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Medicare Claims Processing Manual (Chapter 17, §40) mandates JW and JZ modifiers for separately payable Part B drugs/biologicals from single-use vials/packages to track administered vs. discarded amounts. Modifier Definitions Modifier Usage Requirement JW Discarded/not administered portion from single-use vial Separate line; full documentation of discard process JZ Entire single-use vial administered (no discard); effective 1/1/2023, … Read more
Unlock the power of minimally invasive vascular imaging with CPT 73706: Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing. This code captures a sophisticated CT angiography (CTA) study that visualizes arterial and venous anatomy in the lower extremities with remarkable precision. CTA typically begins with a noncontrast scan for … Read more
NCCI Procedure-to-Procedure (PTP) edits include a modifier indicator (0, 1, or 9) that determines whether NCCI-associated modifiers can bypass the edit for separate payment of both code pairs. Indicator Meanings Indicator Meaning Bypass Allowed? 0 No modifiers permitted to bypass the edit. Both codes cannot be paid together under any circumstance. No 1 NCCI-associated modifiers … Read more
Medicare’s Medically Unlikely Edits (MUE) tables include a column specifying one of three MUE Adjudication Indicators (MAIs) for each HCPCS/CPT code. These numeric values—1, 2, or 3—dictate how claims exceeding the MUE unit threshold are processed by CMS claims-processing contractors. MAI 1: Claim Line Edit Applies as a line-level restriction. If units of service (UOS) … Read more
Mastering ICD-10 pregnancy coding guidelines is a game-changer for medical coders handling obstetric cases. These rules in Chapter 15 ICD-10 pregnancy codes focus on trimester final characters to ensure specificity, boost reimbursements, and ace audits. Packed with obstetric coding tips, this guide delivers practical, real-world advice on trimester coding in ICD-10-CM—your shortcut to top-tier coding. Trimester Definitions in ICD-10 Pregnancy Coding … Read more
Alcohol-related disorders are classified under ICD-10-CM category F10. These codes are used when a patient has problems related to alcohol use, such as abuse, dependence, intoxication, or withdrawal. Use of Blood Alcohol Level Code (Y90.-) If the medical record documents the patient’s blood alcohol level (BAL), you may assign an additional code from category Y90.- … Read more
The American Medical Association (AMA) continues to evolve the Current Procedural Terminology (CPT®) code set to keep pace with rapid advancements in medical technology and clinical innovation. On December 30, 2025, the AMA released its biannual update to the CPT® Category III codes, introducing 28 new codes and revising four existing ones. These updates highlight … Read more
Telehealth billing continues to evolve rapidly, and the CMS Calendar Year (CY) 2026 Medicare Physician Fee Schedule (MPFS) Final Rule introduces several important changes that affect medical coding, billing, and revenue integrity operations. These updates impact telehealth supervision rules, frequency limits, originating site fees, PECOS enrollment, and permanent inclusion of services in the Medicare telehealth … Read more
Introduction CPT codes are standardized medical billing codes created and maintained by the American Medical Association (AMA). These codes allow healthcare providers, hospitals, and insurers to communicate clearly about the services delivered to patients. Every procedure, test, injection, and consultation in U.S. healthcare is linked to a CPT code, making them the backbone of medical … Read more
Topic Quick Answer What is 99396? Annual preventive exam for established patients aged 40–64 Type of visit Preventive (wellness), not sick visit Who can bill it? Primary care physicians and qualified providers Medicare payable? ❌ No (uses G0438/G0439 instead) Common diagnosis Z00.00, Z00.01, Z13.1, Z12.11 Typical payment ~$150–$300 (varies by payer/location) Can it be billed … Read more