Billing, Coding, Risk Adjustment, CPT 2023
Evaluation and Management (E&M) 2023
Billing and documentation for inpatient, emergency room, consultations, nursing facility, and home services will change effective January 2023. Details and education materials are available.
ICD-10Risk Adjustment & Diagnosis Coding
Diagnosis Coding: Accurate diagnosis coding is critical for risk adjustment in the age of value-based care. It's appropriate to select an ICD-10 code for each active condition during each patient encounter.
Diagnosis Coding Education
Coding Specificity & Risk Adjustment Factors eLearning
HCC Job Aid
Frailty Coding: Certain health maintenance and screening services may not be appropriate for patients with severe chronic illness. Use shared decision making to help patients determine whether services are right for them. Be sure to select diagnosis codes to indicate frailty and other conditions to exclude patients from performance metrics that are not appropriate.
Frailty & Exceptions Coding
Slides – Frailty and Exceptions Coding
Codes - Frailty, advanced illness, quality metrics
CCARE: Providers can request education and assistance with accurate diagnosis coding from the CCARE team or their department coding liaisons.
C-CARES Program - Provider Overview
C-CARES Program - Program Outreach
Primary Care Billing and Coding Book
This book reviews basics of Billing & Coding for primary care providers.
- E&M Basics
- Coding for Procedures
- Diagnosis (ICD-10) Coding
- Overview of RVUs
Primary Care Billing & Coding Presentations:
Charging for What You Do
Understanding RVU's and Targets
2021 E&M and ICD10 Updates - Risk Adjustment for Primary Care
Diagnosis Coding and Risk Adjustment for Primary Care
Coding Alert: Newsletter
Coding Alert is a bi-weekly newsletter which reviews coding best practices.
Sample topics include:
-E&M 2021 Office Visit Changes
-Advance Beneficiary Notice (ABNs)
-Preventive Care and Telehealth
-Coding for Diabetes
-Coding for Obesity and Cachexia
Billing, Coding, Documentation Webinars
A collection of webinar links with information for billing and coding in telehealth.
5/09/23 12:00-1:00pm - Modifier -25
6/13/23 12:00-1:00pm - Prolonged Services Case Studies
Available Monday - Friday: 8:30am - 5pmCoding Help Line
Medicare and Annual Wellness Visits
Annual Wellness Visits (AWV) provide health risk screening, preventive care and wellness counseling. Medicare covers these annually to assess health risks and complete preventive care like immunizations, counseling and cancer screening.
RN-Performed Virtual Medicare Wellness Visit [RNP-MWV) - *JHCP ONLY WORKFLOWS*
Do these wellness services help patients? There is evidence that annual wellness visits in older adults leads to better health outcomes, so we encourage annual health assessments and preventive care in all older adults regardless of insurance
Preventive Care in non-Medicare Patients: USFHP and most commercial plans also cover annual preventive care visits. Insured adults ?65 with another primary payer require different components of “preventive care” services compared to Medicare patients. These preventive services are billed using 99397 (established patient) and 99387 (new patient).
Annual Wellness Visits > 65 vs. Whole Health Exams
Whole Health Assessments
The Whole Health Assessment (WHA), also known as Whole Health Exam (WHE), was developed to ensure annual management of chronic health problems and preventative care. The WHA is covered once per calendar year for patients with Medicare Advantage.
AWV Recorded Webinars:
New updates include changes to Medicare Wellness Visit / Annual Wellness Visit workflows and forms. Click the links below to view our recorded webinars on the topic.
5.10.21 - The New Annual Wellness Visit
5.11.21 - Annual Wellness Updates for Clinical Support Staff
Tips & Tricks: MWV/AWV
Tips & Tricks: Medicare Wellness Visit Questionnaire
Health Risk Assessment (HRA): an HRA form is available on paper in several languages. Questions appear in the same order as in the Epic Smartset. Giving patients the paper HRA while waiting for the provider can save time. The HRA can also be sent to patients as a MyChart message to increase efficiency further.
English - Alternate (abnormals in red, not for patient use)
Explanation of Benefits (EOB) Letter
Other Links & Publications