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CPT® Coding - Articles

Billing 99211 Its not a freebie
November 9th, 2018 - BC Advantage
It seems like a simple code to bill, but CPT 99211 (established patient office visit) is by no means a freebie when it comes to documentation and compliance. This lowest level office visit code is sometimes called a "nurse visit" because CPT does not require that a physician be present...
Muscle Testing and Range of Motion Information
November 8th, 2018 - Wyn Staheli, Director of Research
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.
Medi-Cal Coverage Criteria for Hospital Beds and Accessories
November 7th, 2018 - Raquel Shumway
Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.
Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?
November 7th, 2018 - Wyn Staheli, Director of Research
The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...
Common Allergy CPT Codes and MUEs
October 30th, 2018 - Find-A-Code™
Below is a list of common CPT codes for Allergy and Immunology. Each code is listed with the following information: Medicare Unlikely Edits (MUEs) for both a Non-Facility (NF) and Facility (F) setting. Professional/Technical Component (PC/TC) Indicator. Key Indicator or Procedure Code Status Indicator, which is a Medicare assigned "Indicator" to each code in ...
Allergy Testing 10/29/2018
October 29th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Allergy testing may be performed due to exaggerated sensitivity or hypersensitivity.  Using findings based on the patient’s complaint and face-to-face exam. Testing may be required to identify and determine a patient's immunologic sensitivity or reaction to certain allergens using certain CPT codes.  According to CMS, LCD 33261, allergy testing can be ...
Q/A: What Codes do I use for CLIA-Waived Tests?
October 16th, 2018 - Wyn Staheli, Director of Research
Question: I am a certified DOT medical examiner and have applied to get my CLIA lab (waiver) for urinalysis, finger prick blood tests for A1c, cholesterol and glucose. I realize I cannot diagnose patients with these tests, but I am using them to make decisions in the DOT process and with ...
Pelvic Floor Dysfunction Treatment Coverage
October 16th, 2018 - Wyn Staheli, Director of Research
Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings. Coverage by payers ...
Prolonged Services Its Not Just About Time
October 5th, 2018 - BC Advantage
Time, as it applies to E/M codes, has often been viewed as an "if/then" proposition. "If" the documentation shows that a majority of the encounter was based on counseling and/or coordination of care, "then" we choose the highest level of service based on the total time of the encounter. However, a ...
The Potential Impacts of a Flat Rate EM Reimbursement on our Industry
September 26th, 2018 - BC Advantage
The proposed E&M changes by CMS would decrease provider administrative work burden by, per CMS, 51 hours a year; however, how will reducing documentation requirements truly affect the professionals of the healthcare industry? First, let’s discuss the 30,000-foot overview of the most impactful E&M changes—which is the change to the...
Rhizotomy Procedures
September 26th, 2018 - BC Advantage
The terms “rhizotomy” and “Radiofrequency Ablation” (RFA) both mean “destruction of a nerve.” Another term for this is “neurolysis.” The CPT coding choices for a rhizotomy procedure reflect the methods chosen to destroy the nerve(s). Nerve Destruction choices include the following: Chemical Neurolytic Blocks - These require substances that are...
Medicare Timed Codes Guidelines
August 16th, 2018 - Wyn Staheli, Director of Research
Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time. It should be noted that while ...
Are incident to services worth the risk
August 13th, 2018 - BC Advantage
Incident-to services allow non-physician practitioners (NPPs) such as nurse practitioners and physician assistants to bill under a supervising physician if they perform services that are incidental to a physician-created plan of care. Incident-to billing offers two key benefits: First, the physician is reimbursed at 100% of the contracted rate with...
When Medical Necessity and Medical Decision Making Don't Match
August 3rd, 2018 - BC Advantage
As coders and auditors, we are taught the documentation guidelines on how to determine medical decision making. However, Medicare is clear that medical necessity is what determines the overall payment. In order to know what to do when medical necessity and medical decision making do not line up, you must...
Provider-Based Facilities and Split Billing Is Your Facility Being Reimbursed for All Work Performed?
June 8th, 2018 - Sharon Hoglund, CPC, CPMA, CEMC, CEMA
Are you stumped by billing guidelines for provider-based facilities? Who bills for what and why? Read on to hear how a little extra time and effort spent on researching split billing coding guidelines can greatly impact your facility, and even your budget ensuring reimbursement for all services performed...
Q/A: Coding for Lesion Removal and Repair
June 5th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
The CPT book does not indicate repairs, measuring .5 cm and less, during lesion removal. Does this mean that...
AMA vs Medicare rules and the use of the PT modifier
May 22nd, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Be sure to review the specific payer policy you are submitting claims to. Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. The use of the PT modifier is ...
Q/A: Modifiers for Injections
April 17th, 2018 - Nicole Olsen QCC
I'm currently receiving a rejection for my billing with BCBS. We've entered 20550 and 20600 as services for the visit....
Q/A: Which Modifiers to Use When Billing 44005 and 36556 Together
March 26th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
I have a denial for 44005 and 36556 being billed together. I added modifiers 51, 59, and Q6 to 36556 but I am afraid it will deny again?
Q/A: Billing for GI Anesthesia
March 21st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary.
The Comprehensive Error Rate Testing Program
February 23rd, 2018 - Frank Cohen, MBA, MPA
With nearly a million physicians in this country, how do auditing organizations determine whom to audit?
Payment Rates Increase for Behavioral Health Office Services
February 13th, 2018 - Wyn Staheli, Director of Research
Behavioral health providers may see some improvement in payment rates for office-based behavioral health services. This is due to the fact that the overhead expense evaluation portion of the RVU was increased. The following information is from the Federal Register (see References): We agree with these stakeholders that the site of service ...
Medicare Requiring Modifier GP on Physical Therapy Services
February 1st, 2018 - Wyn Staheli, Director of Research
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following (emphasis added): Services furnished under the Outpatient ...
Multiple Diagnostic Imaging Payment Reduction
February 1st, 2018 - Wyn Staheli, Director of Research
CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ...
Strapping and Kinesio Taping Coding Differences
February 1st, 2018 - Wyn Staheli, Director of Research
There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally. Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue. Coding: ...
Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes
February 1st, 2018 - Find-A-Code
According to Noridian L35081, nerve conduction code 95905 does not have levels of supervision 21, 22, 6a, 66, 77 or 7a assigned to it and is therefore not allowed by Physical Therapists. Nerve conduction codes 95907-95913 had their Physician Supervision of Diagnostic Tests Indicators adjusted to 7A effective 01/01/2013 (CR 8169). Therefore, if authorized by state law, ...
Q and A: Coding Mixed Cardiogenic and Septic Shock
February 1st, 2018 - BC Advantage
Q: If the attending documented, "likely mixed cardiogenic and septic shock," can I assign codes R57.0 and R65.21? A: Refer to the documentation within the code book. If you open the book to the R57 code grouping (Shock not elsewhere classified) listed below there is an Excludes1 note. Remember,...
Influenza, Are You Billing Correctly?
January 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
With this year's Flu season being the most widespread on record, providers are seeing more patients and giving more immunizations for influenza than normal. Here are a few things to keep in mind during this flu season.  Know the rules with your payers to ensure proper reimbursement and correct billing. For example, did you ...
Non-Coronary Vascular Stents: Mesenteric Vessels
January 29th, 2018 - Find-A-Code
The following information is according to Novitas Solutions L35084. Mesenteric vessels: This includes Acute mesenteric ischemia Chronic mesenteric ischemia Mesenteric thrombosis Dissection or any other vascular insufficiency resulting in gastrointestinal symptoms Stenting of the mesenteric vessels is covered only when angioplasty of the vessels would not suffice and after the patient has had a thorough medical evaluation and management of symptoms, and for whom surgical intervention is the likely ...
Paravertebral Joint/Nerve Blocks - Diagnostic and Therapeutic
January 29th, 2018 - Find-A-Code
According to Medicare article A50443, a facet joint level refers to the zygapophyseal joint or the two medial branch nerves innervating that zygapophyseal joint. Use CPT codes 64491 and 64492 in conjunction with 64490. Do not report CPT code 64492 more than once per day. Use CPT codes 64494 and 64495 in conjunction with 64493. Do not report CPT code 64495 more than once per day. For injection of ...
Psychiatric Partial Hospitalization Programs
January 25th, 2018 - Wyn Staheli, Director of Research
Psychiatric Partial Hospitalization Programs (PHPs) are a more comprehensive level of care than Intensive Outpatient Programs (IOPs - click here to read more about IOPs). When the patient requires a minimum of 20 hours per week and hospitalization is not clinically indicated, a PHP can be the most effective type of ...
Medicare Requiring Specific Modifiers on Therapy Services
January 15th, 2018 - Wyn Staheli, Director of Research
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following: Services furnished under the Outpatient ...
Paravertebral Joint/Nerve Denervation
January 10th, 2018 - Find-A-Code
A facet joint is supplied by two medial branch nerves. Each medial branch nerve supplies sensation to one half of each facet joint above and below the spinal nerve of origin. Therefore, both of the two related medial nerve branches for each facet joint must be treated. The CPT codes 64635-64636 have a ...

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Understanding ASC Pricing
November 22nd, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
ASCs (Ambulatory Surgical Centers) have a separate fee schedule with a base allowed amount that is adjusted for each state using Core Based Statistical Areas (CBSA). Under the ASC payment system, Medicare pays facilities for specific ASC covered surgical procedures, however, there are only certain types of procedures that are eligible for payment ...
So, How Do You Decide if a Service was Provided?
October 13th, 2017 - David Glaser, JD
An earlier coding tip explained that the oft-repeated "if it isn't written, it wasn't done" is good risk management advice, but not a legal truism.....
E&M Guidelines with NGS is Not Mandatory
September 20th, 2017 - Chris Woolstenhulme, CPC, CMRS
Changes with the 1995 Documentation Guidelines for Evaluation and Management services, is not considered mandatory. NGS had originally planned a change in examination requirements for Expanded Problem Focused and Detailed levels of service. The decision to not mandate the changes was due to feedback and multiple provider queries from NGS providers. All medical records that are reviewed will be ...
Global Surgical Package: When to Bill and When Not to Bill, that is the Question
September 8th, 2017 - Stephanie Allard, CPC, CEMA, RHIT
The global surgical package is inclusive of the services that would normally be provided to the patient following surgery. Depending on the global period assigned to a CPT code, the pre-operative, intra-operative and post-operative services could be included in the global surgical package.....
The Incredible Disappearing Consultation
August 18th, 2017 - J. Paul Spencer, CPC, COC
In January of 2010, CMS ceased payment of CPT codes for consultations (99241 through 99245 for outpatient, and 99251 through 99255 for inpatient).
How to Bill a Dressing Change
August 1st, 2017 - Chris Woolstenhulme, CPC, CMRS
A dressing change may not be billed as either a debridement or other wound care service under any circumstance (e.g., CPT 97597, 97598, 97602). Medicare does not separately reimburse for dressing changes or patient/caregiver training in the care of the wound. These services are reimbursed as part of a billable procedure code that, commonly but not necessarily, ...
Auditing Vaccines
July 28th, 2017 - Paul Chandler
Auditing vaccines can be difficult, as precise attention needs to be paid to the documentation to extract all variables needed for proper coding.
Telemedicine: The Next Frontier in Care Delivery
July 7th, 2017 - Valora Gurganious, MBA, CHBA
Technology is ubiquitous in modern society, and just when we thought that computers could not replace the "human touch" of a healthcare provider, technology is making specialized care accessible to patients anywhere there is an internet connection.
Auditing Incident-to Services
June 16th, 2017 - Michael Miscoe, Esq.
To effectively audit incident-to services under Medicare, the auditor must first have an operational understanding of the rule. Unfortunately, this is not as easy as it sounds. Auditors must also understand that the incident-to rule is a Medicare only rule. This is one area where the maxim "if you are ...
Excluded from the Global OB Package
April 6th, 2017 - Chris Woolstenhulme, CPC, CMRS
First three antepartum E&M visits Laboratory tests Maternal or fetal echography procedures (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, 76821, 76825, 76826, 76827 and 76828) Amniocentesis, any method (CPT codes 59000 or 59001) Amniofusion (CPT code 59070) Chorionic villus sampling (CPT code 59015) Fetal contraction stress test (CPT code 59020) Fetal non-stress test (CPT code 59025) External cephalic version (CPT code 59412) Insertion of cervical dilator (CPT code 59200) more than 24 hr before delivery E&M services which is unrelated ...
E/M Table of Risk
March 29th, 2017 - Wyn Staheli
The final sub-component of Medical Decision Making is the Risk of Significant Complications, Morbidity and/or Mortality. The following is the official Evaluation and Management Table of Risk. The level is selected by choosing one element from three criteria (Presenting Problem, Diagnostic Procedures Ordered, and Management Options), with the highest level selected ...
2014 brings big volume of changes to CCI edits
March 29th, 2017 - Find-A-Code
Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year. There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes....
Acute Postoperative Pain Management
March 20th, 2017 - Wyn Stahel
Caution needs to be observed when reporting post-operative pain management (POPM). In accordance with NCCI edits policies, postoperative pain management is considered bundled in the surgical code(s). There are only a few instances where it may be billed separately. Medicare Global Surgery Rules prevent separate payment for postoperative pain management when ...
Endocervical Curettage and Colposcopy
March 7th, 2017 - Chris Woolstenhulme, CPC, CMRS
If you are coding for endocervical curettage only, use 57505 "Endocervical curettage (not done as part of a dilation and curettage)." If an endometrial sampling (biopsy) was performed in conjunction with a colposcopy, use 57420 "Colposcopy of the entire vagina, with cervix if present," 57421 for "with biopsy(s) of vagina/cervix, or 57452-57461 for "colposcopy of the cervix including upper ...
Menstrual Migraine Coding
March 7th, 2017 - Chris Woolstenhulme, CPC, CMRS
When coding chronic migraines related to menstrual cramps, you must document that the patient has menstrual migraines. With ICD-10 there are a variety of migraines, including those that are neurologic, abdominal, and ophthalmologic based. You must also document whether the menstrual migraine (G43.82- and G43.83-) is intractable or not intractable, including ...
Using Add-On Codes
March 3rd, 2017 - Chris Woolstenhulme, CPC, CMRS
There are certain procedures that are carried out in addition to the primary procedure called add-on codes. They describe a specific type of supplemental procedure done in addition that are labeled as add-on codes. The AMA gives instructions and guidelines with notations such as "List separately in addition to primary procedure" or ...
Using Modifier EY
March 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Some Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items require a detailed Written Order Prior to Dispensing (WOPD), while others require a Detailed Written Order (DWO) prior to billing. The specific requirements for an order are specified in the Medical Policy (Local Coverage Determination and/or Policy Article) for the ...
Care Plan Oversight Services
March 1st, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Care Plan oversight services is commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other health care professional within a 30-day period. G0179 MD re-certification HHA PT May be ...
Using Time Span Codes
February 24th, 2017 - Find-A-Code
The date of service (DOS) is the reference point for determining the frequency of code submission and subsequent reimbursement during that period, generally if the service was provided in a different calendar month, the service would qualify for reimbursement. Modifiers will not override a time span code if it is billed with ...
Coverage and/or Medical Necessity for the Use of Hyaluronan or Derivitive
February 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Verify your local coverage determination and medical necessity requirements for the following codes: Hyaluronate Polymers (L33432) - Noridian Medicare J7320 - Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg J7321 - Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose J7322 - Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg J7323 - Hyaluronan or ...
Anesthesia Code Changes in 2017- Epidural Steroid Injections (ESI)
January 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
Pay close attention to the new 2017 Anesthesia codes there are a few notable changes. There is a new code set for Epidural Steroid Injections (ESI). The difference in the new codes set has a clear distinction on a single injection or a catheter placement for continuous infusion/intermittent bolus and if ...
New and Deleted Angioplasty Codes for 2017
January 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
The following codes have been Deleted as of January 01, 2017 35450   Transluminal balloon angioplasty, open; renal or other visceral artery 35452   Transluminal balloon angioplasty, open; aortic 35458   Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel 35460   Transluminal balloon angioplasty, open; venous 35471   Transluminal balloon angioplasty, percutaneous; renal or visceral artery 35472   Transluminal balloon angioplasty, percutaneous; aortic 35475   Transluminal balloon angioplasty, percutaneous; ...
New and Deleted Drug Screen codes for 2017
January 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
Deleted Codes for Drug Screening, the following codes are no longer valid for services performed on or after January 01, 2017. Deleted Codes for 2017 80300   Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical ...
Sleep Studies: Billing with Reduced Hours
January 12th, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
When using codes 95800, 95801, 95806, 95807, 95810, and 95811, and fewer than six hours of recording is performed, you must report the reduced services using modifier 52. Also, when using 95782 and 95783, and fewer than seven hours of recording is performed, modifier 52 would be appended to the appropriate code. 95805 would require modifier 52 if fewer than four hours of recording is performed. Medicare recognizes the ...
NAMAS: 2017 CPT Updates Bring Big Changes to Physical Therapy
December 16th, 2016 - Find-A-Code
For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The...
Billing for Prosthesis Designed and Prepared by the Dentist
December 6th, 2016 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For maxillofacial services, if a prosthesis is provided, and is designed and prepared by the dentist, the Medicare Part B carrier may be billed with CPT codes 21076 through 21089. If the prosthesis is prepared by an outside laboratory, the laboratory bill goes to the Durable Medical Equipment Regional Carrier (DMERC), with Level ...
E/M 101
November 29th, 2016 - BC Advantage
E/M stands for "evaluation and management". E/M coding is the process by which provider-patient encounters are translated into five digit CPT codes to facilitate billing. CPT stands for "current procedural terminology." These are the numeric codes which are submitted to insurers for payment. Most billable procedures have their own CPT ...
You can charge for Advanced Care Planning (ACP)
October 5th, 2016 - Chris Woolstenhulme, CPC, CMRS
Did you know you could be charging for Advanced Care Planning (ACP). Effective January 1, 2016, payment for the service described by CPT code 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or ...
Visual Field Examination
August 10th, 2016 - Chris Woolstenhulme, CPC, CMRS
The following information from one Medicare payer includes indications and limiatations of coverage as well as Medical Necessity standards for visual field examinations. 92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or ...
How do I tell if a code is defined as unilateral or bilateral
August 3rd, 2016 - Codapedia
There are some procedures which are defined as unilateral procedures, and some defined as bilateral procedures. If the procedure is defined as unilateral but performedbilaterally, then the physician is paid 150% of the fee schedule amount when performed on both sides. If the code is defined as bilateral, there is...
Coding Selective and Non Selective Catheter Placement of Lower Extremity
July 29th, 2016 - Codapedia
- In diagnostic catheterization, codes are given simply at the final position of the catheter. This can be simply understood if we know the anatomy of Aorta. As we know, most of the major arteries arise from Aorta for example, Inominate artery, Left common carotid artery, Left subclavian artery, celiac...
Modifier 52 vs. 53
December 29th, 2015 - Seth Canterbury, CPC, ACS-EM
So you’ve read the descriptions for both Modifiers 52 and 53, but you’re still on the fence as to which one is appropriate for a certain surgical case. This brief article will try to better differentiate between these two often-confused modifiers. Modifier 53 is appropriate when a...
Doing--and coding--for minor procedures in primary care
December 29th, 2015 - Codapedia Editor
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What Does It Mean To Scrub An Insurance Claim?
December 29th, 2015 - David Greene, MD
During the rigorous training physicians undergo to learn their craft, very little education is received on how to deal with submitting claims to insurance companies. It’s unfortunately a necessary evil, as surgeons who contract with insurance companies rely on that reimbursement as the...
Reporting Administration Codes with Vaccines
December 29th, 2015 - Allison Singer, CPC
When it comes to billing for vaccines, the rules for reporting administration codes can be tricky. Reporting the right vaccine code alone is not enough to guarantee proper billing. Most billing scenarios allow providers to charge for both the vaccine product and the administration of the vaccine...
Coding Excisions and Wound Repairs
October 15th, 2015 - Allison Singer, CPC, CPMA
Chart audits frequently examine coding associated with lesion removals and wound repairs. In order to assign the appropriate procedure code, certain documentation must be included in the medical record, such as lesion type, excision size, wound repair, and location. Without these important details,...
Subsequent Observation Services
October 15th, 2015 - Codapedia Editor
CPT® released three new E/M services in 2011, to be used for the second and subsequent days that a patient is in observation status in the hospital. The codes are 99224--99226 and they are out of sequence in the CPT® book. They require the same level of documentation as the three...
How to research coding questions
June 1st, 2015 - Christina Benjamin
How to Research Answers to Coding Questions Perform a search of the discussion board or listserv website prior to posting a new question. For your search terms, include specific words such as the diagnostic statement or procedure statement or the specific code number or ...
Category of Code Selection
March 17th, 2015 - Codapedia Editor
Does anyone remember the good old days, when you didn't need to know the patient's insurance to select a category of code? Now, correct selection of an E/M category of code requires the clinician and coder to consider: Where the service was performed The status of the patient...
Don’t expect to see payment any time soon for ‘telephone consults’
October 15th, 2014 - Scott Kraft
Four new CPT® codes that got some attention when the 2014 CPT® changes were released late last year were a new E/M code series, 99446-99449, designed to be reported when a consulting provider offered a telephone or Internet E/M service that included a verbal and written report back to the...
Who Qualifies for TCM Services?
April 22nd, 2013 - Lacy Gaskins
Any patient post-discharge whose medical and/or psychosocial problems are complex enough to require TCM services qualifies for these codes. Here are the specifics:   1. Location: “TCM is for higher-risk patients being discharged from an inpatient or observation status to their home, rest home,...
Clear the Smoke on Debridement and Active Wound Care Codes
January 5th, 2011 - Jennifer Schmutz
Confused about when to choose a debridement code and an active wound code? CPT® 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth. “Depth is the...
CPT® Consult Rule Changes for 2010
November 2nd, 2009 - Codapedia Editor
By now you've heard the news that starting January 1, 2010, Medicare will no longer reimburse consultation services billed with codes 99241--99245, 99251--99255. But, the consult codes remain in the CPT® book for 2010. However, there is quite a bit of new editorial material related to...
Prolonged Services in an inpatient setting
July 31st, 2009 - Codapedia Editor
This article will describe the coding for using prolonged services in an inpatient setting. The codes are 99356: Prolonged physician service in the inpatient setting, first hour and 99357 each additional 30 minutes. See the CPT® book for the complete descriptions. These codes are used as add...
What is an Incomplete Colonoscopy?
June 12th, 2009 - Alyce Kalb
A complete colonoscopy according to Current Procedural Terminology published by the AMA is: “Colonoscopy, flexible, proximal to the splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate...
Laparoscopic procedure without a code
May 11th, 2009 - Codapedia Editor
Do not use the open code for procedure when performing the service laparoscopically. Use an unlisted code if none exists. Contact your medical society and the CPT® committee to describe the service and advocate for a code. Here is Nancy Maguire's response to this question on the Q&A...
ROS Checklist
April 22nd, 2009 - Rikki Runyon
Review of Systems CHECKLIST: -General- ? Weight loss or gain ? Fatigue ? Fever or chills ? Weakness ? Trouble sleeping ----------------------------------------------------------------------------------- -Skin- ? Rashes ...
How do I submit a question to CPT® Assistant/AMA?
April 10th, 2009 - Christina Benjamin
I contacted AMA when they first started promoting their CPT® Network and offering a 30-day free trial access to it and they gave me the following information: 1. As a CPT® Assistant subscriber, if I have a question that is directly related to CPT® Assistant, they will answer...
How to submit a question to CPT® Assistant/AMA?
April 3rd, 2009 - Christina Benjamin
1. As a CPT® Assistant subscriber, if you have a question that is directly related to CPT® Assistant, they will answer it. Questions can be e-mailed to with subject - call for letters and to attention of Gloria Green per the CPT® Assistant. They ask that...
Using Modifer -59
March 31st, 2009 - Crystal Reeves
By Crystal Reeves, CPC, CMPE, Principal Modifier -59 is probably one of the most misunderstood, misused, and most-feared of all CPT® modifiers. Some practices avoid using it all together because they don’t want to be guilty of unbundling. Some practices do not use it because they are not...
Modifier 79
March 18th, 2009 - Codapedia Editor
Modifier 79 is used to indicate that the physician performed a surgical service that required a return trip to the OR for an unrelated problem during the global post op period. Modifier 79 is appended to procedures. See the CPT® book for the complete definition. It is appended when: A...
Visual Acuity Screening
March 12th, 2009 - Codapedia Editor
Many physician practices are denied by third party payers when billing for a visual acuity test with a well child visit. The code for visual acuity testing is 99173. See the CPT® book for a complete definition of this code. This is a screening test of visual acuity, quantitative, bilateral,...
Modifier 21
March 4th, 2009 - Codapedia Editor
Modifier 21 was deleted from the 2009 CPT® book. It was a modifier that was not recognized by many payers, and did not give the practice any additional payment. See the add on, prolonged services codes 99354--99357 to report prolonged services. See the Codapedia articles about this topic.
Nurse visit and flu shots
February 18th, 2009 - Codapedia Editor
Both CPT® and CMS (Medicare) has made it clear that it is not appropriate to report a nurse visit when giving a flu shot. That is: do not bill a nurse visit when the patient presents to the office for a flu shot. Bill only for the administration of the vaccine and for the serum, if the...

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