Category: Medical Coding

Billing Codes for MRI

2025 Billing Codes Proposed for Complex MRIs with Implants

CMS is proposing new Billing Codes for MRI in the draft 2025 Medicare Physician Fee Schedule to account for the extra work involved in safely performing MRIs on patients with implants or other factors that could pose risks. These additional tasks might involve reviewing a patient’s medical history, researching implant specifics, carefully considering risks and […]
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CPT Codes

The Three Categories of CPT Codes

Current procedural terminology meaning: Current Procedural Terminology or CPT codes are developed by the American Medical Association (AMA) to describe a wide range of healthcare services provided by physicians, hospitals, and other healthcare professionals. These codes are utilized to communicate with other physicians, hospitals, and insurers for claims processing. There are three categories of CPT Codes: […]
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Prior Authorization Requirements

Physician Discovers Hidden prior authorization Details in CPT Codes

A proposal to track prior authorization using CPT codes was pulled back for revision after a surprising finding. An urologist, advocated for the plan to compensate physicians for time spent on prior authorization requirements. He also hoped it would streamline the process and improve patient care. However, the American Medical Association (AMA) informed urologist that […]
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Retina Injection coding

Master Retina Injection Coding for Smooth Billing & Reimbursement

Accurate coding is essential for retina practices performing intravitreal injections, especially when handling retina injection coding. While medication and modifier updates occur frequently, understanding these basics ensures proper reimbursement: CPT® Code Consistency: CPT® code 67028 remains constant for administering the medication. HCPCS Level II Code Tracking: Codes for injected drugs (HCPCS Level II) vary and […]
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ICD-10-CM coding

Top 10 ICD-10-CM Coding Errors

Medical ICD-10-CM coding accuracy is crucial for efficient healthcare reimbursement. Even minor errors can lead to claim denials, delays, and lost revenue. Here are the top 10 medical coding mistakes to avoid: Accuracy is Key: 1. Don’t Skip the Details: ICD-10-CM codes often require specific details in the fourth and fifth digits. Using truncated codes […]
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July 2024 OPPS Update

Comprehensive Overview of CMS July 2024 OPPS Update (CR13632)

The CMS Releases July 2024 OPPS Update (reference: CMS Change Request CR13632, MLN Matters number MM13632). Here’s a summary of key changes: New Coverage for COVID-19 Pre-Exposure Prophylaxis: Drug: PEMGARDA (pemivibart) – Code: Q0224 (Note: This code is not reimbursed under OPPS, but at a “reasonable cost”) Administration: Code: M0224 (Covered: Receives separate payment under […]
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common-medical-coding-mistakes-and-how-ai-is-resolving-them

Common coding mistakes and how AI is resolving them

The administrative burden of accurate coding is a major contributor to physician burnout, a problem even worse since the COVID pandemic. Studies consistently show it’s a leading cause of stress for doctors and staff. Incorrect coding, including medical coding mistakes, can have serious financial consequences for medical practices. Denial of claims, reduced reimbursements, and audits […]
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Benefits of Remote Patient Monitoring (RPM)

The COVID-19 pandemic highlighted the need for alternative healthcare delivery methods. Remote patient monitoring (RPM) emerged as a valuable complement to telehealth, allowing doctors to remotely monitor patients’ health data in real-time. How Remote patient monitoring Works RPM utilizes various devices to track vital signs like blood pressure, heart rate, and blood sugar. It can […]
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