Key Takeaways Psychotherapy for crisis is billed with 90839 for 30 to 74 minutes and 90840 for each additional 30 minutes, and it cannot be combined with most other psychiatric codes on the same day. Medicare pays crisis psychotherapy furnished in non-office, non-facility settings such as a patient’s home through G0017 and G0018, at 150% […]
Carola Cornejo
Assistant Vice President of Client Services and Operations
Carola Cornejo is Assistant Vice President of Client Services and Operations at PGM Billing, where she has spent more than 15 years specializing in physician billing and revenue cycle management. She is one of PGM’s leading experts in appeals filing and denial resolution, with hands-on experience across patient and insurance collections, claims follow-up, fee schedule analysis, and provider credentialing.
Carola’s work spans PGM’s core physician specialties — including cardiology, orthopedics, neurology, gastroenterology, behavioral health, nephrology, and oncology — making her a trusted resource for practices navigating complex billing and coding challenges. She holds a degree in Computerized Accounting from Dover Business College.
Posts by Carola Cornejo
Psychological and Neuropsychological Testing CPT Codes, Explained
Key Takeaways Testing is billed in two parts: evaluation services (96130-96133), billed by the hour, and test administration and scoring (96136-96139), billed in 30-minute units. Who administers the tests determines the administration code: 96136 and 96137 for a psychologist or physician, 96138 and 96139 for a technician. Code 96146 covers a single automated test and […]
How to Bill Collaborative Care (CoCM) and Behavioral Health Integration Codes
Key Takeaways Medicare pays for behavioral health integration (BHI) through two models: psychiatric collaborative care (CoCM), billed with 99492, 99493, 99494, and G2214, and general BHI, billed with 99484, or with G0323 when a clinical psychologist, clinical social worker, marriage and family therapist, or mental health counselor is the treating practitioner. The standalone BHI codes […]
Behavioral Health Carve-Outs: Why Mental Health Claims Go to the Wrong Payer
Key Takeaways A behavioral health carve-out moves mental health and substance use disorder benefits from the medical plan to a managed behavioral health organization (MBHO), whose name may not appear on the front of the patient’s insurance card. Claims sent to the medical plan for carved-out services typically deny with CARC 109, which signals the […]
The Coding and Billing Mistakes Behind Denied Behavioral and Mental Health Claims
Key Takeaways CPT 90832, 90834, and 90837 are separated by strict, non-negotiable time thresholds. Defaulting to 90837 without matching documentation is a common audit trigger. Standalone psychotherapy codes cannot be billed alongside an E/M code on the same date of service. Add-on codes 90833, 90836, and 90838 exist specifically for combined therapy and medication management […]
Cystoscopy, Prostate Biopsy, and Lithotripsy: Where Urology Claims Actually Get Denied
Key Takeaways Urology denials cluster around specific procedures, not one universal coding mistake. CPT 55700 was deleted for 2026 and replaced by a nine-code family that bundles imaging into the biopsy code itself. NCCI edits bundle diagnostic cystoscopy into nearly every therapeutic cystoscopy code performed in the same session. Missing laterality modifiers on lithotripsy and […]
The Coding and Billing Mistakes Behind Denied Allergy and Immunotherapy Claims
Key takeaways Allergy testing and immunotherapy use separate, non-interchangeable CPT code sets. Billing the wrong code combination triggers denials regardless of medical necessity. Immunotherapy dose miscounting is one of the most common sources of underpayment. Medicare does not cover complete-service immunotherapy codes; component billing is required. Modifier 25 has specific, narrow rules for same-day E/M […]
Neurology Billing Collections: Where Practices Lose Revenue and How to Recover It
Key takeaways Neurology billing volume does not guarantee strong collections. Time-based E/M documentation gaps delay or reduce reimbursement. Prior authorization requirements for EMG, nerve conduction studies, and imaging create cash flow lags. Botox and infusion billing errors are a common source of lost revenue. Days in A/R and denial patterns reveal where collections break down. […]
Nephrology Billing Errors: ESRD Monthly Capitation Payment Rules Practices Get Wrong
Key Takeaways The ESRD Monthly Capitation Payment (MCP) is a single monthly code, not a per-visit fee, and code selection depends on the patient’s age and the number of face-to-face visits completed that month. Only one MCP claim is allowed per patient per month, and the billing physician must personally provide at least one of […]
Chemotherapy and Infusion Billing: Coding Errors That Cost Oncology Practices
Key Takeaways Chemotherapy administration must be sequenced before therapeutic infusions and hydration on every multi-service claim. Start and stop times are required for time-based infusion codes — missing documentation forfeits add-on code reimbursement. The JW and JZ modifiers are mandatory on Medicare claims for single-dose vial drugs; missing either causes claims to be returned unprocessable. […]