Medical coding

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

It’s important for medical coders to understand the differences between audio-only visits and telephone visits, as they are not the same, despite both being types of telehealth services. Key Differences in the Codes: Audio-only codes are designed for both new and established patients. This means that these codes can be used whether it’s the first … Read more

HCPCS Level II add-on code G2211 recognizes the significant and ongoing relationship between a patient and their physician. It compensates for the additional time and effort involved in managing the complexities of long-term patient care. This includes activities such as patient conversations, development of comprehensive care plans, and collaborative decision-making. This article explores the billing … Read more