Internal Medicine Billing Services

Internists care for adults, and many of their patients have several long-term conditions at once. Visits are often longer and more complex than in other primary care settings. Documentation has to show that complexity, or payers will pay at a lower level.

Internal medicine billing also covers a lot of non-visit work. Medication reviews, care coordination, hospital follow-up and advance care planning all carry their own codes and rules. When these are missed, revenue slips away unnoticed. Westmont Revenue Partners connects internal medicine practices with vetted billing experts who understand adult medicine, so complex visits and care management services are captured and supported.

Who this is for

• Internists in solo, group or hospital-affiliated practices
• Practices with a large share of Medicare and Medicare Advantage patients
• Clinics that manage diabetes, heart disease, kidney disease and lung disease
• Practices with nurse practitioners and physician assistants
• Internists who also round on hospitalized patients

What gets billed

• New and established patient office visits
• Annual preventive exams for adults
• Medicare annual wellness visits
• Chronic care management and complex chronic care management
• Principal care management for one serious condition
• Transitional care after hospital discharge
• Advance care planning
• Electrocardiograms and other in-office tests
• Blood draws and point-of-care labs
• Tobacco cessation counseling
• Hospital and nursing facility visits

Commonly billed codes

Code	Type	What it covers
99204	CPT	New patient office visit, moderate level
99214	CPT	Established patient visit, moderate level
99215	CPT	Established patient visit, high level
G2211	HCPCS	Add-on for ongoing, longitudinal care in some office visits
99396	CPT	Preventive visit, established patient, ages 40 to 64
G0439	HCPCS	Medicare subsequent annual wellness visit
99490	CPT	Monthly chronic care management by clinical staff
99487	CPT	Monthly complex chronic care management
99495	CPT	Follow-up care after discharge, moderate complexity
99497	CPT	Advance care planning discussion
99406	CPT	Tobacco cessation counseling, short session
93000	CPT	Standard 12-lead ECG with reading and report
I10	ICD-10-CM	High blood pressure without a more specific cause
E11.9	ICD-10-CM	Type 2 diabetes without complications

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in internal medicine

Documenting visit complexity. Many internal medicine visits involve several chronic problems and drug management. Billers help providers see which note elements support a higher level so work is not under-billed.

Risk adjustment and diagnosis detail. Medicare Advantage plans rely on accurately coded chronic conditions each year. Experienced billers watch for vague diagnoses and send documentation questions back to the provider.

Overlapping care management codes. Some care management services cannot be billed in the same month, or by more than one practice. Billers track which services each patient is enrolled in to avoid denials.

Hospital follow-up timing. Transitional care services have contact and visit deadlines after discharge. Billers build a tracking list so the timing is documented before the claim is sent.

ECG and in-office test billing. A test is separate from the visit only when it is ordered, performed and interpreted as the code requires. Billers check each element before billing.

Prior authorization for orders. Imaging, specialty drugs and some tests need approval first. Billers keep payer lists current and flag orders that need approval before the patient leaves.

Split billing with hospital rounding. Practices that also see inpatients must code two settings correctly. Billers match each claim to the place of service and the service date.

How Westmont can help

• Matching you with vetted billing experts experienced in adult and internal medicine
• End-to-end revenue cycle support, from eligibility checks to payment posting
• Denial management, including documentation-based appeals
• Support with payer enrollment and credentialing for new internists
• Review of care management workflows so eligible services are captured

Frequently asked questions

What is the difference between internal medicine and family medicine billing?

Both use the same office visit codes. Internal medicine typically serves adults only, so it has more complex chronic disease visits and fewer pediatric services. Billers should know adult preventive rules, Medicare programs and hospital rounding. Westmont connects you with experts who have handled adult-focused practices.

Can an internist bill chronic care management and an office visit in the same month?

Generally yes, because the care management work is separate from the face-to-face visit. The time counted toward care management cannot also be counted toward the visit. Rules differ by payer and code, so confirm current policy and keep clear time records.

How do I avoid under-coding complex patients?

Make sure notes show the number and status of chronic problems, data reviewed, drug management and risk. Many practices run periodic chart audits against the visit-level rules. A billing expert can sample charts and point out recurring gaps for providers to fix.

Does Medicare cover advance care planning?

Medicare generally covers advance care planning when it is documented and meets time rules, and it can be done during a wellness visit with no cost sharing in some cases. Rules change, so confirm the current-year Medicare guidance and your payers' policies before building it into your workflow.

What should I look for in an internal medicine billing company?

Look for experience with adult chronic disease, Medicare Advantage, care management codes and denials. Ask how they report on claim status and how they handle appeals. Westmont can introduce you to vetted billing experts so you can compare options before you commit.

Related billing services

• Family Medicine
• Geriatrics
• Hospitalist Medicine
• Preventive Medicine
• Concierge / Direct Primary Care