Using time to select a level of service for office visit codes 99202—99215 Total practitioner time on the date of service  can be used to select one of these codes. Counseling and/or coordination of care no longer needs to dominate the service. See also When to use time to select an office visit code using the […]

Question: When can we start using the new E/M rules for new and established patient visits? And, are all payers going to follow them? Answer: The revised definitions for codes 99202—99215 are effective until January 1 2021. These new definitions are now in the 2021 CPT book. CMS and the AMA have joined hands (figuratively […]

CMS rescinds bundled payments for 2021 and accepts CPT® revisions for new and established patients Proposes new HCPCS codes for care management Outlines proposals to further ease burden of documentation As I work my way through the proposed rule, I’ll add new content at the top of this blog post.  The 2020 proposed physician fee […]

CMS released an NCD for ABPM on July 2, 2019. CMS has expanded the coverage for ABPM by allowing it for a greater range of BP measurements. Of course, there are limits or there wouldn’t be an updated coverage determination. Neither the CPT® nor the ICD-10 coding has changed, only the eligibility, expanding the covered […]

Group therapy Group psychotherapy is reported with code 90853. This is not a time-based code: one unit of service should be reported for each group member according to CPT®.  Group therapy typically lasts 45 to 50 minutes, and some payers set a limit at 12 participants.  Many payers require that the number of members in […]

CMS policy update: E/M services performed under the teaching physician rules Download this teaching physician rules quick reference sheet for a summary of the rules. The CMS rules got a major update with the April 26, 2019 Transmittal 4823. A transmittal is a communication from CMS to the Medicare Administrative Contractors. It is followed by […]

In psychiatry if reporting time-based psychotherapy services, the time of the attending physician is the time used to select the code. For psychiatry services that are not time based, the requirement for the presence of the physician may be met if the attending uses a one way mirror or video (not audio) equipment.  This concurrent […]

Question: We are having a disagreement in our coding department. Our cardiologist sees an inpatient at the hospital, but it’s a patient she knows from the office. Should she bill an initial hospital service code or a subsequent hospital service code when she sees this patient, who she knows and has seen many times? Answer: […]

CPT® has added 99491 to the section of chronic care management codes. The other code in this section is 99490 and there are two codes in the complex chronic care management section, 99487 and 99498. This article will discuss CPT® 99491. For in-depth information about existing codes, read our feature about chronic care management here on […]

Please see the Telemedicine article for the rules and guidelines for use during the COVID-19 public health emergency. Medicare covers some services performed via real-time audio and video between a patient in an underserved area and a physician or other practitioner who is not in the same place as the patient. Requirements for Medicare telehealth […]

Question: What are the review of system requirements when an annual physical (99381-99387, 99391-99397) is performed/billed by an OBGYN practitioner? Answer: These codes were revised in 2002, and CPT® stated that comprehensive as defined in the Documentation Guidelines doesn’t apply to comprehensive in these codes. In fact, the Documentation Guidelines never mention preventive services. The […]

There are several factors to consider when coding for destruction of benign and pre-malignant lesions. Let’s begin with a definition. From the CPT® book: “Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia and not usually requiring closure.” Start with location Mouth, eyelid or […]

Some Evaluation and Management codes, and some other codes are defined by the amount of time of the service. This article reflects the rules for using time in the 1995 and 1997 documentation guidelines, for all E/M services. In 2021, how to use time for office visit codes 99202-99215 will change. This article does not […]

Now that the dust has settled from the release of the Physician Fee Schedule Final Rule, maybe it’s time for a re-cap.  This article will also discuss CodingIntel’s survey results.  Thank you for taking the time to complete the survey. CMS postponed the most radical, jaw dropping proposals. In fact, CMS said that it would […]

Skin lesion excisions are reported using codes from the integumentary section: Excision of benign lesions: 11400—11471 Neoplasms Cicatricial (scars) Fibroma Cutaneous lipoma Inflammatory lesions Congenital lesions Cysts Excision of malignant lesions: 11600—11646 Neoplasms of skin (e.g., basal cell CA, squamous cell CA, melanoma) Key points Select the code based on the size of the excision, not the […]

Question: My question is regarding Anticoagulation Management Code 93793. Guidelines state that this code can be performed by a physician, NP, or PA. My question is, if clinical staff performs the service in the doctor’s office setting, can code 93793 be billed under the supervising physician’s name? Clinical staff: Sees the patient face to face […]

Question: I’ve been trying to figure out what the difference is between CPT® codes 99446 and 99451.  I finally found this in re-reading your article.  Is this the only difference between these 2 codes? For 99446, 99447, 99448, 99449, if greater than 50% is in data review and/or analysis, do not bill those codes; according […]

The most common use of modifier 58 in dermatology is for re-excision of a lesion because the margins weren’t clear, based on the pathology report. Benign and malignant excisional biopsies have a 10 day global period. If the patient returns for a re-excision, the same code may be reported again, or a code for a […]