Tag: CPT Codes

medicare telehealth policy changes

Medicare Telehealth Policy Changes: What Patients and Providers Need to Know

Medicare Telehealth Policy Changes are set to reshape the landscape of telehealth services. As the COVID-19 public health emergency ends, Medicare will revert to pre-pandemic policies, imposing stricter rules for telehealth services starting January 1, 2025, unless Congress intervenes. Key changes include: Geographic Restrictions: Patients must generally live in a health professional shortage area, a […]
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External Coding Audit

The Role of External Coding Audits in Healthcare

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? […]
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Debridement Coding

Optimizing Debridement Coding: Tips for Accurate Claims and Payments

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 […]
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Prevent Coding and Billing Errors

Preventing coding and billing errors can reduce claims denials

Accurate medical coding and billing are essential components of a healthcare practice’s financial health. When codes for procedures and diagnoses are recorded correctly, providers can receive timely reimbursements for the services they deliver. However, Prevent coding and billing errors can lead to claim denials, delays in payments, and increased administrative burden This blog post will […]
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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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October 2024 HCPCS Level II Code Set Update

October 2024 HCPCS Level II Code Updates

Discover the October HCPCS Level II Code Set Update: October 2024 HCPCS Level II code set will receive a quarterly update, introducing 32 new drug and biological codes. Additionally, five codes will be deleted, and five others will undergo revisions. Let’s explore what’s in store. New HCPCS Level II Codes The Centers for Medicare & […]
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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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CPT Codes

The Three Categories of CPT Codes

Table of Contents Category I CPT Codes Category II CPT Codes Category III CPT Codes CPT Code Series and CPT Code List 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 […]
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