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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
