Therapy 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,
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2021 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
Read moreAMA Approves 2 New CPT® Codes for COVID-19
One of the codes, 99072, is for reporting additional supplies used to mitigate spread of the virus. The American Medical
Read moreFind Free AAPC CEUs
Maintain your certifications without spending a dime. You passed your credential exam and now you have the responsibility of maintaining
Read moreExpedited Release of 4 New Codes for COVID-19 Testing
Over the past several months, as the COVID-19 pandemic has raged on, the American Medical Association (AMA) has expedited the
Read moreAMA Releases CPT 2021
The updated code set includes E/M code revisions and more. Here’s a preview. Medical coders will get a bit of
Read moreCOVID-19 Test-related Codes Released
It’s clear now which services apply to the no cost-sharing waiver. The Centers for Medicare & Medicaid Services (CMS) recently
Read moreNavigate the New vs. Established Patient Decision Tree
Three years is your key. Selecting the correct code for many evaluation and management (E/M) services (outpatient visits and rest
Read moreClear Up Those Cloudy Days
Ensure your provider’s cataract surgery documentation is audit-proof. Are the documentation requirements for cataract surgery in adults a little fuzzy?
Read moreUpdate Your Understanding of EEG Coding
Familiarize yourself with the 2020 code changes for long-term electroencephalograph recording. Auditing medical claims for long-term electroencephalograph (EEG) and video
Read moreSee What’s New for ICD-10-CM 2021
Make sure your diagnosis coding is up to date by reviewingthis chapter-by-chapter summary of the changes effective October 1. The
Read moreFocus on ICD-10-CM Guideline Changes for 2021
Review the new and revised guidelines for coding and reporting diseases such as COVID-19. While the ICD-10-CM code changes for
Read more2020-2021 Influenza Vaccine Codes, Pricing, and Recommendations
With the novel coronavirus continuing to circulate and cause severe illness in the United States and worldwide, getting a flu
Read moreCMS Proposes Medicare Telehealth Coverage in 2021
Physician Fee Schedule proposed rule lays the groundwork for payment and policy changes. The Centers for Medicare & Medicaid Services
Read more12 New Codes to Identify Therapeutics
And that’s not all: CMS has issued new coding guidance, too. The Centers for Medicare & Medicaid Services (CMS) implemented
Read moreFocus on Coding 3 Common Pediatric Eye Conditions
ICD-10-CM coding is clear when you know what to look for. Children’s Eye Health and Safety Month is a good
Read moreEnsure Good Vision Through Life
August is Children’s Eye Health and Safety Month. With the upcoming school year just around the corner, August is dedicated
Read moreCardiovascular Coding: Solve the PCI Puzzle Using CPT® and NCCI Guidelines
Know what details you need to piece together for proper coding of percutaneous coronary intervention. Percutaneous coronary intervention (PCI) coding
Read moreIt’s Time to Master Pathophysiology
Expand your knowledge and boost your career with AAPC’s newest advanced specialty course. In this ever-evolving healthcare environment, employers need
Read moreMultisystem Inflammatory Syndrome in Children: Here’s What You Need to Know
How to understand and deal with MIS-C and the unknown. As if the threat of COVID-19 wasn’t enough, at the
Read moreI Am AAPC: Yacelin Vazquez, CPC-A
I graduated with a Bachelor of Arts degree in Cuba, and I taught at a university there. When I emigrated
Read moreICD’s Continued Evolution and Impending Transition to ICD-11: Part 2
Part 2: Learn the key to developing a plan for ICD-11 implementation. Starting Jan. 1, 2022, countries around the world
Read moreNew Behavior Assessment Codes for Telehealth
Here’s why you shouldn’t use these codes for physician services … ever. There’s a slew of new health behavior assessment
Read moreGet Paid for COVID-19 Testing/Treatment of Uninsured
Payers are reimbursing providers for all COVID-19-related testing and treatment they are furnishing to their insured members, but what if
Read moreSneak a Peek at ICD-10-CM 2021
There are a slew of changes and only a few months before you will need to start using the new
Read moreJuly 2020 ASC Payment System Update
The Centers for Medicare & Medicaid Services (CMS) released the July 2020 update of the Ambulatory Surgical Center Payment System
Read moreExplore 2020 Cardiovascular System Code Changes
Familiarize yourself with the 2020 CPT® code updates for the cardiovascular system using this simplified guide. During these uncertain times,
Read moreClinical Trials Have a Place for Medical Coders
Research is a big job market often overlooked by healthcare business professionals. Healthcare is changing rapidly. New technology and drugs
Read moreDon’t Dismiss Juvenile Arthritis as Growing Pains
July brings awareness to juvenile arthritis: Learn about it to ensure proper diagnosis coding. When people hear that someone has
Read moreThe Rules Are Changing: ICD’s Continued Evolution and the Impending Transition to ICD-11
Part 1: Insight into the history of ICD and how it has changed over time is key to developing a
Read moreNew COVID-19 Test Codes Effective Immediately
Just when you thought you had all the COVID-19 coding for laboratory testing figured out — hold the phone —
Read moreIs There an NCCI Edit for Those Codes?
Know how to find the answer and improve your clean claims rate. Medicare revises its National Correct Coding Initiative (NCCI)
Read moreNCCI Tightens Up Cardio, Lab Edits July 1
Several procedure-to-procedure (PTP) edit changes in the Medicare National Correct Coding Initiative (NCCI) database will go into effect July 1.
Read moreICD-10-PCS 2021 Adds 544 New Codes
The 2021 ICD-10-PCS files are now available. Inpatient coders will have 544 new codes to work with beginning Oct. 1,
Read moreHCPCS Level II Code Changes in Effect July 1
C1748 Endoscope, single-use (i.e. disposable), upper gi, imaging/illumination device (insertable) C1849 Skin substitute, synthetic, resorbable, per square centimeter C9059 Injection,
Read moreTelemedicine Takes Healthcare Into the 21st Century
Update your understanding of how to code telehealth services now and in the future. Disclaimer: At press time, this information
Read moreLook for Clues When Coding Myocardial Infarction Interventions
Compliant reporting of myocardial infarction revascularization procedures is all in the timing. Does your staff know the coding guidelines for
Read moreHCC Coding for Post-Sepsis Syndrome
Capture risk adjustment payment for physicians who treat patients with late effects of sepsis. In the United States, more than
Read moreCode With Confidence
7 steps to set you down the path to coding claims with certainty. It has been my experience — both
Read moreIs It Alzheimer’s or Dementia?
Proper coding requires medical coders to know the difference. June is when we wear purple to recognize Alzheimer’s and Brain
Read moreTelehealth Coverage for Mental Health Services During COVID-19
As the global pandemic enters its fifth month, we are all feeling the strain. Staying home to slow the spread
Read moreHow Telehealth Services Factor Into Risk Adjustment
2020 has proven to be one of the most complex, busiest times in healthcare — in the 21st century, anyway.
Read moreClean Chiropractic Claims Require Coders to Know Where It’s “AT”
Ever since the publication of the Office of Inspector General’s (OIG’s) portfolio “Medicare Needs Better Controls to Prevent Fraud, Waste,
Read moreMedicare Telehealth Coding as of April 30
Healthcare providers are granted even more latitude for use of telehealth services during the COVID-19 public health emergency. When attending
Read moreMaximize Your Stroke Dx Coding
Tips to improve and streamline your stroke diagnosis coding processes. There are a lot of variables at play when it
Read more2020 Radiology and Imaging CPT® Changes
Become a coding superhero with X-ray vision. When is imaging separately reported, and how? The relative value units (RVUs) for
Read moreCalculating the Effect of the 2021 E/M Changes on Primary Care
Weigh the pros and cons as the healthcare industry prepares to implement new leveling guidelines. Unless you’ve been hiding under
Read moreExpert Documentation & Coding Practices in the EMR
Heightened documentation requirements and new technology require us to see the flaws in our EMRs and correct them. I’ve been
Read moreUsing Modifier 95 for Telehealth Makes Cents
Capture full payment for remote visits during the PHE for COVID-19. An interim final rule published in the April 6,
Read moreWorking as a Remote Coder During COVID-19
If you find yourself struggling to rapidly adjust to the ever-changing environment of the COVID-19 pandemic, you are not alone.
Read moreCoding High-Throughput COVID-19 Testing
The Centers for Medicare & Medicaid Services (CMS) created two new HCPCS Level II codes for lab tests that use
Read moreNew COVID-19 Testing Codes
During an emergency meeting in response to the COVID-19 crisis, the American Medical Association (AMA) convened the CPT® Editorial Panel
Read moreWaive Cost Sharing on Applicable Claims Using Modifier CS
The implementation of the Families First Coronavirus Response Act waives cost-sharing (coinsurance and deductibles) for COVID-19 testing-related services. The Act is
Read moreCOVID-19 Specimen Collection Codes
Clinical diagnostic laboratories can identify specimen collection for COVID-19 testing using two new HCPCS Level II codes, effective March 1,
Read moreGet the Most Out of New ICD-10-CM Addenda and Guideline Updates
On April 1, 2020, the National Center for Health Statistics (NCHS) formally issued updates to the ICD-10-CM List of Diseases
Read moreEase Central Pain Syndrome Coding in the IRF
Specificity will help your inpatient rehab facility meet the 60 percent rule. The opioid crisis has drawn a lot of
Read moreMaster the Art of Obstetrical Ultrasound Coding
Understand the coding mechanics behind some of the most common obstetrical US examinations. An outsider looking in might think diagnostic
Read moreCoding Newborn Attendance at Delivery and Resuscitation
Prepare for the unexpected when the patient is expecting. Oh, those cute little babies! All those fingers and toes and
Read moreICD-10-CM Coding for Spring Fever Mishaps
There’s a diagnosis code for every springtime affliction you can think of. Spring fever is not a definitive diagnosis in
Read moreVitamin D: Get Your Daily Dose
Deficient understanding of this essential vitamin could wreak havoc on your coding for related testing and diagnoses. Vitamin D testing
Read moreRemote Coding and Billing: Dream Job or Nightmare?
Working from home isn’t for everyone. Consider the pros and cons. Working from home can be a dream come true
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