With advancements in artificial intelligence (AI) and augmented intelligence enabled healthcare, the American Medical Association provided guidance outlined in Appendix S taxonomy for describing and classifying various AI applications. This article will help coders understand the AI taxonomy.
CMS developed medically unlikely edits (MUE) as a way to limit the number of times a particular service is allowed to be billed by a single provider to a single patient on any given date of service. This article explains how MUEs can be used to stop errors. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
When a physician requests a consult from another physician, how can medical coders tell if the conversation counts toward the data review column in the medical decision-making table? This article provides guidance on when to count those conversations.
Make sure your staff know when they can count the independent review of a test toward medical decision-making. This article provides guidance on when to count independent interpretations.
Medicare utilization of CPT critical care code 99291 and add-on code 99292 jumped higher during the pandemic years. That bump has subsided, however, and a review of 10 years of progress in critical care utilization suggests the codes have swiftly adjusted to pre-COVID levels.
CMS recently updated the list of preventive service codes that can be reported with complexity add-on HCPCS code G2211. In a recent change request, CMS deleted codes for services not considered covered preventive services and added codes for services that are considered covered preventive services.
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.
Our experts answer questions about the standard of care, reporting reduced services, and problems addressed during evaluation and management office visit.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
Prolonged service codes give practices the opportunity to earn additional revenue when the treating clinician spends extra time on a patient’s care. Evaluation and management (E/M) office visit codes include prolonged service code for exclusive use with office E/M services. Learn some quick facts about prolonged service codes and E/M visits.
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. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Level-based evaluation and management services may be coded based on medical decision-making (MDM). To reach a code based on MDM, the documentation must support at least two out of the three elements. This article covers the first element: number and complexity of problems addressed at the encounter.
The major revisions to the coding guidelines for office/other outpatient evaluation and management visits are almost four years old. And yet, practices continue to face challenges when they document and report these services. This article outlines four actions to avoid and four challenges that practices face when they report these high-value, high-volume services.
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.
CMS finalized its proposal to relax restrictions on complexity of care add-on HCPCS code G2211. The changes come in response to stakeholder concerns that the current CMS policy is disruptive to the way providers normally treat patients. This article covers how to prepare for this update.
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.
