Asthma is a common lung disorder in which inflammation causes the bronchi to swell and narrow the airways, leading to airflow obstruction. Discover the coding considerations surrounding this disorder to ensure you’re documenting it correctly. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The Affordable Care Act provides preventive and early diagnosis healthcare services for free to anyone with a health insurance policy. This article provides coding specialists with guidance to ensure they’re documenting these services correctly so that providers are compensated properly.
While the use of artificial intelligence has begun to change how healthcare organizations process data, large language models have not yet reached the level of sophistication to meet the demands of medical coding, according to an op-ed published by Forbes.
In an environment where there is continuous development of new technology for the treatment of medical conditions, the AMA created a third category of CPT codes. Category III codes are a set of temporary codes for reporting emerging technology, services, and procedures. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Accurate medical coding for dermatological procedures is essential for proper payment and compliance. This article provides a detailed overview of coding guidelines for excisions and repairs, ensuring that healthcare professionals correctly report these procedures.
CMS recently published its HCPCS Quarterly Update, which brings 148 HCPCS Level II code additions, discontinuations, and revisions. The changes became effective April 1.
The nearly 40,000 new National Correct Coding Initiative edits might seem overwhelming at first, but a divide-and-conquer strategy for the next update can make it more manageable. CMS added dozens of CPT codes to the procedure-to-procedure edits that went into effect January 1, 2025, and medically unlikely edit file that went into effect April 1.
Postherpetic neuralgia (PHN) is severe pain caused by damage to the nerves at the area or areas affected by shingles after the rash is resolved. Typically, it is pain that persists four or more months after the initial onset of the rash. For documentation purposes, the physician would need to state which type of PHN the patient has. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The largest barriers and facilitators to screening, documenting, and addressing adverse social determinants of health across United States’ emergency departments have been identified in a recent study published in JAMA Network Open.
Selecting a level of medical decision-making (MDM) is confusing and complicated. In this article, Terry Tropin, MSHAI, RHIA, CCS-P, defines key MDM terms and describes a simplified system for selecting a level of MDM.
Train new coders to follow CMS’ rules when they find CPT guidance that doesn’t match Medicare’s requirements. This article discusses how the CPT manual’s instructions to report modifier -99 (Multiple modifiers) don’t match instructions from CMS and some Medicare administrative contractors.
You may have noticed that people are feeling stressed out throughout the United States. Each individual deals with stress in their own way. Most often, ICD-10-CM diagnosis codes reported for these patients may be a bit vague, especially when you are coding for a primary care physician.
When medical services are rendered, the expectation is that the facility and/or provider will be reimbursed for those services. Sometimes the reality is that a claim will be denied as it “fails to meet medical necessity” by the insurance carrier. It is always in your best interest to appeal all medical necessity denials. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Radiologists and providers who implant or program implantable medical devices should review the six new magnetic resonance (MR) safety CPT codes that went into effect January 1, 2025. The codes describe the work involved when a medical implant or metallic foreign bodies create additional risks for an MR exam.
A recent report from the Brown University School of Public Health compared the average commercial price for low-complexity, low-intensity medical care in New York hospital outpatient departments to the same care provided in non-hospital settings, such as physician offices and ambulatory surgery centers.
On November 1, 2024, CMS released its final rule describing calendar year 2025 policies and rates for Medicare’s Outpatient Prospective Payment System and the final rule was published in the Federal Register. This article is a comprehensive overview of all the major highlights, allowing coders to stay informed about key updates and navigate the changes throughout the year.
Practices upped their use of modifier 59 (Distinct procedural service) in recent years, adding nearly 1 million 59-appended claims to the most frequently reported same-day procedural codes.
With the prevalence of diabetes mellitus among the population expected to grow, an overview of the disease may help you keep track of how to code instances of it. This article will cover the different types of diabetes mellitus and a few tips when coding it.
A recent study published in BMC Public Health, found that patients in Colorado diagnosed with long COVID increasingly sought care from outpatient and specialist visits over hospital and emergency department visits.
With the prevalence of diabetes mellitus among the population expected to grow, an overview of the disease may help you keep track of how to code instances of it. This article will cover the different types of diabetes mellitus and a few tips when coding it.
This article wraps up our coverage of modifiers commonly used by pain management practices that are required by Medicare and private payers when a CPT procedure code on a claim isn’t detailed enough to precisely tell what service or procedure was provided. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Treating providers can perform audio-only evaluation and management visits via telephone for patients who are at home thanks to the three-month telehealth extension through to March 31, 2025. But remember to follow the rules for audio-only visits in the final 2025 Medicare physician fee schedule.
Q: A 64-year-old established female patient visits the orthopedic office for ankle pain and swelling. She stepped off the curb yesterday afternoon to get the mail and missed a step, her sandal caught the edge of the curb and she rolled her right ankle. Physical examination shows notable swelling in the right ankle. Full range of motion, although patient complains of discomfort on extension and flexion. Able to weight bear. X-rays negative for fracture. Based on medical decision-making rules, what would this be coded as?
On November 1, 2024, CMS released its final rule describing calendar year 2025 policies and rates for Medicare’s Outpatient Prospective Payment System and the final rule was published in the Federal Register. This article is a comprehensive overview of all the major highlights, allowing coders to stay informed about key updates and navigate the changes throughout the year.
CMS recently published diagnosis code update files for discharges and patient encounters beginning on April 1, 2025, and through September 30, 2025. Learn about the revisions featured in the updated files.
Medicare or a private payer will ask physicians to put a modifier next to a CPT procedure code listed on their claims when the procedure code isn’t detailed enough to precisely tell what service or procedure was provided. We previously covered three modifiers commonly used by pain management practices. This article reviews three more modifiers commonly used by pain management practices. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
A study published in the Annals of Internal Medicine found that even when patients agreed to be charged for queries sent though a portal, only a tiny fraction of these asynchronous encounters were billed. This article covers why e-visits may be difficult to bill.
When a procedure code isn’t detailed enough to tell your payer precisely what service or procedure was provided, Medicare or the private payer asks physicians to put a modifier next to the procedure code listed on their claim. This article reviews three modifiers commonly used by pain management practices.
A study published in the Annals of Internal Medicine found that even when patients agreed to be charged for queries sent though a portal, only a tiny fraction of these asynchronous encounters were billed. This article covers why e-visits may be difficult to bill.
Although ICD-11 has not yet been adopted in the United States, various countries have implemented it to enhance their health data analysis, improve public health strategies, and foster international comparability. This article covers how other countries that have adopted ICD-11 are using their data.
The worldwide outpatient clinic market is projected to grow considerably in the next few years. Learn what key factors are driving the increase in demand for outpatient services.
There are no CPT or CMS rules that prevent an emergency department clinician from reporting fracture and dislocation care services when that service is provided. However, a decision to do so can have significant ramifications. Learn about some of the factors that must be considered.
When a procedure code isn’t detailed enough to tell your payer precisely what service or procedure was provided, Medicare or the private payer asks physicians to put a modifier next to the procedure code listed on their claim. This article reviews three modifiers commonly used by pain management practices. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Although ICD-11 has not yet been adopted in the United States, various countries have implemented it to enhance their health data analysis, improve public health strategies, and foster international comparability. This article covers how other countries that have adopted ICD-11 are using their data.
The 2025 CPT code set includes new codes for synchronous audio-only and audio-video visits. These visits take place between a patient and a physician or other qualified healthcare professional. This article covers what you need to know about these new codes.
A study recently published in JAMA Network Open examined the effects of outpatient rehabilitation programs for patients with post-COVID-19 condition. Find out how the patients benefited from these programs.
Telehealth rules and requirements from before the COVID-19 public health emergency were restored on January 1, 2025, but CMS will hang on to a few waivers. This article outlines several telehealth waiver extensions, as well as recent changes to telehealth law.
When coding level-based evaluation and management services based on medical decision-making, the amount and/or complexity of data to be reviewed and analyzed is one element that may be used to reach a code. This article covers what that entails. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Physicians and other qualified healthcare professionals have the flexibility to select an evaluation and management level based on either the complexity of medical decision-making or the total time spent on the date of the encounter. This article covers documenting E/M services based on time.
