Alex
Chief Medical Officer, Cortex Charts
Alex is the Chief Medical Officer at Cortex Charts.
- 01Medicare
Can you bill an office visit on the same day as an annual wellness visit?
Yes, for Medicare, when the doctor also evaluates and manages a separate problem. Bill the office visit with modifier 25 next to G0438 or G0439, and tell the patient her usual share applies to that part.
Read essay - 02E/M coding
When do test results count as data for office visit MDM?
Count each unique test once, at the visit where it was ordered, and each outside source's records once. A metabolic panel is one test, not fourteen numbers.
Read essay - 03E/M coding
Does a prescription refill count as prescription drug management for E/M?
A refill counts when the note shows a decision: how the condition is doing, the choice to keep or change the medicine, and the follow-up. "Refill metformin" on its own is an order.
Read essay - 04modifier 25
When can you bill an office visit with modifier 25 on the same day as a minor procedure?
Bill the office visit with modifier 25 when the note shows real work on a problem beyond deciding on and doing the procedure. Here is a joint injection note, line by line, and the claim it supports.
Read essay - 05AI
Where the compliance line sits for AI coding prompts
New OIG guidance and three recent settlements show what regulators object to in coding prompts. Here is what that means for a small practice using AI.
Read essay - 06ICD-10-CM
Can you code a rule-out diagnosis at an outpatient visit?
No. At an office visit, code the symptom, sign or abnormal result you know today. A diagnosis the note calls rule out, probable or suspected stays in the note and off the claim.
Read essay - 07E/M coding
Should you bill an office visit by time or by MDM?
Either one, chosen visit by visit. Time fits visits where counseling, record review or charting took the clinician's day; medical decision making fits visits where the decisions carried the weight.
Read essay - 08ICD-10-CM
Which chronic conditions belong on today's claim?
A chronic condition belongs on today's claim when today's note shows the provider checked it, reviewed a result for it, assessed it, or treated it. A condition that only sits on the problem list stays off.
Read essay - 09E/M coding
99213 vs 99214: what does the note need to show?
A 99214 needs moderate medical decision making in two of three areas: problems, data and risk. A 99213 needs low. Here is the same diabetes visit written both ways.
Read essay - 10chart review
What should you check before signing a primary care chart?
Check five things before you sign: the codes match today's note, no two codes contradict each other, every code that can name a side names one, each chronic condition shows today's care, and the visit level matches the note.
Read essay - 11ICD-10-CM
What's the difference between Excludes1 and Excludes2?
Excludes1 means two diagnosis codes can never go on the same claim, because both can't be true. Excludes2 means the conditions are different, so you code both when the patient has both.
Read essay