In medical coding, CPT modifier are vital for accurate reimbursement of healthcare services. These special codes, attached to primary procedure codes, provide additional details about the complexity or extent of a service. However, using modifiers incorrectly can lead to claim denials and lost revenue. This blog post shares six key tips to help you get […]
In this blog, you should know why healthcare providers need to be aware of the medical coding guide. 1. What is Medical Coding? Medical coding is the process of translating medical diagnoses, procedures, and services into universal alphanumeric codes for proper documentation and billing purposes. 2. Importance of Accuracy: Accurate medical coding is crucial for […]
Modifier 58 vs Modifier 78: Key Takeaway: Modifier 58: Same underlying condition, planned or unplanned additional procedure. Modifier 78: New problem caused by the initial surgery (complication) requiring a return to the OR. Medical Coders often struggle to differentiate between modifier 58 (staged/related procedure) and modifier 78 (unplanned return to OR). Let’s break down the […]
The HCPCS Level II quarterly update for July 2024 is now available on the Centers for Medicare & Medicaid Services (CMS) website. The update includes: 134 added codes 9 discontinued codes 32 codes with long description changes 3 codes with payment changes New HCPCS Level II Codes Effective July 1, 2024, there is one new […]
Modifiers 52: Professional fee-for-service guidelines for modifiers do not apply in the clinical setting. Reduced, Failed, Aborted, Aborted… which one? What are the requirements for using modifiers 52, 73 and 74? These questions are common in the coding center world, and the answers never seem to be clear. Confusingly mix up the medical code instructions […]
The official April 2024 update to the HCPCS Level II code set is now available on the Centers for Medicare & Medicaid Services website. April update includes: 62 new codes 2 changes to scope and long description 21 obsolete codes 11 changes to long description 1 change to changes miscellaneous changes Below are some code […]
New billing codes: Medical experts might consider creating new billing codes for the time doctors and their support staff spends working on prior authorizations. The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Board meets May 9-11 in Chicago. On the meeting’s agenda are three potential new CPT codes “for reporting services (physician, QHP, […]
Explore the intricacies of codes for a better understanding of regulatory compliance in medical coding. Healthcare billing and documentation are based on medical coding. An accurate representation of the patient’s health journey, appropriate reimbursements, and avoiding potential legal pitfalls are crucial to ensuring accurate representation of the patient’s health journey, not just an administrative formality. […]
Preventive Services Vs Office Visits: It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services Vs Office Visits is […]
2024 MPFS Final Rule: If you don’t have time to read the final medical fee schedule rule, be sure to read this section. Medicare policies may have a significant impact on all payer policies. Therefore, it is important for anyone working with health insurance claims to be aware of policy changes in the New Year. […]