general advice on coding for family practice/primary care?

[Dialmam]

Hi,

I'm looking to move from coding for multi-specialty pediatrics to adult primary care. What's it like coding for primary care? like every specialty, getting to know the codes really happens when you're using them day to day. Are there a variety of procedure codes used other than E/M codes? any advice or comments are greatly appreciated. Thanks!

 

[Arlene2022]

General Advice Primary Care Coding

I work for a multi-specialty group. We've got 4 Primary Care physicians in the group as well as NP's and PA's.

E/M codes yes, majority of billing
Vaccines, each season - learn how to correctly code multiple vaccines and how to code Medicare vs Commercial.

Our physicians do xrays, bone densities, pft's (simple) wound care, etc etc in our office.
We also have our own lab for those insurance that allow draw/test in office.....

Knowing how/when to use modifier 25 and 59 is key.

Please feel free to contact me if you have questions as you go along. I'm always happy to help.

email: acastello@njaim.com

 

[Cynthia Hughes]

coding for family practice/primary care

Hi,

I'm looking to move from coding for multi-specialty pediatrics to adult primary care. What's it like coding for primary care? like every specialty, getting to know the codes really happens when you're using them day to day. Are there a variety of procedure codes used other than E/M codes? any advice or comments are greatly appreciated. Thanks!

My advice is to familiarize yourself with Chapters 12 and 18 of the Medicare Claims Processing and Chapter 15 of the Medical Benefit Policy Manuals and most importantly, the web site of your local Medicare Administrative Contractor (MAC). The Medicare NCCI and payment policies vary from those of Medicaid and some private payers. I also recommend looking at the coding resources of your physician's specialty organizations like American Academy of Family Physicians, American Osteopathic Association, and American College of Physicians.

The G codes used by Medicare for preventive services, care plan oversight, and certain other services can be confusing but there are good authoritative resources from CMS and local MACs.

Best wishes,
Cindy

 

[rcanales]

general quetions

Hi Acastello,

I am in a similar practice to you and sometimes I have questions. Would it be ok for me to reach out to you for any questions I may have in the future?

 

[Dialmam]

Thanks!

Thank you for your replies! It's good to know there is diversity but also the real motivator here for me would be the switch from Medicaid to Medicare and I think strengthening my skill sets ultimately relies on me working with Medicare and it may be that primary care is an excellent starting point for that. I think.. i hope