Medical coding

Historically, many patients have only sought medical attention when experiencing illness. However, modern healthcare initiatives, particularly under the Affordable Care Act (ACA), emphasize preventive care and early detection services as essential strategies for improving population health and reducing long-term healthcare costs. These services are covered without patient cost-sharing (e.g., copayments or deductibles) when properly documented … Read more

CMS Proposes Significant ICD-10-CM Code Updates in the FY 2026 IPPS Proposed Rule On April 11, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2026 Hospital Inpatient Prospective Payment System (IPPS) proposed rule, which includes substantial revisions to the ICD-10-CM code set. The proposal outlines the following changes: 487 … Read more

Understanding the appropriate use of surgical modifiers is essential for accurate coding and compliance. Recent audits by the Office of Inspector General (OIG) have revealed significant billing inaccuracies related to co-surgeon and assistant-at-surgery procedures, underscoring the need for careful review and application of relevant guidelines. OIG Findings on Modifier Usage In a November 2022 report, … Read more

Medical coders play a vital role in ensuring accurate and compliant documentation of services rendered by healthcare providers. One such code, CPT 99024, is integral in reporting post-operative evaluation and management (E/M) services included in the global surgical package, especially for providers reimbursed through Medicare or Medicaid. Background and Importance In a 2012 report, the … Read more

Assigning accurate and complete diagnosis codes for diagnostic radiology studies—such as X-rays, CT scans, MRIs, ultrasounds, and mammograms—can present a unique challenge, even for experienced medical coders. Unlike other clinical services, diagnostic radiology reports are based on interpretations by radiologists who typically do not have direct patient interaction. Instead, they rely on information provided by … Read more

Get ready, medical coders! The April 1, 2025, ICD-10-PCS and MS-DRG grouper updates are packed with changes, and you won’t want to miss out! The Centers for Medicare & Medicaid Services (CMS) has released a ton of new codes, deletions, and updates across multiple sections of the ICD-10-PCS classification system. This is your guide to … Read more

Medical Decision-Making (MDM) can be a complex and confusing process for medical coders. However, by understanding key concepts and following a simplified system, coders can accurately determine the appropriate MDM level for a given case. This article breaks down MDM and its components, providing a clear guide to help coders make more informed decisions. What … Read more

Vaccine codes, including those for immunizations and related procedures, are frequently updated, especially when new vaccines are introduced or billing requirements change. The American Medical Association (AMA) has updated the CPT code set to reflect these changes for the 2024-2025 period. In addition to updates for the influenza season, two new vaccine codes have been … Read more

Prolonged service codes provide a valuable opportunity for medical practices to earn additional revenue when a clinician spends extra time providing care to a patient. These codes are specifically designed to be used in conjunction with office-based Evaluation and Management (E/M) visits, allowing practices to report extended service time beyond the typical office visit. Here’s … Read more