Category: Medical Coding

CPT license

FAQs: Do you need a CPT license to use CPT codes

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 […]
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ICD-10 For Natural Disaster

ICD-10 Codes Related to Natural Disasters

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 […]
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Spinal neurostimulator implantations

CMS Prior Authorization for Spinal Neurostimulator Procedures

Prior Authorization for Spinal Neurostimulator Implantations: The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization requirement for spinal neurostimulator implantations surgeries on July 1, 2021. This policy change took effect after the Office of Inspector General (OIG) had concluded its field work but before the release of its investigation report. CMS specifically […]
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medical coding and CDI

Unlocking AI Power for Medical Coding and CDI: Essential Features

 Unlocking the Power of AI: Essential Features for Medical Coding and CDI Tools: When choosing an AI tool to improve medical coding or clinical documentation integrity (CDI), healthcare organizations navigate a complex landscape of emerging technologies. To ensure the right selection, focus on key features that enhance accuracy, efficiency, and compliance. One crucial aspect is […]
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AI-Driven Coding Automation

AI-Driven Coding Automation: The Future of Reimbursement Capture

AI-driven coding automation can save your practice countless hours each week, allowing physicians and staff to focus on higher-value tasks. This innovative technology is set to revolutionize the coding process entirely. In the future, it’s likely the healthcare industry will look back and wonder, “How did we ever manage coding without AI?” Now, let’s dive […]
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Modifier 50

Mastering Modifier 50: Ensure Accurate Billing for Bilateral Procedures

Modifier 50 is used to indicate that a procedure or service was performed on both sides of the body during the same operative session. It’s essential to use this modifier correctly to ensure accurate billing and reimbursement. Key points for appropriate use: Bilateral Procedures: The procedure must be performed on identical, opposing structures (e.g., eyes, […]
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Q4 HCPCS Level II code

Q4 2024 HCPCS Level II code Update: new Codes, Descriptor Changes, more

The Centers for Medicare & Medicaid Services (CMS) has announced updates to the Q4 HCPCS Level II code, effective October 1, 2024. These changes include: 58 new codes 10 codes with updated descriptions 6 discontinued codes Key Changes: New codes for medical and surgical supplies, outpatient procedures, durable medical equipment, and orthotic procedures. Replacement code […]
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CDI and coding

Overcoming CDI and Coding Challenges: The Power of AI-Driven Solutions

Defining the Challenge: Overcoming Obstacles in CDI and Coding: To clarify the overwhelming claims made by technology vendors, I’ve provided some basic definitions. As we embark on this journey, it’s crucial to pinpoint the specific obstacles we face. This will help us demonstrate to senior leadership and stakeholders the need for AI-driven solutions to enhance […]
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Reimbursement-methodology

Understanding Medical Codes and Reimbursement Methodologies

The Role of Medical Codes in Reimbursement Methodologies: Medical codes, such as CPT, HCPCS, and ICD-10 (CM and PCS), are essential components of various reimbursement methodologies. The Inpatient Prospective Payment System (IPPS), used by Medicare fee-for-service, categorizes patient stays into Medicare Severity Diagnosis Related Groups (MS-DRGs) based on ICD-10 codes processed through a computerized system. […]
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