The American Medical Association (AMA) released the calendar year 2023 CPT code set on September 9. Learn about new codes pertaining to virtual reality technology, cognitive behavioral therapy, and abdominal hernia procedures.
Q: For colonoscopies, is it appropriate in CPT coding to report the excision of several lesions in the same portion of colon separately if they are removed by the same technique?
Shelley Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how, beginning in 2023, medical decision-making (MDM) will be used to determine E/M leveling for additional visit services, following similar changes for outpatient visits implemented in 2022.
The Office of Inspector General (OIG) recently released a data brief on billing risks associated with Medicare telehealth services during first year of the COVID-19 pandemic.
Q: How do CPT codes 28295 (correction, hallux valgus, with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method) and 28298 (…; with proximal phalanx osteotomy, any method) differ?
On August 31, the American Medical Association (AMA) announced eight new CPT codes for bivalent COVID-19 vaccine booster doses. The vaccine boosters are designed to combat both the original COVID-19 strain and omicron subvariants BA.4 and BA.5. Of the eight new CPT codes, four are to be used for Moderna booster vaccines and four are to be used for Pfizer-BioNTech boosters.
A recent Medicare Provider Compliance Newsletter highlights accurate documentation and CPT coding for total hip arthroplasty (THA) surgery. This newsletter explains relevant codes and reminders when reporting these procedures.
Streamlined coding and shorter time requirements for prolonged services are on the horizon for physicians and qualified healthcare professionals. The pending update to the E/M chapter of the CPT Manual , effective January 1, 2023, will replace four prolonged services with two 15-minute codes.
Erectile dysfunction, sometimes called impotence, is a common male disorder. Debbie Jones, CPC, CCA covers physiology, symptoms, and treatment for erectile dysfunction, as well as associated ICD-10-CM and CPT codes.
Coding professionals can get an early start to 2023 by reviewing CPT codes that will be added, revised, and deleted next year. Analysis of the 2023 Medicare Physician Fee Schedule proposed rule reveals changes to 10 chapters in the CPT Manual , in addition to the revisions to the E/M chapter.
Arthroscopic procedures have been the topic of controversy and confusion in the coding community. This article covers relevant anatomy, common shoulder arthroscopy and arthroplasty procedures, and National Correct Coding Initiative edits to keep in mind. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Interventional radiology describes a set of procedures that involve the insertion of medical devices and instruments to diagnose or treat disorders of blood vessels. This article covers common revascularization procedures, CPT codes associated with each vascular territory, and potential coding errors. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association (AMA) released the Category I vaccine product codes for monkeypox tests and vaccines. The organization made them effective immediately upon their approval by the CPT Editorial Panel on July 26. The new codes are scheduled to appear in the in the 2024 CPT Manual.
In part two of this series, expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, addresses the “nuts and bolts” of ICD-10-CM coding for anesthesia services, including how and when to append modifiers.
Coding professionals can get an early start to 2023 by reviewing CPT codes that will be added, revised, and deleted next year. Analysis of the proposed 2023 Medicare Physician Fee Schedule reveals changes to 10 chapters in the CPT Manual , in addition to the revisions to the E/M chapter.
A broken nose is a break in the bone or cartilage over the bridge of the nose or over the septum—the structure that separates the nostrils. Debbie Jones, CPC, CCA , explains how to select the most specific CPT codes for nasal fracture and dislocation treatments.
Because of the prevalence of eating disorders, coders should become familiar with their types, symptoms, codes, and relevant guidelines. They appear in ICD-10-CM under category F50 (eating disorders), but codes for individual symptoms appear throughout the manual.
CMS proposes to adapt the 2023 AMA CPT guideline changes to the nursing facility (NF) codes into its Medicare policy structure next year, according to the 2023 Medicare Physician Fee Schedule proposed rule.
Because of the prevalence of eating disorders, coders should become familiar with their types, symptoms, codes, and relevant guidelines. They appear in ICD-10-CM under category F50 (eating disorders), but codes for individual symptoms appear throughout the manual. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Most coders never have the opportunity to code for anesthesia. Expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains that ICD-10-CM coding for anesthesia services is interesting and straightforward, but can be confusing if an individual is unfamiliar with coding guidelines and terminology for anesthesia administration.
A broken nose is a break in the bone or cartilage over the bridge of the nose or over the septum—the structure that separates the nostrils. Debbie Jones, CPC, CCA , explains how to select the most specific CPT codes for nasal fracture and dislocation treatments.
Payment cuts are in the offing for Part B providers in 2023, along with a series of other projected changes targeting E/M services, COVID-19-related billing flexibilities, and value-based care, according to the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule released July 7.
The 2023 CPT update will shift provider consults, facility, and home-based E/M visits to a coding model based on medical decision-making (MDM) or time, according to the AMA.
Q: Based on National Correct Coding Initiative Manual guidelines, CMS allows facilities to bill 1 unit of CPT code 94640 per episode of care regardless of the number of treatments provided. Should you bill 1 unit of CPT code 94640 even if the service was performed three times?
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. Refresh your knowledge of this modifier with coding tips and example scenarios.
The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services is used to control improper coding leading to inappropriate payment for Part B services. This article provides an in-depth overview of 2022 updates to the NCCI Manual including new and revised reporting guidance. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. Refresh your knowledge of this modifier with coding tips and example scenarios.
Hospital coding for wound procedures is notoriously difficult, as the process can seem as messy as the injuries themselves. Clarify wound documentation and guidance for reporting wound diagnoses and procedures using ICD-10-CM, CPT, and HCPCS Level II codes.
Hospital coding for wound procedures is notoriously difficult, as the process can seem as messy as the injuries themselves. Clarify wound documentation and guidance for reporting wound diagnoses and procedures using ICD-10-CM, CPT, and HCPCS Level II codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medication Therapy Management (MTM) is a group of services provided by pharmacists that involve active management of drug therapy. Review CPT coding, the role of pharmacists, and documentation tips associated with MTM.
Sometimes even the most seasoned revenue integrity professionals get stumped trying to navigate the maze of billing, charging, and coding rules that govern chargemaster structure. Review expert answers to perplexing chargemaster questions.
Podiatry is the study, diagnosis, and treatment of disorders or deformities of the foot and ankle. Read up on foot and ankle anatomy and CPT coding for hallux valgus and rigidus corrections, cock-up fifth toe repairs, toe amputations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the difference between an implant and a foreign body removal and outlines CPT coding for these procedures.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the difference between an implant and a foreign body removal and outlines CPT coding for these procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Certain provider services such as acupuncture and cosmetic surgery are not reimbursed by Medicare. This article describes when and how to apply HCPCS modifiers for non-covered services.
Physician service modifier -FT for unrelated E/M visits provided on the same day has been a source of confusion for many coding and billing professionals. Review the latest coding and billing guidance for reporting this modifier.
Certain provider services such as acupuncture and cosmetic surgery are not reimbursed by Medicare. This article describes when and how to apply HCPCS modifiers for non-covered services.
Providers can now code for E/M visits based solely on medical decision-making. Julia Kyles, CPC , outlines how to use the first column of the medical decision-making chart in the CPT Manual to determine E/M level selection.
Arterial embolization is less invasive than open surgery and is often performed as an outpatient procedure in a hospital setting. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, evaluates medical necessity and CPT coding for uterine artery embolization.
Under certain circumstances, a service or procedure may be partially reduced or eliminated at the discretion of the physician. Read up on the correct application of hospital modifiers -52, -73, and -74 for reduced and discontinued procedural services.
To assign the most specific CPT codes for spinal procedures, coders need a solid understanding of spinal anatomy and surgical terminology. Review spinal anatomy and CPT coding for vertebral corpectomies, discectomies, laminectomies, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Under certain circumstances, a service or procedure may be partially reduced or eliminated at the discretion of the physician. Read up on the correct application of hospital modifiers -52, -73, and -74 for reduced and discontinued procedural services.
State and federal prosecutors continue to extract sizable settlements from practices that allegedly submitted fraudulent claims for one type of service—urine drug tests (UDT). In this article, Julia Kyles, CPC , breaks down fraudulent coding and billing patterns for UDT services.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for subsequent hospital visits and services provided on the day of discharge from inpatient status.
Review new CPT codes 98975-98981 for the monitoring of non-physiologic patient data such as musculoskeletal system status, respiratory system status, and medication adherence.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes that it’s not unusual for an outpatient coder to advance their career by diving into inpatient coding. When deciding to learn about ICD-10-PCS, it’s important to first understand the basics and compare and contrast ICD-10-PCS and CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Review documentation requirements and CPT coding for radiology services including computed tomography and x-ray scans, breast mammography, and bone length studies.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for subsequent hospital visits and services provided on the day of discharge from inpatient status.
Review documentation requirements and CPT coding for radiology services including computed tomography and x-ray scans, breast mammography, and bone length studies. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Selecting the most specific E/M code for a physician-patient encounter can be tricky. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down facility documentation and E/M coding for office visits and initial hospital care.
CMS recently released the 2022 National Correct Coding Initiative Policy Manual for Medicare Services . Julia Kyles, CPC , breaks down procedure-to-procedure and medically unlikely edits for a selection of new provider-based services.
Medical practices in the U.S. are expanding treatment options for major depressive disorder to include transcranial magnetic stimulation (TMS). Laurie Bouzarelos, MHA, CPC, reviews the basics of TMS, types of providers who can deliver TMS, and ICD-10-CM/CPT coding for TMS delivery and management.
The 2022 CPT code set includes 249 new codes that went into effect January 1. Review new CPT codes for spinal decompressions, cataract removals, auditory implantations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2022 CPT code set includes 249 new codes that went into effect January 1. Review new CPT codes for spinal decompressions, cataract removals, auditory implantations, and more.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, breaks down CPT coding for hearing assessments and for auditory osseointegrated implants used to treat certain types of hearing loss.
Shelley C. Safian, PhD, RHIA, CCS-P, COC , breaks down CPT coding for hearing assessments and for auditory osseointegrated implants used to treat certain types of hearing loss.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks CPT coding for breast biopsies, mastectomies, lymph node excisions, breast reconstructions, and other procedures used to prevent and treat breast cancer.
Four new CPT codes for principal care management services take effect January 1, 2022. Review documentation requirements and billing edits that will affect reporting of these new codes.
Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for mammography, breast ultrasound, and breast magnetic resonance imaging for cancer screening and diagnosis.
Read up on documentation requirements and CPT coding for psychiatric diagnostic evaluations and psychotherapy services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, breaks down ICD-10-CM and CPT coding for Meniere’s disease and perilymphatic fistulas—two conditions of the inner ear that affect hearing and balance.
Transcatheter arterial septostomy and transcatheter intracardiac shunt procedures are used to treat congenital cardiac diseases that restrict blood flow and atrial communication. Review documentation requirements and CPT coding for these minimally invasive surgeries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Transcatheter arterial septostomy and transcatheter intracardiac shunt procedures are used to treat congenital cardiac diseases that restrict blood flow and atrial communication. Review documentation requirements and CPT coding for these minimally invasive surgeries.
Kimberly A. Hoy, JD, CPC , summarizes proposed changes to physician coding and billing for therapy assistant services in the 2022 Medicare Physician Fee Schedule proposed rule.
The latest quarterly National Correct Coding Initiative (NCCI) update includes a reversal of procedure-to-procedure (PTP) edits that involve E/M codes along with new medically unlikely edits (MUE) for a series of COVID-19 vaccination codes. Review the changes, which went into effect on October 1.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks ICD-10-CM coding for uncommon obstetric (OB) complications and symptoms and CPT coding for surgical management of miscarriages.
Several CPT modifiers have similar definitions, which can make distinguishing between them challenging. Review guidance for the appropriate application of modifier -51 versus -59 and discontinued service modifiers -52, -53, -73, and -74.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for diagnostic services performed during the second and third trimesters, and provides an overview of an obstetric (OB) hospitalist's role in caring for high-risk maternity patients.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , writes about endocrine anatomy and physiology as well as ICD-10-CM/CPT coding for thyroid, parathyroid, adrenal, and pineal irregularities.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for diagnostic services performed during the second and third trimesters, and provides an overview of an obstetric (OB) hospitalist's role in caring for high-risk maternity patients.
Several CPT modifiers have similar definitions, which can make distinguishing between them challenging. Review guidance for the appropriate application of modifier -51 versus -59 and discontinued service modifiers -52, -53, -73, and -74. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for ancillary services provided by obstetric providers including targeted ultrasound services and maternal serum tests used to screen for fetal abnormalities.
Outpatient coding for injections and infusions can be challenging given the foundational definitions and complex rules that drive reporting of these services. This article breaks down the facility drug administration hierarchy and CPT coding for therapeutic infusions, injections, and hydration. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
To select the most specific CPT codes for prenatal care, physician coders must have a solid understanding of complex guidelines for reporting pregnancy-related office visits. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks services included in the global obstetric package and CPT coding for routine prenatal care.
Review proposed updates to the CPT set for 2022, including new codes for chronic care management, laser interstitial thermal therapy, spinal anesthesia, and more.
Outpatient coding for injections and infusions can be challenging given the foundational definitions and complex rules that drive reporting of these services. This article breaks down the facility drug administration hierarchy and CPT coding for therapeutic infusions, injections, and hydration.
Review proposed updates to the CPT set for 2022, including new codes for chronic care management, laser interstitial thermal therapy, spinal anesthesia, and more. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
CPT coding for vaginal and cesarean deliveries and postpartum care requires strong attention to detail. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down stages of delivery and CPT coding guidance for childbirth.
Earlier this year, the Office of Inspector General (OIG) added a new OIG Work Plan item for reporting E/M services with minor surgical procedures. Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CICA, CAC, CACO , reviews appropriate use of modifier -25 for separately identifiable E/M services.
To select the most specific CPT codes for prenatal care, physician coders must have a solid understanding of complex guidelines for reporting pregnancy-related office visits. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks services included in the global obstetric package and CPT coding for routine prenatal care.
Hospital coders often review charts for patients with diarrhea, ulcerative colitis, and other colorectal problems. Review ICD-10-CM coding for common conditions of the large intestine and CPT coding for proctosigmoidoscopies, sigmoidoscopies, and colonoscopies. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2022 Medicare Physician Fee Schedule (MPFS) proposed rule includes significant policy updates affecting physician coding and billing. Review proposals to decrease to the Medicare conversion factor, revise guidelines for critical care services, and loosen telehealth coverage requirements.
Cardiovascular conditions affect the structure and function of the heart and are a leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. This article details ICD-10-CM coding for common heart conditions and CPT coding for cardiac catheterization procedures.
Cardiovascular conditions affect the structure and function of the heart and are a leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. This article details ICD-10-CM coding for common heart conditions and CPT coding for cardiac catheterization procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hip and knee replacements are two of the most commonly performed elective surgeries, according to the American Academy of Orthopedic Surgeons. Review major joint anatomy and CPT coding for hip and knee revisions and replacements. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Pacemakers are small devices implanted in the chest to help regulate inconsistent heart rates. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down documentation and CPT coding for pacemaker insertions, repairs, and relocations.
National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUE) can throw a wrench in the Medicare billing process, delaying appropriate revenue. Learn how to apply recent guidance and best practices to resolve challenging edits.
CPT coding for psychotherapy and psychiatric diagnostic evaluations can be challenging, especially when these services are provided with office visits. Shelley C. Safian, PhD, RHIA, CCS-P , breaks down documentation and CPT coding for visit services provided with psychiatric care. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medicare waivers and flexibilities allow providers to deliver care via telecommunication technology during the COVID-19 public health emergency (PHE). Judith Kares, JD , reviews CPT coding for e-visits, virtual communication services, and telephone E/M services.
CMS withdrew the split/shared and critical care sections of the Medicare Claims Processing Manual and announced its intent to update coverage policies for these services. Prepare for changes to come by reviewing documentation, CPT coding, and billing guidance for split/shared and critical care services.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CICA, CAC, CACO , describes upcoming changes to CMS’ prior authorization program, including expansion of the program to include two additional outpatient services, effective July 1.
In the U.S., tympanostomy tube insertion is the most common ambulatory surgery performed on children under 15, according to StatPearls. Debbie Jones, CPC, CCA , reviews common types of ear infections and CPT coding for myringotomies with tympanostomy tube insertion. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With the inpatient-only (IPO) list set to be phased out, HIM departments need to prepare for the larger operational and financial impacts. Consider how these changes will affect your organization.
