How to prepare for 2025: New codes/New Rules

As we navigate this complex world of coding, every year we prepare for changes, updates, new codes as well as deletion of codes.  For 2025, there are 420 overall updates that are in the CPT 2025 code set.  Those include 270 new codes, 112 deletions, and 38 revisions.  Interesting to note that the biggest impact…

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Audit Validity

  December 06, 2024 | By Pam Warren, MHA, COC, CPC, Fellow It is very important to healthcare providers and leaders that the work auditors perform, the results auditors report and the recommendations auditors make are valid.  An auditor’s reputation is dependent upon audits that are legitimately performed and accurately reported.  If audits are perceived…

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Oncology Coding Tip: Mastering the Complexities of Radiation and Medical Oncology Billing

  November 22, 2024 | By Jordan Johnson, MSHA Coding for oncology services is an intricate task, requiring attention to detail, a deep understanding of clinical workflows, and the ability to navigate multiple systems and payer requirements. In radiation oncology, services often span multiple months, with a patient’s treatment involving 30-50 Current Procedural Terminology (CPT)…

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Auditing the Infusion Center

  November 15, 2024 | By Scott Kraft, CPMA, CPC When I audit services performed in an infusion center, I’m addressing two key questions. First, were all of the patient’s infusion, injection, and/or hydration services documented appropriately for what is being billed? Second, if evaluation and management services were performed, were they medically necessary and…

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Insurance Discrimination – Against the Provider

Insurance Discrimination – Against the Provider Author: Jeana M. Singleton, Esq.  When the concept of “insurance discrimination” rears its ugly head, we often think of it in the context of when an insurance company treats some people differently than others based on protected classes, such as race, national origin, sex, or religion.  Sometimes, this type…

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Understanding Independent Interpretation in E/M Coding: Three Essential Requirements

Understanding Independent Interpretation in E/M Coding: Three Essential Requirements Shannon O. DeConda, CPC, CPMA, CEMA, CPA-EDU October 4, 2024 In the realm of Evaluation and Management (E/M) coding, independent interpretation is an often misunderstood component of the Medical Decision Making (MDM) table. Proper documentation of independent interpretation is required to impact the MDM and, consequently,…

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Here’s Your Sign…

Here’s Your Sign… Shannon O. DeConda, CPC, CPMA, CEMA, CPA-EDU August 30, 2024 I recently visited a new provider’s office and noticed two prominent signs posted everywhere—one about a $100 no-show fee and another offering B-12 shots for cash. Surprisingly, the compliance issue isn’t with the no-show fee but with the B-12 cash service. Let’s…

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