Often, a seemingly routine preventive visit or minor surgery can take an unexpected turn when a patient mentions a new concern, such as “Oh, by the way…” If a physician provides additional care beyond the originally scheduled service, you may be able to bill for a separate evaluation and management (E/M) service using modifier 25. […]
The constant updates in medical codes and evolving payer regulations, healthcare providers are increasingly turning to external coding audits. This blog post explores the importance of external coding audits, benefits, and how they support the healthcare industry in minimizing compliance risks, improving revenue integrity, and enhancing operational efficiency. 1. What Is an External Coding Audit? […]
The growing U.S. wound care market, fueled by an aging population and rising rates of chronic conditions, presents significant opportunities for healthcare providers. Accurate debridement coding is essential to maximize reimbursement and optimize patient care. Pressure injuries alone affect around 2.5 million Americans each year, leading to more than 60,000 deaths and costing between $9.1 […]
When you bill for distinct, separate procedures, it’s crucial to know which modifiers will ensure full payment for each service. Modifier 59, “Distinct Procedural Service,” acts as a universal tool to unbundle procedures that are typically included in a larger procedure or “bundled” together. This modifier signals to the payer that specific circumstances justify separate […]
Halloween is a time for fun, frights, and… the funniest ICD-10 codes for Halloween? Yes, you read that right! The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a complex system used to classify diseases and injuries. While it’s a serious tool for healthcare professionals, some of its codes can be quite amusing, […]
Healthcare fraud in medical coding, particularly through practices like upcoding and unbundling, has become a major concern for medical coding and billing professionals. A recent healthcare market research survey found that 90% of respondents view upcoding as a significant ethical challenge Upcoding involves assigning higher-level codes to medical services than are warranted, leading to inflated […]
The recent ICD-10-CM and PCS code updates, let’s delve into a mixed bag of relevant topics. One significant change allows us to assign severity levels for certain eating disorder diagnoses. For anorexia nervosa (both restricting and binge eating/purging types), bulimia nervosa, and binge eating disorder, we can now specify the following severity levels: Mild Moderate […]
Navigating the intricate landscape of medical billing and coding demands a firm grasp of Current Procedural Terminology (CPT) codes. One of the most commonly used yet frequently misunderstood codes is CPT 99211. This low-level evaluation and management (E/M) code is employed for services rendered by healthcare providers, typically in outpatient settings. While it might appear […]
The CPT license to use CPT codes is required for accessing the CPT code set, which is developed and maintained by the AMA as the standard medical language for reporting procedures and services in the US. This system is used by both public and private health insurance programs. CPT codes are also used for administrative […]
The International Classification of Diseases, 10th Revision (ICD-10), is a standardized medical classification system developed by the World Health Organization (WHO). It categorizes diseases, injuries, and other health conditions, including ICD-10 Codes for Natural Disasters. For natural disasters, the ICD-10 provides specific codes to classify related injuries and health issues. Here are some of the […]