Tag: CPT Codes

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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Medical Coding Audits: Trends and Guide for Providers

The landscape of medical coding audits is constantly evolving.  Staying informed about these trends and implementing best practices can significantly reduce stress and ensure a smooth audit experience. The Shifting Landscape of Medical Coding Audits Traditionally, medical coding audits felt like a lottery. Providers faced the uncertainty of random reviews, often scrambling to address issues […]
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14 Things To Know About Medical Coding

14 Things To Know About Medical Coding

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 […]
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AMA Aims to Streamline Prior Authorization Billing with New Codes

AMA Aims to Streamline Prior Authorization Billing with New Codes

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, […]
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Differences: Preventive vs. Office Visits in Medical Coding & Billing

Differences: Preventive vs. Office Visits in Medical Coding & Billing

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 […]
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The Importance of Accurate Medical Coding in Healthcare Reimbursement

The Importance of Accurate Medical Coding in Healthcare Reimbursement

In the intricate realm of healthcare, where patient well-being is paramount, the financial dimension often receives less attention. Yet, it’s imperative to recognize that healthcare encompasses not only patient treatment but also ensuring fair compensation for healthcare providers. Precise medical coding is a cornerstone of this endeavor. This piece delves into the profound importance of […]
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New and Updated HCPCS Codes for July 2023

New and Updated HCPCS Codes for July 2023

Newly introduced as of July 1, 2023, are updated CPT® codes detailed in MLN Matters 13210, issued on June 13. Accompanying this, a supplementary document, Change Request 13210, offers more comprehensive insights. Included in the fresh set of codes are those related to COVID vaccination and its administration. Specifically, 0174A pertains to administering the Pfizer-BioNTech […]
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Tips To Maximize Medical Billing and Coding Efficiency

Tips To Maximize Medical Billing and Coding Efficiency

Ensuring precise claims processing and prompt reimbursements, healthcare practitioners rely heavily on efficient medical billing and coding procedures. The act of streamlining these functions holds the potential to not only heighten overall effectiveness but also to curtail administrative burdens and mitigate the risk of errors. Within this article, we will delve into a selection of […]
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How to Bill an E/M With a Minor Procedure

To determine the appropriate use of modifier 25, review this case study in otolaryngology. The Cigna Group has delayed the requirement for submitting documentation with claims that involve a 25 modified offices or other outpatient evaluation and management (E/M) service (CPT® 99212-99215) and a minor procedure. Despite the payer not enforcing this requirement, physician practices […]
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