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The Field Guide to Physician Coding 3rd Edition

The Field Guide to Physician Coding 3rd Edition

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Betsy Nicoletti, MS, CPC

"All Physicians can increase their revenue and improve their compensation through accurate coding. This book tells you how."

Written by nationally-renowned physician coding expert Betsy Nicoletti, The Field Guide to Physician Coding Third Edition delivers a payload of precise information on coding rules and relevant billing guidelines. Her explanations shed light on why the rules were created and how certain topics are linked to other information about which you must be aware. Nicoletti also steers you to critical source documents for today's coding rules so you don't have to spend hours hunting for key facts in long official documents. Sleep well knowing that your practice is compliant with government rules and you're collecting all of the money you are entitled to collect!


  • Cloning Notes in an EHR
  • Diagnosis CodingTransitional Care Management
  • Foot Care
  • Modifier 33
  • New Patient Coding
  • Consults
  • Wellness visits
  • Changing Medicare Regulations
  • Transition to ICD-10
  • PPACA/Health Reform Act

This book should be on the desk of every clinician, biller and coder in the country! No-nonsense advice supported by weblinks that answers the most pressing questions from physicians, practice managers, billers and coders.

  • The "Rules" that help doctors get paid, not just the codes
  • Organized alphabetically, by topic, for ease of use
  • Relevance to all specialties

Rules explained in plain, easy-to-understand prose Each entry includes:

  • The definition of the service
  • Clinical examples, when relevant
  • Medical references, CPT rule references


Table of Contents

  • Accounts Receivable Benchmark Data Adjusted Collection
  • RatioAdvance Beneficiary Notice (ABN)
  • AgingReport
  • Assistant at Surgery Services
  • Care Plan Oversight (CPO) – CPT® Codes (NonMedicare) Care Plan
  • Oversight for Medicare Patients
  • Category of Code Charts
  • Certification of Home Health Services
  • Cerumen Removal
  • CLIAWaivedTests
  • Cloning Notes in an Electronic Health Record
  • Comprehensive Error Rate Testing (CERT)
  • Consolidated Nursing Home Billing
  • Consultations
  • Critical Care Services
  • Days in Accounts Receivable
  • Diagnosis Coding
  • Documentation Guidelines
  • Emergency Department Visits
  • Evaluation and Management Services and Profiles
  • FootCare: Routine
  • General Principles of Medical Record Documentation
  • Global Surgical Package
  • Gross Collection Ratio
  • Healthcare Common Procedure Coding System (HCPCS) Hospital
  • Discharge Services
  • Hospital Initial Services, Inpatient
  • Hospital Observation Services
  • Hospital Subsequent Services
  • ICD-10-CM
  • Immunization Administration for Vaccinations
  • Incident to Services (Medicare)
  • Legibility
  • Local Coverage Determinations (LCDs)
  • Locum Tenens Billing
  • Medical Necessity
  • Medicare Physician Fee Schedule Database (MPFSDB)
  • Mini Mental Status Exam
  • Modifier 22
  • Modifier 24
  • Modifier 25
  • Modifier 26
  • Modifier 33
  • Modifier 50
  • Modifier 51
  • Modifier 55
  • Modifier 53
  • Modifier 58
  • Modifier 59
  • Modifier 78 and Modifier 79
  • Modifier PT
  • Multiple Endoscopic Procedures
  • Multiple Surgical Procedures
  • National Correct Coding Initiative (NCCI) National Coverage
  • Determinations (NCDs) New Patient
  • Nurse Visit
  • Nursing Facility Visits
  • Office of Inspector General (OIG) Work Plan
  • Patient Protection and Affordable Care Act (PPACA) aka Health Care Reform Act of 2010
  • Pelvic and Breast Clinical Exam Pre-operative Exams
  • Preventive Medicine Services
  • Preventive Medicine Services (Medicare) Prolonged Services
  • Reciprocal Billing Arrangements
  • Reviewing Medical Records
  • Shared Visits (Medicare)
  • Smoking Cessation Counseling
  • Teaching Physician Rules Based on Time
  • Teaching Physician Rules for Critical Care Services
  • Teaching Physician Rules for Evaluation and Management Codes
  •  Teaching Physician Rules for Medical Students
  • Teaching Physician Rules for Primary Care Exception
  • Teaching Physician Rules for Surgical Procedures
  • Telephone Calls
  • Time-based Codes
  • Transitional Care Management (TCM) Services
  • Welcome to Medicare
  • Wellness Visits: Initial and Subsequent
Betsy Nicoletti

Betsy Nicoletti, MS, CPC, has extensive auditing experience in physician services, ensuring that code selection accurately reflects the services performed.

Joking that she is in the “protection” business, Betsy explains that her mission is to simplify complex coding and reimbursement rules for medical practices, thereby "protecting" physician practices. She is the author of The Field Guide to Physician Coding, now in its third edition, and Everyday Medical Coding, as well as a regular journal contributor. Betsy also speaks to groups on the national scene. When speaking to clinicians, she engages them with an in-depth knowledge of their professional lives. When speaking to fellow auditors, she guides them through the nuances of finding black and white answers in a morass of gray guidelines.

Betsy, who began her consulting business in 1999, has a master’s degree in Organization and Management from Antioch New England and is a Certified Professional Coder. She is a member of the Medical Group Management Association and the National Speakers Association. She lives in New England with her dog. Betsy can be reached at www. You can read her blog at

"Every practicing physician will find this book the perfect resource for documentation and coding, just as I've found Betsy Nicoletti to be the perfect resource. Nicoletti puts complicated concepts into very practical terms. Keep the book close at hand for a chapter-by-chapter reference when questions arise"

Rosemarie Nelson, MS, MGMA Consultant
Jamesville, NY

"Betsy Nicoletti understands how physicians think. This is an excellent resource for physicians and coders alike.”

William Romer MD
MediSync, Cincinnati, OH

"Working with Betsy Nicoletti for years, I know that you can rely on her advice regarding coding and auditing. She’s a pro’s pro!"

Karen Zupko, President, Karen Zupko & Associates
Chicago, IL