Faculty Group Practice Newsletter

Accurate medical coding is the backbone of healthcare revenue cycle management. Among the most critical aspects of coding is ensuring that ICD-10 diagnosis codes are reported to the highest level of specificity. This practice impacts accurate reimbursement and influences compliance, data integrity, and patient care outcomes.

Prolonged Services are to be used when the level of service is based on time and the time for the highest level of service (99205 or 99215) has been exceeded. Time includes both face-to-face activities and non-face-to-face activities when performed on the same calendar date as the office visit.

Critical Care Time is one of the areas where we see an opportunity. Please use this table when calculating and coding for critical care services.

CMS created the G0136 to be used for billing the Social Determinants of Health (SDoH) Risk Assessment. There are certain rules and documentation requirements surrounding this code. This code is time based; time must be documented.

Per CPT Guidelines, if an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented evaluation and management service, then the appropriate office visit should also be reported.

eConsults are available for use by all UTMB departments, effective June 10, 2025. eConsults are an assessment and management service in which the treating provider (faculty or APP) requests advice and/or opinion from a specialist for treatment and/or management of the patient’s problem.

Do you ever have a circumstance when you can bill a preventive care and a sick visit during the same encounter? If so, are you documenting and coding correctly? This is often a missed opportunity. Both visits may be documented in the same encounter note and must justify the codes billed.

These codes are used for extensive time in addition to seeing the patient and must relate to a service for a patient where direct face-to-face patient care has occurred or will occur and be part of ongoing patient management. The time spent for prolonged non-face-to-face services does not need to be continuous but must be on the same calendar date.

Medicare has extended the Telehealth Flexibilities until Sept. 30, 2025. Other payers are starting to make decisions as to how they would like to handle telehealth. It is very important that when completing a telehealth visit, the TELEHEALTH NOTE is used. Using the telehealth note will bring up the proper documentation elements and add the appropriate telehealth modifier and place of service.

When co-surgeries and assistant surgeries are performed, it is very important that it is documented correctly so the appropriate modifiers can be added. Also, not all CPT codes can be billed as a co-surgery or an assistant surgery. Observing does not qualify as a co-surgery or an assistant surgery.

ICD-10 is essential to documenting medical necessity for services rendered, and accurate codes mean better outcomes for the patient, your claims, and your practice or facility.

The only way to trigger the charges for medications administered in the clinic (injection drugs such as steroids, IUD and Nexplanon devices, etc.) is to order and administer the medication in the MAR. Typically nursing staff will complete this; however if it was not completed you may receive a Coding Action Required in Epic.

The Inpatient or Observation Discharge Service is time based. Time for 99239 is required. 99238 – Hospital Inpatient or Observation Discharge Day Management – 30 minutes or less on the date of the encounter 99239 – more than 30 minutes on the date of the encounter

CMS introduces a new complexity code for Infectious Disease, G0545, and makes changes to the G2211 complexity code effective January 1, 2025.

CD released the FY2025 ICD-10-CM changes effective 10/1/2024. There are 252 new codes, 36 deleted codes, and 13 code revisions. Here we share a few highlights.

This month, we are delving into a long-standing belief around hospital follow-up visits at UTMB, or the “HFU” you might see on your schedule. In short, there is no such thing as a "free" hospital follow-up visit.

CPT codes describe the service you performed and the associated ICD-10 diagnosis codes describe the reason you performed that service. Together these codes tell your patient’s story for today’s visit and help to demonstrate medical necessity. It is important that these codes make sense to the payor.

Surgeons and proceduralists are often faced with a high volume of patients, complex cases, and demanding schedules. In this context, it can be challenging to complete and close patient notes in a timely manner. However, closing patient notes is not only a legal and ethical obligation, but also a crucial factor for ensuring patient safety, quality of care, and workflow efficiency.

The G2211 – visits complexity code may be a missed opportunity for you. This code was created by Medicare but other payors are recognizing and reimbursing for this code.

eConsults are an assessment and management service in which a treating faculty or APP requests advice or opinion from a specialist to provide advice and/or opinion in treating and/or management of the patient’s problem without fact-to-face contact with the consultant.