Enhanced care management codes for advanced primary care management services in the physician fee schedule proposed rule have been cleared. This article discusses the terms billing providers and their teams must meet when providing these services.
Coders should use particular care when selecting diagnosis codes, always selecting the most specific code possible, based on the clinician’s documentation. This article covers diagnosis coding guidelines to help avoid using vague or non-specific diagnosis codes that will likely result in denials. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What were the AMA’s goals for revising evaluation and management (E/M) services that were implemented starting in January 2021 and continued in January 2023?
Patients diagnosed with a malignant neoplasm, commonly known as cancer, are now living longer due to better treatments. In 2025, there are 47 new ICD-10-CM codes to be used to report lymphoma in remission. This article broadly reviews those new codes.
CMS recently issued a proposed rule for 2026 that includes provisions aimed at limiting Medicare Advantage in-network cost-sharing for behavioral health services to be no greater than the traditional Medicare rates. Find out what the proposed behavioral health cost-sharing standards are in the proposed rule.
The changes proposed in the final rule for Medicare’s burgeoning behavioral health category have been finalized, expanding its purview beyond previous therapeutic models and even into digital care engaged by the patients themselves. Review those changes in this article.
Q: Why is modifier -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service) scrutinized?
Selecting a level of evaluation and management (E/M) service can be based on either the complexity of medical decision-making or the total time spent on the date of the encounter. Providers need to decide which to use. This article covers the pros and cons of both methods.
A recent OIG audit estimates that Medicare improperly paid $190.1 million for outpatient services provided to hospice enrollees over five years. Learn how the audit was performed and why the payments were improperly made.
Assigning proper codes plays a role in the integrity of medical records, supports effective communication between healthcare providers, and safeguards a practice against compliance issues. This article discusses some common dermatological conditions and their respective ICD-10-CM codes/categories.
