Medical Coding Guide

In the 2026 CPT update, Category III code 0042T for cerebral perfusion analysis has been deleted and replaced by two new Category I codes: 70472 and 70473. These codes support critical applications like acute stroke evaluation, occlusive carotid disease assessment, post-aneurysm vasospasm detection, brain tumor grading, stereotactic biopsy guidance, and treatment response monitoring. Perfusion analysis typically follows a … Read more

Medical coders must accurately report hydration therapy and injection administration using specific CPT codes, ensuring compliance with time-based rules and documentation standards. Hydration Services 96360: Intravenous infusion, hydration; initial, 31 minutes to 1 hour 96361: Each additional hour (list separately in addition to code for primary procedure) Therapeutic, Prophylactic, and Diagnostic Injections 96372: Therapeutic, prophylactic, … Read more

Definition of “With Contrast” The phrase “with contrast” applies only to contrast material administered intravascularly, intra-articularly, or intrathecally. Oral or rectal contrast administration alone does not qualify as a “with contrast” study. CMS Policy on Low Osmolar Contrast Material (LOCM) CMS has eliminated prior payment restrictions for LOCM, making it available to all Medicare beneficiaries. LOCM use is now standard … Read more

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