Category: Medical Coding

Get-Ready-for-EM-Coding-in 2023

Get Ready for E/M Coding in 2023

The reverberations of the 2021 evaluation and management (E/M) documentation guidelines have barely subsided, yet we are already on the verge of witnessing further changes in this segment of CPT® for 2023 – and this time, the implications stretch beyond mere office visits. If your healthcare institution conscientiously adopted the 2021 E/M guidelines, there’s no […]
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New-Codes-on-Covid-19-Vaccine

New codes on COVID-19 Vaccine for patients 4 years and below

The effective date for 0081A-0083A and 91308 is June 17, 2022. The Food and Drug Administration (FDA) granted emergency use authorization (EUA) to the Pfizer-BioNTech COVID-19 vaccine for patients ages 6 months to 4 years. The new CPT® codes for reporting this vaccine are: 0081A Immunization administration by intramuscular injection of severe acute respiratory syndrome […]
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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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Medical-Necessity-Denials-Image

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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how-are-medicare-patients-using-interstate-telehealth-visits

How are Medicare patients using interstate telehealth visits?

Opponents of the loosened interstate telehealth restrictions that were instituted at the start of the COVID-19 pandemic argued that it would result in out-of-state doctors luring patients away from their current physicians. But a new study finds that most out-of-state telehealth is used for continuity of care, not acquiring new patients. The study compares interstate […]
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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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