CPT

Radiation oncology uses high-energy radiation to shrink or kill tumors or cancer cells with minimal harmful effects to healthy surrounding cells. To correctly code for radiation oncology services, coders need to understand the various elements of the treatment.

In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section.

E/M coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G-codes.

As new and more effective treatment options are created and evaluated, AMA must update the CPT® Manual to add and revise codes that allow providers to accurately report the work they performed. The 2015 updates include more than 500 changes, including more than 250 new codes that impact nearly every section. In the 2015 CPT Manual, only the integumentary and respiratory system sections remain unchanged.

After 14 years of few to no changes, the psychiatry section of the CPT ® Manual received a major overhaul for 2013.

The AMA revised the molecular pathology codes in the CPT ® Manual in 2012, but at that time CMS did not adopt the codes as it was still debating whether and how to change the reimbursement system for these services going forward. For CY 2013, CMS elected to recognize the codes, which meant it had to finalize how to pay for them. While CMS did not change pamyent for these services under the Clinical Laboratory Fee Schedule (CLFS) despite industry pressure, its change to the new codes means a change in the payments providers can expect this year and in the future.

Because CMS has not created any national ED E/M guidelines, providers must create their own criteria for each visit level. CMS has developed a list of 11 criteria that it uses when auditing facility E/M criteria.

Adding modifiers to CPT ® codes can bypass NCCI edits for Medicare payments, but they're often misapplied.

The AMA added five new nuclear medicine codes to the radiology section of the 2013 CPT Manual , while revising and deleting a number of codes that represented outdated technology or were bundled into placement procedures.

Pain is an expected component of injuries, illnesses, and surgical procedures. Let's face it, breaking your leg hurts. In some instances, however, the patient's pain is unexpected or is worse than predicted. Sometimes, the pain can last well beyond the time it should have resolved.