Category: Coding Coach

Modifier 52 vs. 53
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Modifier 52 vs. 53

January 19, 2023 Question: We are confused about the difference between modifier 52 and 53. What is the difference? Answer: Modifier 52 Reduced Services is used when the procedure or surgery is partially reduced or eliminated by the physician. This is used when a procedure has an existing CPT code, but not all of the...

Consultations in 2023
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Consultations in 2023

January 19, 2023 Question: I am putting together E&M Guideline educational information for my providers based on the 2023 changes for reference throughout the year. I did some education in 2022 and now working on the tools. In 2022, I kept hearing that inpatient and outpatient consultation codes were being deleted. However, they are still...

Forehead Flap
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Forehead Flap

January 19, 2023 Question: Our Otolaryngologist routinely does repairs after Mohs surgery. What CPT code do I report for a paramedian forehead flap to reconstruct a nasal defect after Mohs surgery. Answer: The correct code to report is CPT code 15731 (Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead flap)....

E&M Coding Based on Time
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E&M Coding Based on Time

January 19, 2023 Question: When choosing the level of E&M we are confused about the History and Exam. If we choose a level of E&M based on time, does this time count toward total time, or is it only time spent on MDM? Answer: When choosing a level of E&M based on time, CPT identifies...

New vs Established Patient
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New vs Established Patient

December 15, 2022 Question: I am a contracted physician with a group practice (Practice A) in our town. I have an opportunity to contract with another practice (Practice B) not in the same town, but near enough that my patients could see me in either location. My question has to do with the definition of...

Consultation Coding in 2023
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Consultation Coding in 2023

December 15, 2022 Question:  In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing. Answer: Beginning January 1, 2023, consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep...

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Coding Coaches