Thank you to everyone who joined our October Coding Coven — a lively hour of profee coding insights, practical scenarios, and auditor‑ready documentation tips. Below is a tight recap of key ideas to help you apply what you learned without giving away the full spell book. 🧙♀️
High‑Value Highlights (No Spoilers, Just the Good Stuff)
1) Preventive + Problem Oriented? Use Modifier 25 When It’s Truly Separate
- Lean on authoritative guidance (think AMA’s “Debunking the Myth” and the CPT manual) to determine when a significant, separately identifiable problem justifies an E/M in addition to a preventive visit.
- Documentation must clearly show a distinct HPI and medically appropriate exam for the problem beyond the preventive service.
- Quick rule of thumb from our scenarios: a new rash or elevated BP that requires assessment/management often qualifies; stable chronic problems briefly noted usually do not.
2) Procedures the Same Day? Know What’s Included
- Routine pre and post procedure work is bundled into the procedure code. Additional E/M requires work that’s above and beyond (e.g., evaluating an unrelated problem).
- New vs. established status doesn’t make or break it — documentation does. We walked through a lesion removal case with a separate concern documented and billed appropriately.
- Remember: modifier 25 belongs on the E/M code — use it judiciously to avoid denials.
3) G2211: Add On for Longitudinal or Serious Conditions
- Designed for ongoing relationships or managing a single serious or complex condition; commonly used in primary care but not limited to it.
- Track recent CMS/MAC updates expanding where G2211 may apply; ensure your notes show continuity, repeated diagnoses, and an active care plan.
- Templates and smart phrases are fine — just individualize them with specific assessments and follow ups.
4) Combination Codes and When Linkage is Automatic
- For diabetes with listed manifestations (per ICD 10 guidelines), linkage is automatic unless the provider states otherwise — create quick reference tip sheets for your team.
- Beware of NEC terms: don’t auto link to diabetes without a more specific diagnosis — remember that 2018 Coding Clinic nuance.
- Other common auto linkages: hypertension with heart disease or CKD — use them consistently for accurate risk adjustment.
5) Vaccine Coding: Don’t Leave Admin Dollars on the Table
- With counseling (≤18 years): document face to face counseling for each component; code each antigen’s administration separately.
- Without counseling (or >18): use the appropriate administration codes for each vaccine given.
- Always add Z23 for immunization encounters and ensure your documentation supports what you bill.
What This Means for Your Team
Bottom line: Accuracy lives in the documentation. Create clear separation for preventive vs. problem oriented work, know your procedural bundles, document continuity for G2211, and operationalize combination code rules with concise tip sheets.
- Refresh provider education on modifier 25 and same day services — use real scenarios.
- Audit a small sample for G2211 documentation continuity (diagnoses repeated, plan progression).
- Publish a one pager of common ICD 10 combination linkages (diabetes, HTN + heart/CKD) and when not to auto link.
- Review vaccine admin workflows for counseling vs. non counseling pathways.
Want the Full Walkthrough?
We kept this recap intentionally concise. The recording includes deeper dives, live decision trees, and nuanced payer considerations discussed during Q&A.
About Jeanie Heck
Jeanie Heck, CCS, CPC, CRC, ICD-10-CM Approved Instructor
Education Consultant
Jeanie Heck, CCS, CPC, CRC, ICD-10-CM Approved Instructor has over 30 years of experience as an expert physician and coder educator for CPT, ICD-10-CM and an accomplished Evaluation and Management auditor. She has been the lead senior auditor for the CMS HHS-RADV (Risk Adjustment Data Validation) audit for the past 7 years. She works with documentation improvement for coding integrity and HCC coding. Jeanie provides education regarding coding, auditing, and billing to physicians and their staff.
She is currently an adjunct faculty member at Camden County College and Santa Barbara City College teaching various coding courses. Her management positions include Director of Education, Coding and Billing Director, Practice Manager, and Business Manager. Ms. Heck’s most recent speaking engagements include topics such as Missed Opportunities in Coding and Billing, HCC Overview, and What you Need to Know about Risk Adjustment. She recently co-authored an article for the Revenue Cycle Strategist magazine entitled “Are you Ready for MACRA and MIPS? The New Healthcare Payment Reform.”