Having been on the receiving end of audits, and also having been an individual who has conducted them, I know the mindset from both sides of this equation. The one element to this equation that has changed over time is the increase in payer denials: those that are now clinical- and coding-focused, often resulting in […]
CHICAGO – Much of remote digital health depends on the Current Procedural Terminology, or the CPT code set, which opened the door to payment for remote patient monitoring and remote therapeutic monitoring. Providers should be aware of CPT changes, especially for any codes that may be going away at the end of the public health […]
Medical coding is an essential aspect of healthcare in that it translates diagnoses, procedures, medical services, and equipment into alphanumeric codes. The processes involved in medical coding is complex, however, so errors can often result in payment delays and significant financial losses. The most common errors leading to delays and lost revenue are tracking down […]
The new code set has been officially adopted by 35 countries. The World Health Organization (WHO) officially unveiled the first version of ICD-11 in February 2022, marking the eleventh version of the International Classification of Disease (ICD) as officially implemented. Recently, in February 2023, the WHO announced the release of ICD-11 2023 version, just a […]
The agency proposes to strengthen the ties that bind payments to quality data reporting. The Centers for Medicare & Medicaid Services (CMS) issued, April 10, the Inpatient Prospective Payment System/Long-Term Care Hospital (IPPS/LTCH) proposed rule for fiscal year (FY) 2024. If finalized as written, inpatient hospitals and LTCHs that do not successfully report quality data […]
You won’t find these codes in your 2023 code books, but they are effective April 1. The Centers for Medicare & Medicaid Services (CMS) has released coding changes and policy updates for the Outpatient Prospective Payment System (OPPS). The updates include the addition of many new HCPCS Level II codes, the deletion of a few […]
In recent years, there has been an increase in scrutiny regarding the use of modifier -25 to identify separate evaluation and management (E/M) services on the same day as another procedure. Insurers are now demanding documentation of such services both before and after payment, leading to a significant administrative burden for urology practices. The reason […]
CPT code 99214. Is that Jean Valjean’s number? No. It is an evaluation and management (E&M) code of moderate complexity. Few CPT® codes cause goosebumps, a chill in the air, and a pit in your stomach besides CPT code 99214. It is an E&M code of moderate complexity. For a low-complexity visit, the code decreases […]
It may become common practice to identify genetic abnormalities prior to the development of manifestations. The March 2023 ICD-10-CM Coordination and Maintenance Committee Meeting presented me with a dilemma (Topic packet March 8, 2023, ICD-10-CM Coord & Maint Cmte Meeting). Now that we have the technology to unravel the genetic basis for conditions, are we […]
On March 14, 2023, the U.S. Food and Drug Administration amended the emergency use authorization (EUA) of the bivalent Pfizer-BioNTech COVID-19 vaccine to allow providers to administer a booster to certain young patients. As a result, on March 17, the American Medical Association (AMA) released a new CPT® code for booster administration. Here’s what you […]