Tag: CPT Codes

Updated Booster Codes for COVID-19 Vaccine Released

Updated Booster Codes for COVID-19 Vaccine Released

Age determines who qualifies for the bivalent formulations from Pfizer and Moderna. On Aug. 31, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 vaccines to include updated booster bivalent formulations. These latest formulations include messenger RNA components to help build immunity against both […]
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CPT Modifiers for Physicians to Get Paid

CPT Modifiers for Physicians to Get Paid

During a typical office visit, physicians may provide evaluation and management (E/M) services, minor procedures and more. The question is: Can they bill for each one separately? In some cases, the answer is no. In others, though, the answer is yes — but they must know what current procedural terminology (CPT) modifier to append. Modifiers […]
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Get Ready for E/M Coding in 2023

Get Ready for E/M Coding in 2023

The reverberations of the 2021 evaluation and management (E/M) documentation guidelines have barely subsided, yet we are already on the verge of witnessing further changes in this segment of CPT® for 2023 – and this time, the implications stretch beyond mere office visits. If your healthcare institution conscientiously adopted the 2021 E/M guidelines, there’s no […]
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How to avoid medical necessity denials

How to avoid medical necessity denials

How to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is normally addressed during an AWV. How to avoid it:“I often tell doctors to […]
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Can you bill E_M from the same appointment

Can you bill E/M from the same appointment?

Despite myths to the contrary, physicians are not prohibited from coding and billing for both preventive and problem-focused evaluation and management (E/M) services when they are performed during the same appointment. Motivated by a desire to avoid audits, many physicians tend to undercode for the work they perform. Others, however, are just unaware that the idea that […]
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2022 care management services codes to know

2022 care management services codes to know

Question: Can you please tell us what the new codes are for principal care management and chronic care management? Answer: There are three new codes in the care management section of the CPT codebook. Care Management Services Principal Care Management Services New CPT codes have been added in 2022 to describe “Principal Care Management Services.” […]
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Learn About OPPS Changes in July Update

Learn About OPPS Changes in July Update

Please be mindful that several coding and billing alterations pertaining to outpatient claims have been backdated to either April or January. Numerous modifications to Medicare’s Outpatient Prospective Payment System (OPPS) in the July update closely mirror those in the Medicare Physician Fee Schedule Database (MPFSDB) update for the same quarter. These include the introduction of […]
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Take the Complexity Out of Behavioral Health Coding

Take the Complexity Out of Behavioral Health Coding

The secret to ensuring both proper payment and compliance is in the details. Why is mental health coding so complex? Laurie Bouzarelos, MHA, CPC, asked and answered that question in her presentation “Coding and Billing for Psychiatry and Outpatient Mental Health Providers” at AAPC’s virtual HEALTHCON 2022, March 27-30. Bouzarelos manages to take much of […]
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