AAPC Social Hour: Career Paths and Certifications
The AAPC Social Hour on Facebook Live, July 15, at 11 a.m. MT (1 p.m. ET) focused on career paths
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CMS Forecasts Increase in Dialysis Payment, Health Equity Gap Reduction
Proposed rule improves payment rates, incentives, and ESRD treatment choices. Disadvantaged Medicare patients suffer from end-stage renal disease (ESRD) at
Read moreFeds Act to Regulate Surprise Billing
Interim final rule lays groundwork for implementing No Surprises Act by 2022. On July 1 the U.S. Department of Health
Read moreTake 5: Medicare News Flash – June 2021
Who has time to read all those wordy news releases and transmittals? Here’s news you can use in under 5
Read moreMy AAPC Brings Membership to Your Phone
Track an exam, sign up for HEALTHCON sessions, and renew your membership with this easy-to-use mobile app. Did you know
Read moreWhat’s Included in an AWV?
Set the record straight with patients to prevent surprise billing. If you work in a medical billing office, you know
Read moreUsing Regulatory Guidance to Support Audit Findings
Know where to find the proof you need to support your coding, billing, or auditing. As a medical auditor, biller,
Read more2021 E/M Guidelines FAQ – July
AAPC’s senior VP of products answers your questions about coding for office and other outpatient services. Ever since the release
Read moreModifier 59: Don’t Stop! Yield and Investigate
A quick check of the NCCI PTP edits can pay off in a big way. Let’s say you’re cruising along
Read moreHere’s What You May Not Know About Artificial Intelligence
Find out why “machine learning” is the most important part of the AI puzzle. Artificial intelligence (AI) is an ever-expanding
Read moreImproper Billing of P-Stim Devices Leads to More Fraud Settlements
Two chiropractic practices agree to pay over $800,000 to resolve liability for the alleged improper billing of P-Stim devices. In
Read moreTwo of a Kind
Meet AAPC’s first members of the month: Kim Huey and Sandy Giangreco Brown. Wondering who the ladies are on the
Read moreLeveraging Telehealth
Stay on top of the latest telehealth risk adjustment requirements and guidance to ensure continued compliance. It has been more
Read moreHypertensive Chronic Kidney Disease
Check your diagnosis coding for this patient encounter. A patient presents today for a follow-up for her hypertension. At her
Read moreClean Up E/M Documentation With SOAP
The old standby still works like a charm to show medical necessity. The American Medical Association’s (AMA’s) 2021 Evaluation and
Read moreAdvice From a CCVTC™
AAPC member Lena Holbrook, CPC, CDEO, CPMA, CCVTC, CEMC, has worked in healthcare for 15 years and currently works for
Read moreReview What’s New for ICD-10-CM 2022
Stay on top of the latest in diagnosis coding by reviewing this chapter-by-chapter summary of the changes effective October 1.
Read moreI Am AAPC: Sara Harvey, CPC, CEMC
I became an AAPC member because of my mom. She was a certified coder with a specialty certification in obstetrics/gynecology
Read more10 Service/Supply Claims Under Review
If your provider furnishes Medicare patients with any of the services or supplies on this list, expect an ADR. Ever
Read moreMedical Necessity: Is It Really Necessary?
Come to terms with payers to protect your provider’s revenue stream. “Medical necessity” is an important concept for medical coders
Read moreEvaluate Your OT and PT Coding
These services may seem alike, but differences in requirements can make or break your code assignment. Physical therapy (PT) and
Read more6 Reasons Why You Need More Than a 4-Week Online Course for Medical Billing and Coding
How long does it take to become a medical billing and coding specialist? If you’re considering a career in medical
Read moreResume and Interview Pro Tips
The AAPC Social Hour on Facebook Live, June 9, at 11 a.m. MT (1 p.m. ET) focused on resume and
Read moreCMS Updates Medicare Part B Drug Prices
Retroactive code pricing updates may require claims lookback. The Centers for Medicare & Medicaid Services (CMS) has posted a retroactive
Read moreMedical Reviews are Back on Track
Make sure your physician practice is prepared for renewed scrutiny of Medicare claims. Medicare Part B post-payment, service-specific medical reviews
Read moreTake 5: Medicare News Flash – May 2021
No time to read all those wordy transmittals? Here’s news you can peruse in under 5 minutes. Catch up on
Read more2020 Officer of the Year: Emily Schmidt
AAPC Chapter Association Board of Directors recognizes Schmidt and others who were nominated. The AAPC Chapter Association Board of Directors
Read moreRecurrent Inguinal Hernia
Check your diagnosis coding for this patient encounter. PREOPERATIVE/POSTOPERATIVE DIAGNOSIS: Recurrent right inguinal hernia. PROCEDURE PERFORMED: Laparoscopic right inguinal herniorrhaphy
Read moreAdvice From a CIRCC®
AAPC member Patricia Sonnemann, CPC, COC, CIC, CIRCC, CPMA, works for Concept Plus LLC, where she audits medical records for correct
Read moreI Am AAPC: Sherlyn Miranda Sulapas, RN, CPC, CPC-I
My path to coding and training began after I passed the 2008 Nursing Licensure Exam (NLE) in the Philippines. After
Read moreBreak Down Billing for New Drugs
Follow these steps when adding novel drug therapies to your practice management system to ensure accurate payment. New drugs, often
Read moreConquer Coding for Sepsis and SIRS
Arm yourself with a solid understanding of key terms and guidelines to overcome sepsis coding hurdles. Sepsis, systemic inflammatory response
Read moreTop 10 ICD-10-CM Coding Errors
There are many rules and regulations medical coders must follow for diagnosis coding. Avoiding these 10 most common errors will
Read moreAAPC Social Hour: Certification Exam Tips
The AAPC Social Hour on Facebook Live, May 26, at 11 a.m. MT (1 p.m. ET) focused on how to
Read morePHE Accelerated and Advance Payments Come Due
If you received government loans during the public health emergency, they may already be due. On March 28, 2020, the
Read moreHospice Addendum Problems Solved
2022 Hospice proposed rule would help with addendum statement snags, but other problems remain. In the Hospice proposed rule, published
Read moreGet Paid for Noncovered COVID-19 Vaccine Fees
HHS program reimburses healthcare providers and facilities for testing, treatment, and vaccine administration fees associated with insured patients. On May
Read moreAAPC Social Hour With Jill Young
Join subject matter expert Jill Young as she talks through the questions and concerns on everyone’s mind. The upcoming AAPC
Read moreNew Codes, Rates for COVID-19 Therapeutics
Healthcare providers administering monoclonal antibodies to Medicare patients with COVID-19 will soon see an increase in reimbursement, especially if providing
Read moreCPT Codes Created for Novavax COVID-19 Vaccine, Administration
The CPT code is the fifth created for providers to document and bill for the administration of COVID-19 vaccines, AMA
Read moreBasal Cell Carcinoma
Check your diagnosis coding for this patient encounter. A patient presents today to discuss the results of her skin biopsy.
Read moreCoding for MIS Procedures With Direct Visualization
Consider code descriptors, surgical anatomy, technology used, and type and amount of visualization. Most CPT® codes get added to the
Read moreIs MEAT Satisfying Your RAF Hunger?
Sometimes the acronym leaves you wanting for more. MEAT is an acronym for Monitoring, Evaluating, Addressing/Assessing, and Treatment. The coding
Read moreBegin to Understand 2021 E/M Guidelines
Get answers to the top 10 questions about coding for office and other outpatient services in 2021. Ever since the
Read more99211 in 2021
It’s about time for this nonphysician provider E/M code change. How do you feel you are handling the new American
Read moreTake 5: Medicare News Flash
No time to read all those wordy transmittals? Here’s news you can peruse in under 5 minutes. Catch up on
Read moreModifier 24: Determine How Your Payer Defines “Unrelated”
Brush up on modifier 24 guidelines to ensure payment for postsurgical unrelated E/M services. Standard postoperative care, including related evaluation
Read moreIs It an Audio-Only Phone Call or a Virtual Check-in?
Make sure your practice’s billing for communication technology-based services is compliant before the OIG comes calling. In response to the
Read moreRPM Coding by the Numbers
Know when to use remote physiologic monitoring codes and what to look out for when you do. Along with accelerating
Read moreAppend Surgical Modifiers With Confidence
Know how to differentiate modifiers 58, 78, and 79 to ensure proper reimbursement for all procedures performed. Modifiers convey important
Read moreBilling Opioid Use Disorder Treatment Services in 2021
Medicare expands coverage, creates new codes, and revises others. In December 2020, the Centers for Medicare & Medicaid Services (CMS)
Read moreAMA Releases 2021 CPT® Errata and Technical Corrections
Every year we take direction from the most recent CPT® code book, but it’s important to recognize that it doesn’t
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Telehealth Reimbursement Requires Provider Education, Documentation
COVID-19 was a catalyst for telehealth reimbursement, but provider education on coding and documentation processes is key to successful payments.
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Key Considerations for COVID-19 Vaccine Billing and Coding
Now that a COVID-19 vaccine is approved, providers need to execute a medical billing and coding strategy to sustain vaccination
Read moreCMS Increases COVID-19 Vaccine Admin Fee
New payment rates are effective immediately. The Medicare payment amount for administering the COVID-19 vaccine is increased, effective March 15,
Read moreApril Updates Bring HCPCS Changes
Make sure you’re using the latest code files for your Medicare claims. A second quarter update to the HCPCS Level
Read moreHow-to Modifier 22
Understand the additional work required to receive rightful payment. When a procedure exceeds the normal range of complexity, modifier 22
Read moreWhat to Do When a Pregnant Patient Has New Insurance
Counting the number of visits is key to proper billing of antepartum services. Open enrollment means that you may have
Read moreRefine Provider Coding Practices with CBRs
Avoid compliance issues and erroneous billing by utilizing comparative billing reports to educate providers. How do your billing submissions and
Read moreTherapy Threshold Amounts for 2021
Know your modifier KX rules to ensure payment. The annual update to the threshold amounts for physical therapy, speech-language pathology,
Read more2021 ICD-10-CM Coding Guidelines Get a Refresh
Several changes have been recently made to the ICD-10-CM Official Guidelines for Coding and Reporting for fiscal year (FY) 2021.
Read moreCPT 2021 Update: New Lab, Category III Codes
0640T Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation
Read moreGive Your Immunization Coding Skills a Boost
The answers to three frequently asked questions may surprise you. Here are three frequently asked questions (FAQs) about vaccination coding
Read moreImagine a Future in Medical Coding
Visionaries predict the role of the medical coder will change. Here’s what you need to know to secure your place
Read more6 Questions Ensure E/M Compliance
Take a look, from an auditor’s perspective, at using MDM to code office visits in 2021. When training providers on
Read moreCoding Diabetes Requires Precision
Look to the ICD-10-CM guidelines for accurate selection and sequencing of diagnosis codes for diabetes. Diabetes mellitus (DM) is a
Read moreTop Error Rates Offer Clues to Denials
Use CERT program reports to improve proper payment rates for Medicare claims. The Comprehensive Error Rate Testing (CERT) program grew
Read moreOPPS Final Rule Eliminates Inpatient Only List
The 2021 OPPS final rule seeks to increase patient choice and lower out-of-pocket costs. On Dec. 2, 2020, the Centers
Read moreMajor Stimulus Bill Would Pump Funds Into Healthcare
A $1.4 trillion government spending bill and $900 billion COVID-19 relief package is on its way to the White House.
Read moreExpect Give and Take in 2021 Physician Fee Schedule
In a final rule, CMS expands telehealth coverage but enforces budget neutrality mandate. After a slight delay, the Centers for
Read moreFinal Rule Updates MIPS for 2021 and beyond
CMS continues to phase in the Quality Payment Program while MACRA mandates loom. The long-awaited Physician Fee Schedule (PFS) final
Read moreHow to Report Regeneron’s REGN-COV2
Medicare issues two codes for second COVID-19 antibody therapy. A new investigational monoclonal antibody therapy for Medicare patients with mild
Read moreCMS Releases ICD-10 MS-DRG V38.1
Latest update includes assignments for new COVID-19-related diagnoses and procedures. The ICD-10 Medicare Severity-Diagnosis Related Group (MS-DRG) V38.1 Grouper Software,
Read moreShed Light on Coding SAD
Accurate ICD-10-CM reporting starts with understanding seasonal affective disorder. December is Seasonal Depression Awareness Month, and for good reason: In
Read more10 Tips for Refining Your Coding Productivity and Efficiency
Take your coding to a whole new level by getting more done in less time. Coding professionals face a new
Read moreTake a Stab at Pain Management Coding
Here’s how to report a trio of PM needle procedures. Pain management (PM) practices see a revolving door of patients
Read moreBecome a Modifier Virtuoso
Accurate coding and proper reimbursement hinge on understanding modifier usage. When I began my coding career in 2002, I was
Read moreMen in Medical Coding
Gain perspective as several men reflect on working in a female-dominated field. Medical coding is a rewarding field, as evidenced
Read moreE/M Time-Based Coding Made Easy
Familiarize yourself with CPT® guidelines to ensure proper coding and payment of evaluation and management services. Although evaluation and management
Read moreClinical Validation: The Next Big Challenge in Inpatient Coding
Denials resolution is a natural step up the career ladder for medical coders. As inpatient coders, we often are asked
Read more10 Ways to Improve Medical Coding and Billing Accuracy
Make your New Year’s resolution to reduce your error rate. Medical coding and billing errors can cause a host of
Read moreMedicare Finalizes COVID-19 Vaccine Payment Amounts
Just in time for new COVID-19 vaccine, administration, and treatment codes. The government is working at warp speed to make
Read moreMPFSDB October Update Clarifies Code Payment
Revised instructions indicate payment status for new CPT codes. The Centers for Medicare & Medicaid Services (CMS) has issued changes
Read moreCABG: Bypass Problematic Coding Scenarios
Proper claims payment is certain when you map out the best route. Coding coronary artery bypass graft (CABG) surgery is
Read moreFactor in Uncommon Diabetes Complications for Risk Adjustment
Make sure you’re not missing any diagnoses that will better portray patient risk to your payer. Diabetes causes elevated blood
Read moreDon’t Be Derailed by Discontinued Procedures
Ensure compliance and proper reimbursement using this guide to coding discontinued inpatient procedures. In the inpatient coding world, a great
Read moreUse Gastro E/M Scenarios to Ease 2021 Anxiety
Stomach the coming coding changes to evaluation and management services with this primer. By now, everyone knows of the seismic
Read moreTest Your Understanding of Modifier 57
Become a modifier expert by looking at the numbers. Pop quiz: A patient is admitted to the hospital. The provider
Read moreCOVID Tests Worth Less in 2021
Labs soon will have to work harder to merit the maximum allowed Medicare payment for high-throughput tests used to detect
Read moreAppropriate Use Criteria Testing Period Extended
The Appropriate Use Criteria (AUC) program, slated to begin Jan. 1, 2021, has been postponed. A notice on the Centers
Read moreCMS Adds 11 Codes to Telehealth List
Physicians can now offer more services via telehealth and get paid. The Centers for Medicare & Medicaid Services (CMS) is
Read moreWhen to Apply Modifiers 26 and TC
Modifiers 26 and TC are unique coding tools that may be used in specific circumstances. It can be easy to
Read moreFinal Rule Encourages Home Dialysis and Living Donor Kidney Transplants
Mandatory model aims to reduce Medicare expenditures for ESRD patients while improving their quality of care. Medicare beneficiaries suffering with
Read more3 New Codes for Infectious-Agent Detection
The latest changes to the CPT® code set will help clinicians distinguish seasonal infections from COVID-19 in their reporting. Three
Read morePayers Ending Telehealth Expansion Coverage
Unless ordered otherwise, most commercial payers will return to business as usual Jan. 1, or sooner. The COVID-19 public health
Read moreConfirm Breast Cancer Screening Coding
Breast Cancer Awareness month is the perfect time to review your practice’s medical coding for preventive and diagnostic breast imaging.
Read moreDeconstruct Diagnostic Categories and Disease Levels
Bolster your clinical coding by understanding the differences between syndromes, disorders, and diseases. While most people are familiar with the
Read moreOutpatient CDI: Next Step in Your Career Journey?
Opportunity is knocking for medical coders who want to transition into a new role. What is CDI? Clinical documentation improvement,
Read moreYour Guide to Provider-Based Billing
Here’s what you need to know to stay ahead of the curve and master hospital outpatient billing. When discussing the
Read more99000: The Little Code with Big Issues
For a code that has no relative value units (RVUs) and commands $0.00 in Medicare nonfacility fees, 99000 Handling and/or
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