Category: Medical Coding

Surgical Procedure

How to code global surgery modifiers 54, 55, and 56

To understand these modifiers, we first need to review the surgery global period. All medical procedures that include a global period are made up of three parts, explained in more detail later in the article: Pre-operative services Intra-operative services, and Post-operative care. If a physician does not perform all three parts of the service, compliant […]
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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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The Past, Present, and Future of E&M Services

Providers are currently stuck with outdated templates, leaving plenty of room for improvement. I thought it might be appropriate to take a “four score and seven years ago” look across evaluation and management (E&M) services, looking at what we had, what we have, and what is still to come. So, to begin, I will rewind […]
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Hundreds of new inpatient procedure codes finalized for fy 2023

Hundreds of new inpatient procedure codes finalized for fy 2023

CMS finalized the fiscal year (FY) 2023 inpatient procedure code set along with accompanying guidelines. KEY TAKEAWAYS331 new procedure codes will become effective October 1.The middle revenue cycle will need to be updated on recent coding changes that will affect hospital reimbursement. The FY 2023 ICD-10-PCS procedure code set and the ICD-10-PCS Official Guidelines for […]
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New Procedure Codes Coming This Fall

Look for them at a hospital near you. The ICD-10-PCS update for fiscal year 2023 is now available. To prevent coding errors that result in claim denials, inpatient coders should download the code files and familiarize themselves with the changes to inpatient coding that go into effect Oct. 1. The fiscal year (FY) 2023 ICD-10-PCS […]
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Regulations Open Doors for Telehealth Services in FQHCs

Make sure your facility is aware of all the Medicare policy changes that permit payment for expanded services. Telehealth as a healthcare delivery platform has been in existence since the late 1960s. It was first introduced through projects initiated by the National Aeronautics and Space Administration (NASA) and the Nebraska Psychology Institute. The declaration of […]
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Use 0074A for COVID-19 Pediatric Booster

Limit this code to administration of the Pfizer-BioNTech vaccine. On May 17, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to authorize the use of a booster dose for patients 5 through 11 years of age. The CPT® code to report administration of this […]
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