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…
November 29, 2024 | By Terry A. Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM, PACS Telehealth 2025: The Final Rule CMS issued the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) final rule on Nov. 1, 2024, publishing guidance that will have providers and coders scratching…
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)…
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…
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…
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,…
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…
Navigating Prescription Drug Medical Weight Loss Stephanie Allard, CPC, CEMA, CPA-RA, RHIT August 23, 2024 This year, a recurring issue is continuing to pop up in the audit reviews that I am completing for clients. The issue is related to medical weight loss and what I think is a complete misunderstanding in the industry regarding…
April 5, 2024 | By: Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM (updated 4/6/2024) 2024 brought new HCPCS codes that Medicare, Medicare Advantage and some 3rd-party Commercial plans that they will now pay for. One of those codes is the G0136; that is the Social Determinate…
December 22, 2023 | By: Edward Baker, Of Counsel | Lieff Cabraser Heimann & Bernstein On September 30, 2023, the U.S. Department of Justice announced a $172 million False Claims Act (FCA) settlement with Cigna relating to the submission of invalid HCC diagnosis codes to CMS in order to increase Medicare Advantage member risk scores, and therefore,…