Category: Blog

ICD-11 Codes

News Alert: ICD-11 Codes Released by WHO

A major shift in the reporting of transgender issues is at hand. They’re here, but it won’t be until sometime until after 2022 that the United States is expected to adopt the codes of ICD-11 – the new International Classification of Diseases, Version 11 – released by the World Health Organization (WHO) in Geneva. According […]
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CPT Modifiers 52 and 53 vs. 73 and 74

CPT Modifiers 52 and 53 vs. 73 and 74

Modifier 74 description: Modifier 74 is used in the medical billing and coding field to indicate that a surgical procedure performed in an outpatient setting was terminated due to extenuating circumstances. When this modifier is applied to a billing code, it signifies that the procedure was initiated but discontinued before completion due to reasons beyond […]
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Fight Back Against Denied Insurance Claims

Fight Back Against Denied Insurance Claims: 5 Steps

Appealing a denied insurance claim can be frustrating, but don’t give up! By following these steps and understanding the process, you can increase your chances of getting the coverage you deserve. Here’s a detailed guide: 1. Understand Why Your Claim Was Denied (and Know Your Rights) Review the Denial Letter Carefully: This document should clearly […]
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July Brings Several Physician Service Code Updates

July Brings Several Physician Service Code Updates

Here’s a summary of the changes for the July update to the 2018 Medicare Physician Fee Schedule Database (MPFSDB). Changes are effective for dates of service on and after July 1, 2018. Indicator Change for RHC and FQHC Care Management Codes. For the following two HCPCS Level II codes, the PC/TC indicator is changed to […]
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CMS’ Verma Says No To Medicaid Lifetime Limits

CMS’ Verma Says No To Medicaid Lifetime Limits

Brief:  CMS Administrator Seema Verma on Tuesday said the agency will not approve any state requests to put lifetime coverage limits on Medicaid beneficiaries.  Earlier this month, CMS rejected Kansas’ request to place a three-year lifetime limit on Medicaid benefits. Still, four other states have requested similar Medicaid waivers: Utah, Arizona, Maine and Wisconsin.  Despite […]
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13 New Laboratory Codes

13 New Laboratory Codes – Updates & Changes By CMS

Clinical diagnostic laboratories can look forward to 12 new laboratory codes were effective April 1 and one code effective retroactively January 1. The Centers for Medicare and Medicate Services (CMS) released the changes May 5, 2018. The new codes are contractor priced until addressed at the annual Clinical Laboratory Public Meeting in July. All the […]
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Understanding Risk-Adjusted Payment Methodology

Understanding Risk-Adjusted Payment Methodology

The importance of an effective outpatient CDI program cannot be overstated We all know that getting the most accurate and appropriate documentation has always been an issue. Trying to clarify documentation to obtain the most accurate diagnosis coding has expanded to more and more areas, moving from inpatients with DRGs to outpatient with APCs, and […]
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