Primary Care Coding Alert
News You Can Use:
Keep Coding Current With Our 2020 PFS Primer
E/M revisions continue apace, while PCM gets a much-needed introduction. More evaluation ... Read more
Keep Coding Current With Our 2020 PFS Primer
E/M revisions continue apace, while PCM gets a much-needed introduction. More evaluation ... Read more
Year in Review:
Revisit These 3 Key Decisions, Refresh Your 2019 Coding Knowledge
CPT®, CMS continue to move forward on telemedicine, E/M revisions. The year 2019 can be ... Read more
Revisit These 3 Key Decisions, Refresh Your 2019 Coding Knowledge
CPT®, CMS continue to move forward on telemedicine, E/M revisions. The year 2019 can be ... Read more
E/M Coding:
Get Answers to All Your NOPP Questions With This FAQ
Use this guide, understand how presenting problems relate to E/M levels. Whenever you cal... Read more
Get Answers to All Your NOPP Questions With This FAQ
Use this guide, understand how presenting problems relate to E/M levels. Whenever you cal... Read more
Reader Question:
Work This Additional Info Into Your E/M Know-How
Question: If our provider orders labs for anemia, and we get the lab results the following... Read more
Work This Additional Info Into Your E/M Know-How
Question: If our provider orders labs for anemia, and we get the lab results the following... Read more
Reader Question:
Observe This Unusual Inpatient Scenario Coding Solution
Question: One of our physicians admitted a patient to hospital after an evaluation and man... Read more
Observe This Unusual Inpatient Scenario Coding Solution
Question: One of our physicians admitted a patient to hospital after an evaluation and man... Read more
Reader Question:
Use This Dx in This Positive Drug Screen Scenario
Question: What diagnosis code should I assign to an 80305 urine test after a patient tests... Read more
Use This Dx in This Positive Drug Screen Scenario
Question: What diagnosis code should I assign to an 80305 urine test after a patient tests... Read more
You Be the Coder:
Educate Yourself on These DSMT Guidelines
Question: We have a nurse practitioner (NP) in our office that offers diabetes education. ... Read more
Educate Yourself on These DSMT Guidelines
Question: We have a nurse practitioner (NP) in our office that offers diabetes education. ... Read more
ICD-10 Coding:
Use This Advice to Determine Eating Disorder Dx
Avoid these common F50/R30 errors for precision coding. You may be familiar with the most... Read more
Use This Advice to Determine Eating Disorder Dx
Avoid these common F50/R30 errors for precision coding. You may be familiar with the most... Read more
Coding Quiz:
Take This Quiz, Extend Your Non-Face-to-Face Prolonged Service Knowledge
And code this scenario to become a 99358/+99359 master. If you've ever been confused abou... Read more
Take This Quiz, Extend Your Non-Face-to-Face Prolonged Service Knowledge
And code this scenario to become a 99358/+99359 master. If you've ever been confused abou... Read more
Case Study Corner:
Can You Code These Sinusitis Encounters?
Know how to code the condition while active, when resolved. A 59-year-old male patient re... Read more
Can You Code These Sinusitis Encounters?
Know how to code the condition while active, when resolved. A 59-year-old male patient re... Read more
Coding Quiz Answers:
Check Your Answers to Our Non-Face-to-Face Prolonged Service Coding Quiz
Once you've answered the quiz questions, compare your answers with the ones provided below... Read more
Check Your Answers to Our Non-Face-to-Face Prolonged Service Coding Quiz
Once you've answered the quiz questions, compare your answers with the ones provided below... Read more
Reader Question:
Link Encounter Code With Procedure When Performed
Question: Our provider saw a patient who had not seen a doctor in years and who wanted to ... Read more
Link Encounter Code With Procedure When Performed
Question: Our provider saw a patient who had not seen a doctor in years and who wanted to ... Read more
Reader Question:
Solve This Incident-To UTI Puzzle
Question: If a patient is being treated by a doctor for recurrent urinary tract infections... Read more
Solve This Incident-To UTI Puzzle
Question: If a patient is being treated by a doctor for recurrent urinary tract infections... Read more
You Be the Coder:
Understand These Medicare Colonoscopy Criteria
Question: What documentation do we have to provide for a Medicare patient to justify a scr... Read more
Understand These Medicare Colonoscopy Criteria
Question: What documentation do we have to provide for a Medicare patient to justify a scr... Read more
News You Can Use:
Get Your First Look at the CPT® Revisions for 2020
New vaccine codes, tweaks to ABPM and virtual E/Ms to take effect January 1. As you would... Read more
Get Your First Look at the CPT® Revisions for 2020
New vaccine codes, tweaks to ABPM and virtual E/Ms to take effect January 1. As you would... Read more
E/M Coding Update:
Know How to Manage These New, Revised E/M Codes
Online E/M, monitoring codes to change in the New Year. Beginning on January 1, 2020, you... Read more
Know How to Manage These New, Revised E/M Codes
Online E/M, monitoring codes to change in the New Year. Beginning on January 1, 2020, you... Read more
Condition Spotlight:
Follow This Step-By-Step Guide for Perfect Prediabetes Coding
Distinguish between tests, Dx codes, with these pro coding tips. When the Centers for Dis... Read more
Follow This Step-By-Step Guide for Perfect Prediabetes Coding
Distinguish between tests, Dx codes, with these pro coding tips. When the Centers for Dis... Read more
Reader Question:
Avoid This Code for Male Estrogen Excess
Question: Our provider diagnosed a male patient with estrogen excess and used E28.0 for th... Read more
Avoid This Code for Male Estrogen Excess
Question: Our provider diagnosed a male patient with estrogen excess and used E28.0 for th... Read more
Reader Question:
Stay in Control of This Diabetes Diagnosis
Question: One of our doctors provided the following diagnosis for a diabetic patient: “p... Read more
Stay in Control of This Diabetes Diagnosis
Question: One of our doctors provided the following diagnosis for a diabetic patient: “p... Read more
Reader Question:
Establish This Rule for New Provider's Patients
Question: A new provider has just joined our practice, and a number of patients that had b... Read more
Establish This Rule for New Provider's Patients
Question: A new provider has just joined our practice, and a number of patients that had b... Read more
You Be the Coder:
Get Physical With Private Payer Policy to Clear Up Code Confusion
Question: We have a patient who is a pilot, and per Federal Aviation Administration (FAA) ... Read more
Get Physical With Private Payer Policy to Clear Up Code Confusion
Question: We have a patient who is a pilot, and per Federal Aviation Administration (FAA) ... Read more
News You Can Use:
Get Ready for These 4 Big Potential Changes to Care Management
PFS proposal includes TCM, CCM, complex CCM overhaul and introduction of PCM. On July 29,... Read more
Get Ready for These 4 Big Potential Changes to Care Management
PFS proposal includes TCM, CCM, complex CCM overhaul and introduction of PCM. On July 29,... Read more
Procedure Coding Update:
Expand Your Understanding of Medicare ABPM Coverage
NCD updates criteria, thresholds for hypertensive beneficiaries. On July 2, the Centers f... Read more
Expand Your Understanding of Medicare ABPM Coverage
NCD updates criteria, thresholds for hypertensive beneficiaries. On July 2, the Centers f... Read more
Guidelines:
Include Excludes Instructions in Your Dx Coding Knowledge
Know when, when not, to “code here.” “If you are confused about the Excludes notes ... Read more
Include Excludes Instructions in Your Dx Coding Knowledge
Know when, when not, to “code here.” “If you are confused about the Excludes notes ... Read more
Reader Question:
Note This Advice for Flawless Flushing Dx
Question: Our physician just saw a 39-year-old female patient and gave a diagnosis of hot ... Read more
Note This Advice for Flawless Flushing Dx
Question: Our physician just saw a 39-year-old female patient and gave a diagnosis of hot ... Read more
Reader Question:
Know These Definitions for Medical Necessity
Question: My practice has had a couple of claims denied. The payers said the services... Read more
Know These Definitions for Medical Necessity
Question: My practice has had a couple of claims denied. The payers said the services... Read more
Reader Question:
Resolve This Condition Conclusion Coding Conundrum
Question: One of our patients was admitted to the emergency room (ER) for cellulitis, then... Read more
Resolve This Condition Conclusion Coding Conundrum
Question: One of our patients was admitted to the emergency room (ER) for cellulitis, then... Read more
You Be the Coder:
Use Provider Documentation Only to Code Acute, Chronic Conditions
Question: When should I code for an acute form of a condition as opposed to a chronic form... Read more
Use Provider Documentation Only to Code Acute, Chronic Conditions
Question: When should I code for an acute form of a condition as opposed to a chronic form... Read more
News You Can Use:
Look for These New Pressure Ulcer, Injury, Encounter ICD-10-CM Codes
This year's diagnosis code revisions won't hurt a bit. The good news about this year's IC... Read more
Look for These New Pressure Ulcer, Injury, Encounter ICD-10-CM Codes
This year's diagnosis code revisions won't hurt a bit. The good news about this year's IC... Read more
ICD-10 Update:
Prepare for These Changes in Circulatory Disease Codes
New codes, notes, in store for Chapter 9. The 2020 edition of ICD-10-CM features some big... Read more
Prepare for These Changes in Circulatory Disease Codes
New codes, notes, in store for Chapter 9. The 2020 edition of ICD-10-CM features some big... Read more
Case Study Corner:
Code This Counseling Encounter Correctly, Curb Claim Confusion
And don't forget to tell the full story with additional encounter codes. A provider meets... Read more
Code This Counseling Encounter Correctly, Curb Claim Confusion
And don't forget to tell the full story with additional encounter codes. A provider meets... Read more
Reader Question:
Monitor the Answers to This Blood Pressure Encounter
Question: A patient came in and picked up our 24-hour blood pressure monitor. He came back... Read more
Monitor the Answers to This Blood Pressure Encounter
Question: A patient came in and picked up our 24-hour blood pressure monitor. He came back... Read more
Reader Question:
Test Your Knowledge of CMP Result Reporting
Question: What is the correct diagnosis code to use when a patient's aspartate aminotransf... Read more
Test Your Knowledge of CMP Result Reporting
Question: What is the correct diagnosis code to use when a patient's aspartate aminotransf... Read more
You Be the Coder:
Don't Let These Codes Come Back to Bite in This Tick Scenario
Question: A patient came in to see our physician after being bitten by a tick. The patient... Read more
Don't Let These Codes Come Back to Bite in This Tick Scenario
Question: A patient came in to see our physician after being bitten by a tick. The patient... Read more
News You Can Use:
Are You Ready for the CMS Primary Cares Initiative?
CMS's new value-based payment model points to primary care future. There's a lot to unpac... Read more
Are You Ready for the CMS Primary Cares Initiative?
CMS's new value-based payment model points to primary care future. There's a lot to unpac... Read more
Guidelines:
Understand the Dos and Don'ts of Special Service/After-Hours Coding
Go beyond guidelines, apply crucial definitions for correct application. Of the six after... Read more
Understand the Dos and Don'ts of Special Service/After-Hours Coding
Go beyond guidelines, apply crucial definitions for correct application. Of the six after... Read more
Clip & Save:
Learn How to Document HPI Elements to Make Them Count
And use these 3 tips for precision reporting. Back in May, we discussed the history of pr... Read more
Learn How to Document HPI Elements to Make Them Count
And use these 3 tips for precision reporting. Back in May, we discussed the history of pr... Read more
Reader Question:
Question Bundling in This E/M Scenario
Question: A carrier is denying a claim for a 99213 with an 81000 saying that the urinalysi... Read more
Question Bundling in This E/M Scenario
Question: A carrier is denying a claim for a 99213 with an 81000 saying that the urinalysi... Read more
Reader Question:
Complete This Report of an Incomplete Service Encounter
Question: Our provider recently performed incomplete G0101 and Q0091 services to a patient... Read more
Complete This Report of an Incomplete Service Encounter
Question: Our provider recently performed incomplete G0101 and Q0091 services to a patient... Read more
You Be the Coder:
Comprehend Components to Avoid Modifier Madness
Question: Which modifiers should I use for an encounter where our physician provided an in... Read more
Comprehend Components to Avoid Modifier Madness
Question: Which modifiers should I use for an encounter where our physician provided an in... Read more
News You Can Use:
Get Ready for Extensive CPT® Outpatient E/M Service Changes
Revisions to 99201-99215 poised to take effect January 1, 2021. As we first reported in P... Read more
Get Ready for Extensive CPT® Outpatient E/M Service Changes
Revisions to 99201-99215 poised to take effect January 1, 2021. As we first reported in P... Read more
Coding Quiz:
Can You Code This Chart?
Compare your answers to those of our experts. Nothing helps sharpen your coding skills mo... Read more
Can You Code This Chart?
Compare your answers to those of our experts. Nothing helps sharpen your coding skills mo... Read more
Preventive Medicine:
Know These 4 Things, Code 99401-99412 With Confidence
End risk factor reduction and behavior change intervention confusion. What happens when a... Read more
Know These 4 Things, Code 99401-99412 With Confidence
End risk factor reduction and behavior change intervention confusion. What happens when a... Read more
Coding Quiz Answers:
Check Your Chart Coding Answers to Our Experts'
Once you've read over the chart and coded it, compare your answers with the ones provided ... Read more
Check Your Chart Coding Answers to Our Experts'
Once you've read over the chart and coded it, compare your answers with the ones provided ... Read more
Reader Question:
Code by Record, Not by Order
Question: The practice where I currently work has a standing order to code patients with s... Read more
Code by Record, Not by Order
Question: The practice where I currently work has a standing order to code patients with s... Read more
You Be the Coder:
Document Risk Reduction, Behavior Change Codes Accurately
Question: We have just started using the counseling risk factor reduction and behavior cha... Read more
Document Risk Reduction, Behavior Change Codes Accurately
Question: We have just started using the counseling risk factor reduction and behavior cha... Read more
Guidelines:
Take These 3 Tips, Make HPI Errors a Thing of the Past
Avoid the 1995/1997 guideline confusion once and for all. Documenting the patient's histo... Read more
Take These 3 Tips, Make HPI Errors a Thing of the Past
Avoid the 1995/1997 guideline confusion once and for all. Documenting the patient's histo... Read more
ICD-10 Coding:
Follow This Advice for Accurate Seasonal Allergy Coding
This comprehensive guide to the allergic rhinitis codes is nothing to sneeze at. You know... Read more
Follow This Advice for Accurate Seasonal Allergy Coding
This comprehensive guide to the allergic rhinitis codes is nothing to sneeze at. You know... Read more
E/M Coding:
Remember These 5 Rules for Successful TCM Documentation
Don't let intimidating, extensive guidelines get in the way of clear coding. When a patie... Read more
Remember These 5 Rules for Successful TCM Documentation
Don't let intimidating, extensive guidelines get in the way of clear coding. When a patie... Read more
Reader Question:
Document Questionable Dx Consistent With Guidelines
Question: Our provider documented a patient with “a rash consistent with livedo reticula... Read more
Document Questionable Dx Consistent With Guidelines
Question: Our provider documented a patient with “a rash consistent with livedo reticula... Read more
Reader Question:
Interpret These Guidelines to Report Smoking Counseling Correctly
Question: A patient saw our provider for an allergy test. While there, the doctor counsele... Read more
Interpret These Guidelines to Report Smoking Counseling Correctly
Question: A patient saw our provider for an allergy test. While there, the doctor counsele... Read more
Reader Question:
Specify Dx, not Symptom, for Strep Test Success
Question: We recently ran a rapid strep test on a patient who came in complaining of a sor... Read more
Specify Dx, not Symptom, for Strep Test Success
Question: We recently ran a rapid strep test on a patient who came in complaining of a sor... Read more
You Be the Coder:
Provide Purpose for Clear Breathing Treatment Documentation
Question: I have been asking my providers for pre- and post-treatment descriptions when do... Read more
Provide Purpose for Clear Breathing Treatment Documentation
Question: I have been asking my providers for pre- and post-treatment descriptions when do... Read more
News You Can Use:
Know Which Integumentary Surgery Codes CMS Added, Deleted, From CCI PTP List
Latest round targets numerous lesion shaving, excision, and destruction procedures. Unlik... Read more
Know Which Integumentary Surgery Codes CMS Added, Deleted, From CCI PTP List
Latest round targets numerous lesion shaving, excision, and destruction procedures. Unlik... Read more
Coding Quiz:
Be Careful to Answer These Chronic Care Management Questions Correctly
Subtle CCM reporting differences, billing-specific RPM codes key to CPT® changes. In Pri... Read more
Be Careful to Answer These Chronic Care Management Questions Correctly
Subtle CCM reporting differences, billing-specific RPM codes key to CPT® changes. In Pri... Read more
Guidelines:
Follow These Dos and Don'ts for Modifier 59 Success
Know how to use, but not misuse, the “unbundling modifier.” When it comes time to unb... Read more
Follow These Dos and Don'ts for Modifier 59 Success
Know how to use, but not misuse, the “unbundling modifier.” When it comes time to unb... Read more
Coding Quiz Answers:
Check Your Answers to Our CCM Coding Quiz
Once you've answered the quiz questions on page 27, compare your answers with the ones pro... Read more
Check Your Answers to Our CCM Coding Quiz
Once you've answered the quiz questions on page 27, compare your answers with the ones pro... Read more
Reader Question:
Bill to Physician When PA Performs Independent Services
Question: I'm coding a chart for an evaluation and management (E/M) visit in which a physi... Read more
Bill to Physician When PA Performs Independent Services
Question: I'm coding a chart for an evaluation and management (E/M) visit in which a physi... Read more
Reader Question:
Don't Be in a Rush to Report This Rash
Question: A patient presented with an itchy, blistered rash on her skin, which she believe... Read more
Don't Be in a Rush to Report This Rash
Question: A patient presented with an itchy, blistered rash on her skin, which she believe... Read more
You Be the Coder:
Look to Anatomic Site in This Lesion Removal Encounter
Question: Our provider removed a vaginal lesion from a patient using a punch technique. Hi... Read more
Look to Anatomic Site in This Lesion Removal Encounter
Question: Our provider removed a vaginal lesion from a patient using a punch technique. Hi... Read more
Procedure Coding:
Follow This Guide to Navigate the New Biopsy Code Guidelines
Learn how, when to document 11102-+11107. When we reported on the introduction of the new... Read more
Follow This Guide to Navigate the New Biopsy Code Guidelines
Learn how, when to document 11102-+11107. When we reported on the introduction of the new... Read more
Guidelines:
Know These 4 Essential Things, Keep Current With Telehealth Coding
Let this primer get you up to speed. With its ever-changing codes and complex guidelines,... Read more
Know These 4 Essential Things, Keep Current With Telehealth Coding
Let this primer get you up to speed. With its ever-changing codes and complex guidelines,... Read more
Case Study Corner:
Understand Choices, Ace This Tetanus Case Study
Context key for correct procedure, Dx documentation. A 35-year-old patient reports to you... Read more
Understand Choices, Ace This Tetanus Case Study
Context key for correct procedure, Dx documentation. A 35-year-old patient reports to you... Read more
Reader Question:
Add on This Code for Time, not Follow-Up
Question: Recently, our provider administered a Wechsler Adult Intelligence Scale (WAIS) t... Read more
Add on This Code for Time, not Follow-Up
Question: Recently, our provider administered a Wechsler Adult Intelligence Scale (WAIS) t... Read more
Reader Question:
Know Primary Dx, Modifier, in This Screening Scenario
Question: Our provider screened a patient for peripheral artery disease (PAD) using bilate... Read more
Know Primary Dx, Modifier, in This Screening Scenario
Question: Our provider screened a patient for peripheral artery disease (PAD) using bilate... Read more
You Be the Coder:
Document More Than Time in This Consult-Patient Scenario
Question: Our doctor called a radiologist to discuss an X-ray with him. This took aro... Read more
Document More Than Time in This Consult-Patient Scenario
Question: Our doctor called a radiologist to discuss an X-ray with him. This took aro... Read more
News You Can Use:
Take Note of These New PTP Edit Pairs
CCI adds 2019 biopsy, care management, and psych test codes to list. With 45,727 addition... Read more
Take Note of These New PTP Edit Pairs
CCI adds 2019 biopsy, care management, and psych test codes to list. With 45,727 addition... Read more
E/M Coding:
Mend Modifier 25 Misunderstandings
Clear up coding confusion with the answers to these four simple questions. Modifier 25 (S... Read more
Mend Modifier 25 Misunderstandings
Clear up coding confusion with the answers to these four simple questions. Modifier 25 (S... Read more
Case Study Corner:
Determine Depression Level in This Anxiety Case Study
Don't let similar-sounding Dx cloud your reporting. Diagnosis coding for anxiety disorder... Read more
Determine Depression Level in This Anxiety Case Study
Don't let similar-sounding Dx cloud your reporting. Diagnosis coding for anxiety disorder... Read more
Reader Question:
Remove These Codes from This FBR Encounter
Question: Using forceps and a needle, our provider recently removed a splinter from a pati... Read more
Remove These Codes from This FBR Encounter
Question: Using forceps and a needle, our provider recently removed a splinter from a pati... Read more
Reader Question:
Provide This Info for Patient Prevnar Purchase
Question: Our nurse administered Prevnar 13 to a patient who had already purchased the vac... Read more
Provide This Info for Patient Prevnar Purchase
Question: Our nurse administered Prevnar 13 to a patient who had already purchased the vac... Read more
Reader Question:
Unbundle Injection to Avoid Infusion Confusion
Question: We have a patient who comes in regularly for allergy injections. Recently, we ga... Read more
Unbundle Injection to Avoid Infusion Confusion
Question: We have a patient who comes in regularly for allergy injections. Recently, we ga... Read more
You Be the Coder:
Avoid E/M Determination When Components Don't Add Up
Question: An established 66-year-old patient presented to our provider. She did not state ... Read more
Avoid E/M Determination When Components Don't Add Up
Question: An established 66-year-old patient presented to our provider. She did not state ... Read more
E/M Coding:
Avoid Repeating History Mistakes With These 4 PFSH Tips
And know if documentation will change in 2019. If you code evaluation and management (E/M... Read more
Avoid Repeating History Mistakes With These 4 PFSH Tips
And know if documentation will change in 2019. If you code evaluation and management (E/M... Read more
Coding Quiz:
Start 2019 With This 2018 Year-in-Review Coding Quiz
Hint: all the answers can be found in previous issues of last year's Primary Care Coding A... Read more
Start 2019 With This 2018 Year-in-Review Coding Quiz
Hint: all the answers can be found in previous issues of last year's Primary Care Coding A... Read more
ICD-10 Coding:
Take These 5 Steps, Code COPD With Ease
Remember that J44.9 doesn't always paint the whole picture. What do you do when your prov... Read more
Take These 5 Steps, Code COPD With Ease
Remember that J44.9 doesn't always paint the whole picture. What do you do when your prov... Read more
Coding Quiz Answers:
Check Your Answers to Our Year in Review Coding Quiz
Once you've answered the quiz questions on page 3, compare your answers with the ones our ... Read more
Check Your Answers to Our Year in Review Coding Quiz
Once you've answered the quiz questions on page 3, compare your answers with the ones our ... Read more
Reader Question:
Take the Time to Use This Code for Travel Abroad Counseling
Question: Our provider saw a husband and wife together and counseled them on travel medici... Read more
Take the Time to Use This Code for Travel Abroad Counseling
Question: Our provider saw a husband and wife together and counseled them on travel medici... Read more
Reader Question:
Re-Evaluate Billing for E/M Service on Hospital Discharge Day
Question: A patient of ours was hospitalized for a urine infection. On the same day he was... Read more
Re-Evaluate Billing for E/M Service on Hospital Discharge Day
Question: A patient of ours was hospitalized for a urine infection. On the same day he was... Read more
You Be the Coder:
Know IPPE/AWV Difference to Prevent Medicare Denials
Question: We have been using CPT® codes 99396 or 99397 for preventive medicine visits/ann... Read more
Know IPPE/AWV Difference to Prevent Medicare Denials
Question: We have been using CPT® codes 99396 or 99397 for preventive medicine visits/ann... Read more