Medicare pays for therapy services when the medical record and the information on the claim form accurately report covered therapy services. That means your documentation must be legible, relevant, and sufficient to justify the services billed. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to the National Multiple Sclerosis Society, almost one million people in the United States have been diagnosed with multiple sclerosis (MS), a chronic autoimmune neurological disorder. Discover how to code the diagnostic tests for MS, the varieties of the disorder, and treatments for it.
The implementation of the 21st Century Cures Act has resulted in radiology patients in the outpatient setting being able to view their examination results quicker, according to a study published in JAMA Network Open.
The Outpatient Code Editor provides the answers to the test, but to use it effectively you need to understand the history and the complex configuration of all the parts.
A study published in Respiratory Care found that integrating respiratory therapists (RT) in a chronic obstructive pulmonary disease (COPD) clinic led to significant improvements in symptoms and exacerbation rates among patients, as well as a reduction in hospitalizations.
CMS recently updated its July 2025 update to the Ambulatory Surgical Center Payment System to include several new HCPCS codes and revised information about coding for drugs, biologicals, and radiopharmaceuticals. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published the fiscal year (FY) 2026 ICD-10-CM Official Guidelines for Coding and Reporting to accompany the ICM-10-CM update that will be effective October 1, 2025. The guidelines include clarifications and revisions to several areas that coders should note.
Prepare now for 21 code revisions that coders will find in the 2026 CPT manual by reviewing changes in the proposed 2026 Medicare physician fee schedule.
The most common ankle tendon repair is for the Achilles tendon, the largest and strongest tendon in the body. Brush up on the CPT codes for repair of this tendon. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Machine learning (ML) has evolved beyond its status as a technological trend to become an indispensable asset in outpatient surgical risk stratification. Within the domains of medical coding and claims adjudication, coding professionals play a pivotal role in optimizing ML model performance.
To make sure your ICD-10-CM codes are correct and complete, you may need to use an X as a placeholder to expand the code to the proper length. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What if a provider sends a summary of their visit with a patient to the patient’s primary care provider. Is this considered a “discussion” of patient management?
Physical, occupational, and speech therapy are the most common types that people think of when therapy is recommended. However, there is a new type gaining momentum: pelvic floor therapy.
The calendar year 2026 OPPS and ambulatory surgical center (ASC) proposed rule, released on July 15, details payment updates, services covered, outpatient service volume, and quality reporting, among other proposals.
The proposed 2026 Medicare physician fee schedule, released July 14, boosts the Part B conversion factor for calendar year 2026, adds billing opportunities for behavioral health services, previews new codes, and updates the agency’s quality reporting programs.
Medicare considers the shoulder to be “a single anatomic structure,” according to the National Correct Coding Initiative policy manual. In this article, find out what that means from a coding standpoint. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What’s the difference between CPT code 90791 (Psychiatric diagnostic evaluation) and 90792 (Psychiatric diagnostic evaluation with medical services)?
Practices turned to two of the X-series modifiers in place of modifier -59 (Distinct procedural service) more than 7 million times in 2023 and saw mixed results with denial rates on the top-billed codes.
The second quarter edition of Coding Clinic included questions and answers for coding very specific situations not easily found using the Alphabetic Index. Review some of the noteworthy scenarios.
CMS recently released the fiscal year (FY) 2026 ICD-10-CM update, which includes 487 new diagnosis codes effective October 1, 2025. The new codes cover a range of diagnoses, so be sure to review the code update files.
We are just entering summertime and meteorologists are already warning about increased heat indexes all over the country. Staying hydrated is important advice because serious maladies can take place when the body becomes dehydrated.
Pain management providers primarily perform radiology services from the diagnostic imaging and radiologic guidance sections of the CPT code book, so specialty coders must know when these services can be separately reported and their documentation requirements. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Make sure you incorporate current CMS coding guidance for three preventive services into your workflow and check for denials that might be candidates for an appeal. Review the latest rules for HIV PrEP, hepatitis vaccine, and CRC screens.
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.
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.
Clients who participated in court-ordered assisted outpatient treatments (AOT) displayed significant improvements across several outcome measures, according to a study recently published in Psychiatric Research and Clinical Practice.
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.
A recent study published in the American Journal of Psychiatry looked into national trends in outpatient mental healthcare and found that the use of psychotherapy increased while the use of psychotropic medication alone decreased.
Modifier -25 is used to report a significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The first quarter edition of Coding Clinic included new and revised guidelines, a change to the Alphabetic Index, and a question and answer section which discusses complicated coding issues. This article highlights noteworthy changes.
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.
Effective October 1, 2024, three new diagnostic codes have been added to the ICD-10-CM classification system. These three new codes are designed to capture early stage type 1 diabetes preceding the onset of symptoms.
There are three ways to bill the services of a non-physician practitioner: incident-to, direct, and shared billing. The type of billing used often depends on the location of service and the degree of physician supervision. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
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.
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.
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.
