The concept of social determinants of health (SDOH) has transformed significantly, advancing from increased awareness to data integration and the development of tools and frameworks. This article explores the importance of integrating SDOH into the healthcare framework and the coding process, as well as best practices for leveraging this data to inform health interventions.
With CMS publishing annual updated versions of its Medicare National Correct Coding Initiative (NCCI) Policy Manual, as well as quarterly updates to the individual NCCI edit files, it is often hard for facilities to keep up with the changes. This article details the latest updates, as well as provides insights on implementing NCCI-associated modifiers and tips for preventing and overriding common edits.
CMS implemented modifier -FS (Split [or shared] E/M visit) as part of a major revision to its rules for split/shared services on January 1, 2022. This article provides tips for using modifier -FS from top reporters as it approaches its third year of active status.
CMS recently announced updates to the January 2025 Integrated Outpatient Code Editor, including new HCPCS codes and changes to a handful of status indicators.
CMS may have major changes in store for outpatient hospital reimbursement and compliance, according to the 2025 Outpatient Prospective Payment System proposed rule. The proposed rule, released in July, includes potential changes to payment, coding, and billing for hospital outpatient services.
Medicare patients who qualify for the new preventive service designed to protect them from HIV will be eligible for up to eight counselling and screening services a year, according to a recently released CMS national coverage determination.
Protect your practice by understanding the code level selection risks that could impact E/M office visit claims. Incorporate the guidance in this article into your compliance plan to make sure they stay on your risk radar. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In January 2024, CMS released guidance for the implementation of the office and outpatient evaluation and management visit complexity HCPCS add-on code G2211. Courtney Crozier provides a breakdown of the code, including documentation requirements and appropriate and inappropriate billing scenarios.
Looking to improve the speed and accuracy of your trigger point injection coding? This article will help you spot the information you need to code the services and find areas where your treating providers need extra help to improve their documentation.
Q: What codes should a coder consider for a patient diagnosed with an eating disorder (e.g., anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder)?
ICD-10-CM contains specific pain codes based on the type of prosthetic device, mesh, or implant. This article reviews best practices for using placeholders and selecting the correct encounter code, as well as other considerations when using diagnosis codes.
How do you code the conversion of a previous unicompartment knee arthroplasty to a total knee arthroplasty when there is no conversion code? This article reviews the AMA’s and the American Academy of Orthopaedic Surgeons’ takes on this issue. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Based on the instructions for sacroiliac joint injections, our physicians believe they can bill the injection and report imaging separately if they use ultrasound. Is this true?
The American Medical Association recently announced new codes, deletions, and revisions included in the CPT 2025 code set. Explore these notable updates to the code set.
Revisions to the E/M guidelines have simplified documentation and eliminated unnecessary documentation. Clinicians may choose levels of E/M services based on time or level of medical decision-making. Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC, CPC emeritus , dives deep into both processes and provides best practices for each.
The American Medical Association recently announced new codes, deletions, and revisions included in the 2025 CPT code set. Explore these notable updates to the code set.
