Category: Medical Coding

Coding-Critical-Care-in-2022

Latest updates on Critical Care Coding

Medicare updates its policy for these services to align with CPT®. The Centers for Medicare & Medicaid Services (CMS) revised its Part B benefit policy for critical care services, effective Jan. 1, 2022. Policy changes finalized in the 2022 Medicare Physician Fee Schedule (MPFS) final rule include a new definition of critical care services, who […]
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How to avoid medical necessity denials

How to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is normally addressed during an AWV. How to avoid it:“I often tell doctors to […]
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what-ai-can-and-cant-yet-do-in-payment-integrity

What AI Can and Can’t Yet Do in Payment Integrity

It’s important to be realistic about what AI can and can’t do currently. Artificial intelligence (AI) has been a buzzword in payment integrity for years. Companies are increasingly using AI and data mining to identify healthcare savings. This technology can be helpful in the right scenarios. Data versus Nuance AI, which includes technologies like machine […]
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2022 care management services codes to know

Question: Can you please tell us what the new codes are for principal care management and chronic care management? Answer: There are three new codes in the care management section of the CPT codebook. Care Management Services Principal Care Management Services New CPT codes have been added in 2022 to describe “Principal Care Management Services.” […]
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Evolving E&M Documentation: Where We’ve Been and Where We’re Headed

Providers today are stuck using outdated templates, leaving ample room for improvement. Let’s take a retrospective look at evaluation and management (E&M) services—examining what we had, what we have now, and what lies ahead. Before the implementation of the 2021 documentation guideline (DG) changes, many providers relied on templates built around outdated office-based documentation requirements […]
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