removal
This chart is a quick reference for soft tissue excision. It includes anatomic location and size for subcutaneous and subfacial excisions.
Excision of Benign or Malignant Lesions
This article reviews codes and guidelines for excision of skin lesions. For more information about minor procedures, see additional resources at the bottom of this page. This article includes: CPT® Codes for Excision Excision of Benign Lesions Excision of Malignant Lesions Excision of Soft Tumors Reporting Excision of Multiple Lesions of the Same Size Coding […]
How Physician Services are Paid – Infographic
CPT® codes, HCPCS, modifiers, global surgical packages, CMS formulas, diagnosis codes, location, and more…how do all these pieces come together for medical reimbursement? This helpful infographic from CodingIntel shows how physician services are paid with proper medical billing and coding.
Surgical Modifiers
This article includes: Surgical modifiers with definitions Guidelines for billing multiple surgical procedures Modifiers in the post-op period Avoiding CPT® modifier mishaps Citations Members can also download the Global Surgery Coding Guide. Some of the information in this article and in the billing guide is the same. Billing for Surgical Services Before submitting a claim […]
Definitive Guide to Documenting Time | Reference Sheet
Office visits, inpatient care, prolonged services, critical care…properly documenting time can help ensure that you receive the maximum allowable payment for the time you spent with the patient. Use this handy reference guide to make sure your documentation includes all the necessary components.
Can I Get Paid for…an Office Visit the Same Day as a Minor Procedure
Can you bill an E/M service on the same day as a minor procedure? Sometimes yes, sometimes no. The decision to perform a minor procedure is included in the payment for the procedure, unless a significant and separate E/M is needed, performed and documented. Watch this short video to learn more.
Can I Get Paid for…My Nurse Doing Ear Lavage
The nurse flushed the patient’s ear so I could examine the TM. Free or Fee? Find out more about billing for ear lavage done by nursing staff in this brief video. Back to list Relevant Search Terms: 69209, 69210, cerumen, removal, irrigation, ​
Can I Get Paid for…Signing the Home Health Certification Form
An Overview of Home Health Certification CPT® CMS pays a small fee for the planning, certification, supervision and re-certification of home health services. Don’t do the work and forget to get paid. Find out more about getting paid to sign the home health certification form in this brief video from CodingIntel dedicated to home health […]
Can I Get Paid for…a Problem Oriented Visit and Wellness Visit on the Same Day
Patients who come into the office for a physical or wellness visit often have a problem they want to discuss, or chronic conditions that need to be assessed and managed. Whether the patient is receiving a preventive medicine service or a Medicare wellness visit, the decision is the same. Report both services when the practitioner […]
Can I Get Paid for…Evaluation Prior to Surgery
The surgeon evaluates a patient, and determines that surgery is needed. Can the surgeon get paid for this initial service? Watch this short video about billing for evaluation prior to surgery. See also modifier 57. Back to list Relevant Search Terms: modifier 57, global surgical package, global surgery
Non-Face-to-Face Prolonged Service – 99358
This article covers: CPT® Rules for Prolonged Care Non-Face-to-Face Using 99358 for Phone Calls There are two time-based CPT® codes for non-face-to-face prolonged care services. These codes may not be used on the day of an Evaluation and Management (E/M) service, such as an office visit or hospital service. Physicians and other qualified health care […]