CMS recently released a national coverage determination update to the Medicare Claims Processing Manual . This update covers new requirements for CPT coding associated with acupuncture and dry needling services.
Q: Our coding department has a longstanding issue with physicians not presenting enough information to properly report CPT debridement services for ulcers, resulting in queries and denials. What do you recommend?
Cardiopulmonary resuscitation (CPR) is a lifesaving treatment used when the heart or lungs cease to function. Whether CPR is conducted alone or with other services, Nancy Reading, RN, CPC, CPC-P , covers the various ways that CPR can be reported and how to do so.
While taking time to relax is important, professionals must seize all opportunities to prepare for updates. Connie White, CPC, CPAR , reviews the process her team at Northside Hospital in Atlanta, Georgia takes to prepare for annual CPT code changes.
CMS’ 2024 OPPS proposed rule, released July 13, details major changes to price transparency requirements and proposes numerous changes to behavioral health reimbursement, coverage of dental services, and more.
Julie Kyles, CPC, explains that CMS issued a modest set of hospital and practitioner procedure-to-procedure and medically unlikely edits in the latest quarterly update to the National Correct Coding Initiative (NCCI) edits, effective July 1
Surgical osseointegrated bone prostheses have emerged as a popular alternative to hearing aids. Debbie Jones, CPC, CCA, defines how these devices work and how to report implantation, removal, and replacement of these devices in CPT.
The aim of every hernia repair procedure is to manipulate the herniated organ back into its proper position. This article reviews procedures and 2023 CPT coding guidance for hiatal, inguinal, femoral, abdominal, and parastomal hernia repairs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julia Kyles, CPC, offers insights into the risk category of the medical decision-making (MDM) table with three scenarios presented by Peter Hollmann, MD, and Barbara Levy, MD, co-chairs of the CPT/RUC Workgroup on E/M.
Q: A physician performs a lithotripsy on a stone in the ureter or removes a stone from the ureter through a transurethral approach, then performs a percutaneous nephrostomy and treats a stone in the kidney. Would both procedures be reported?
CMS released Transmittal 12053 in May, outlining CMS’ intended changes in the July 2023 OPPS update. The new HCPCS codes will be used to report gastric procedures, insulin pump equipment, echocardiography processing, and more.
CMS published its first quarter 2023 HCPCS Application Summaries and Coding Recommendations April 27, which summarizes the final decisions on HCPCS Level II code assignments. CMS created 58 new HCPCS codes, deleted seven codes, and revised one code. Most changes will be implemented July 1.
Q: A patient with a history of prostatic hypertrophy and dysuria receives a laparoscopic prostatectomy conducted with robotic assistance. Which CPT code would be used to report this?
Laura Evans, CPC , takes a deep dive into four CPT Category III codes that were released in the 2023 CPT Manual . Those codes are used to report cutting-edge regenerative musculoskeletal procedures, the use of animal implants, and facet joint replacements.
This article reviews the most common types of external diagnostic cardiology tests, examines relevant CPT coding guidelines, and offers reporting advice from an expert. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Modifier -25 is used to report a significant, separately identifiable E/M service by the same physician. Courtney Crozier, MA, RHIA, CCS, CDIP , reviews the American Medical Association’s guidance on correct reporting of modifier -25, and outlines when and how to report it.
Shockwave intravascular lithotripsy treats areas of severely calcified coronary arteries. Jane Arbogast-Schappell, CCS, CPC, CCC, CIRCC, explains the procedure and how to report it in HCPCS with coding examples.
Pain treatment procedures for trigger point injections have a history of high denial rates. Julia Kyles, CPC , offers insight on what coders and physicians can do to improve reporting of these procedures.
Q: Which CPT code would be reported for an emergency department (ED) visit for an asthma patient experiencing exacerbated symptoms and released with a prescription for treatment?
Coding audits are often a source of irritation in small and large practices alike. This article covers common misconceptions about the auditing process and offers tips from experts on how to correct them. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association’s (AMA) CPT Editorial Panel recently approved a new vaccine administration code for COVID-19. It also released a summary of panel actions, which includes accepted and deleted code and guideline revisions for July 2023, January 2024, and January 2025.
Receiving payments for rendered physician services relies on clean claim submission with accurate CPT codes. This article reviews common CPT coding and billing errors, their causes, and strategies for preventing them.
CMS has published CPT and HCPCS Level II updates that take effect in April. Review highlights of the code and modifier changes in the April 2023 HCPCS Level II and OPPS updates.
The January 2023 update to the CPT manual had almost every chapter undergoing some form of change. In this article, Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, delves into some of the major changes to E/M coding and considerations for documentation integrity.
E/M coding guidelines for emergency department services (CPT codes 99281-99285) were recently updated for the first time in decades. Hamilton Lempert, MD, FACEP, CEDC, reviews these changes, along with coding requirements for many other E/M services.
The American Medical Association introduced E/M updates for 2023 and there are more E/M changes scheduled for 2024, according to the CPT Editorial Summary of Panel Actions. Julia Kyles, CPC, explains several 2023 and 2024 code revisions and additions that coders would benefit from making note of in their CPT manuals.
CMS recently published its fourth quarter 2022 HCPCS Application Summaries and Coding Recommendations. The new codes will be used to report injections and skin substitutes and are scheduled to take effect April 1.
Kathleen M. Romero, MSN, RN, EBP-C , Cynthia Beal, MBA-HCM, BSN, RN, and Renee Pate, MSOL, MSN Ed., RN, CCDS, explain how they implemented a CDI program in their facility’s emergency department and the how establishing this program improved coding accuracy and increased reimbursement.
The HCPCS first quarter 2023 update, released in December, introduced several new codes and modifiers for medical products and procedural services. Most of the changes took effect January 1.
The CPT Editorial Panel made a handful of changes to codes for ocular and auditory system procedures as part of its 2023 update to the code set. This article reviews canaloplasty and auditory osseointegrated implant CPT code revisions and additions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Pam Warren-Brooks, MHA, COC, CPC, explains different types of psychiatric healthcare providers, outpatient facilities, and best practices for reporting psychiatric services using CPT codes.
Q: Would a same date admission/discharge E/M code be used for a scenario in which a patient is admitted at 11 p.m. on a Monday, is seen by the provider at 4 a.m. on Tuesday, and discharged at 8 p.m. on Tuesday?
The 2023 Medicare Physician Fee Schedule (MPFS) final rule finalized major documentation and coding changes. This article summarizes new guidance for reporting E/M and telehealth services and a significant cut to physician payments.
CMS recently published an FAQ document on the use of drug waste modifiers. The resource addresses how the modifiers affect Medicare policy, to which products they can be appended, billing concerns, and more.
Q: What are the differences between remote therapeutic monitoring and remote physiologic monitoring and what details should we look for in documentation to report these services with CPT codes?
This article outlines kidney anatomy, explains percutaneous nephrolithotomy and pyelolithotomy procedures, highlights relevant CPT guidance, and includes insight from experts. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
This article outlines when and how to report new and revised 2023 CPT codes for arthroplasty and arthrodesis procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Remote therapeutic monitoring is one of the latest services to enter the virtual landscape since the COVID-19 public health emergency began. Debbie Jones, CPC, CCA, defines the services and reviews CPT guidance for reporting them.
Q: When is it permissible under Medicare to assign CPT add-on code 37186 for a secondary thrombectomy when an atherectomy is performed in the same vascular territory?
The CPT Editorial Panel released 20 new Category III CPT codes. These new codes, along with two revisions, are mainly for cardiovascular procedures and take effect July 1.
The American Medical Association's update to the 2023 CPT code set has brought three code additions, one revision, and one deletion to the integumentary chapter (CPT codes 10030-19499). This article provides procedure descriptions and coding guidance for the new and revised codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Alysia Minott, CIRCC, CCS, CDIP, explains that CPT coding for complex procedures performed using interventional radiology (IR) can be mastered; the first step is learning how to interpret applicable coding guidelines.
The new batch of diagnosis codes and revised guidelines for social determinants of health (SDOH) that will go into effect April 1 highlight the importance policymakers place on collecting this data. Julia Kyles, CPC, provides tips for capturing the SDOH using these new codes.
Coders can reinforce their understanding of the 2023 CPT E/M medical decision-making (MDM) requirements with tips from Peter Hollman, MD , who oversaw the changes.