Accurately documenting and coding E/M services is critical to reducing compliance risk and maximizing revenue for the evaluation and management services your practitioners provide. This guide is specific to documenting and coding E/M for dermatology. History Component for Dermatology E/M services Definition History is one of the three key components (history, exam, and medical decision […]

Question: A CodingIntel member writes: “I am getting mixed information about incident-to and I was wondering if you could weigh in? If a NPP changes a medication dosage or medication type, but is treating the same problem, is this to be a change in treatment plan and would they bill under their NPI number. Or, […]

Checking my crystal ball, my guess is Friday, November 2. Late afternoon. CMS releases its final rule about 60 days before it goes into effect, and this rule’s effective date is January 1, 2019. We are anxiously awaiting their decision about the fate of E/M office codes, payment reduction when modifier 25 is on a […]

Question: For an established patient, if I don’t document a physical exam, am I required to say that the visit was a counseling visit and document time? Answer: No. And, it would be incorrect to do so, if counseling did not dominate the visit. Established patients require two of the three key components of history, […]

HCC diagnosis coding for depression can be confusing. This quick reference sheet simplifes the process with an easy to follow chart. Includes a handy reference to alternate descriptions listed in some EMR’s for relevant ICD-10 codes.

Originally published on kevinmd.com When I talk to medical practices about Hierarchical Condition Category (HCCs) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends. Let’s separate fact from fiction. Don’t miss our Billing Guide on Risk-adjusted Diagnosis Coding for an in-depth look at this topic. Urban […]

The information in this post applies to services provided PRIOR TO 1/1/2023 Coding for services done by hospitalists and other specialty physicians in the hospital can be confusing.  After watching these videos and downloading the guides, you’ll be confident that you are selecting the right category of code and level of service.  The third video […]

This updated quick reference sheet includes the description for Behavioral Health Integration and CCM codes codes, time requirements, reimbursement rates and more. Download the PDF – BHI and CCM Codes | Reference Sheet The CMS Final Rule released in November 2017 included new HCPCS codes for behavioral health management services, or behavioral health integration (BHI), […]

Coding. Why does it keep changing? The article you are looking for was out of date, and we removed it. May we suggest… Using Modifier 25 | Reference Sheet Modifier 25 CMS Physician Final Rule 2019     Back to blog   Relevant Search Terms: Proposed physician fee schedule rule, modifier 25, payment reduction, multiple […]

Recorded December 13, 2018 It’s our annual overview of new CPT® codes. Get up to speed on the new codes and 2019 CPT® coding changes. This is a broad overview of all of the changes, not an in depth exploration of any one area of the book. Have your CPT® book handy for this fast-paced […]

Recorded November 20, 2018 The wait is over! Hear what coding and payment policies CMS is implementing for January 1, 2019 and how they will affect your practice and your revenue. The Final Rule is released in early November and this year, we’ll hear CMS’s response and decisions about the Documentation Guidelines for office services […]

Recorded September 20, 2018 @ 12:00 pm (EST) Primary care practices can be reimbursed for the non-face-to-face work of caring for chronically ill patients using long-standing and new CPT® codes. However, practices must know the coding and documentation requirements before performing the services and submitting claims. This webinar will review the coding rules and provide […]

Question: Where does it say in CPT® that two physicians can’t bill for the same period of time when performing critical care? Answer: It doesn’t. This is a Medicare rule. There are two significant differences in critical care coding rules between CPT® and CMS. (Wouldn’t our lives be easier if they were the same?) The […]

Let me start with apologies for stealing Mark Twain’s words!  And, a quick search will show I’m not the only one to apply these words to fee-for-service medicine. Be sure to take a look at Five urban legends about risk-adjusted diagnosis coding after reading this post. Volume to value For years, we’ve been reading about […]

Question: Regarding non face-to-face prolonged care, does Medicare require start and stop times, they way they do for prolonged face-to-face care? As long as the provider documents the total time spent reviewing old records is sufficient to bill this service, am I correct? (Codes 99358, 99359) Note, beginning 1/1/2023 these codes have an invalid status indicator […]

Table of Contents Modifier introduction Initial evaluation – minor procedure E/M service same day Initial evaluation – major procedure Post-operative care CPT® modifiers Assistant at, co-surgery, team surgery HCPCS modifiers List of modifiers included Using CPT® and HCPCS code modifiers correctly is critical to ensure accurate and timely payment. Some modifiers bypass the claims editing […]

Recorded August 16, 2018 Some Fee Schedule rules are almost boring, but not this year! CMS is proposing significant changes to the payment of and documentation for new and established patient visits. This will be a sea change for most groups, particularly groups that use RVUs for physician compensation or that have coders coding all […]

CMS pays Medicare Advantage plans differentially based on Hierarchical Condition Category (HCCs). This coding model uses demographics and diagnoses to predict future health care costs for Medicare beneficiaries enrolled in a Medicare Advantage plan. Each year, Medicare announces what the rates will be and indicates any coding changes in the HCC model. Between 2017 in […]

Coding. Why does is keep changing? This post was out of date and has been removed. For information about E/M requirements, see these resources: E/M in 2019: A look ahead Everyday Coding for Medical Practices Documenting History Documenting Exam Or Browse the resource library by topic, keyword, or code Back to blog  

This reference is the companion resource for the webinar I presented in June with Edwin Knights, M.D., Improving the accuracy of your diagnosis risk scores. Members login to watch the webinar on-demand. Not a member? Learn how you can access the webinar. The handout includes: A quick comparison of fee-for-service vs. risk-adjusted diagnosis coding Explanation of risk […]

Question:  Are the surgeon’s subsequent hospital visits or office visits between their original consult and the final visit prior to surgery billable? This is not referring to a pre-op H&P or an extra visit to answer more questions from the patient and family members after the decision for surgery. Here’s the scenario. A surgeon evaluates a […]