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Medicare Regulations:

Attack Financial and Operational Impact of Denials

Published on Thu Sep 04, 2025

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September 2025

Optometry/Ophthalmology Coding:
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Learn the difference between hypertropia and hypotropia. Strabismus, commonly known as crossed eyes or misalignment [...]

Anesthesia Coding:
Rely on These Codes for Obstetric Anesthesia Services
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Anesthesia Coding:
Aim for Specificity for Coding Anesthesia During Lithotripsy
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General Coding:
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Question: I’m new to coding and am having trouble understanding when to use modifiers that [...]

Technology & Innovation:
Prepare for RTM/RPM Changes in the 2026 CPT® Code Set
Make sure treatment management services are performed in real time. The 2026 AMA CPT® code [...]

Technology & Innovation:
Are AI Codes in the 2026 CPT® Code Book?
Question: Will the 2026 CPT® code book include any more codes that use artificial intelligence [...]

Podiatry Coding:
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Diagnostic Radiology Coding:
Strengthen Your Spinal MRI Coding Knowledge
Pay attention to region and contrast for accurate coding. The spine is one of the [...]

Technology & Innovation:
Lure Cyberattackers in With AI-Powered Honeypots
Question: I keep reading articles about how healthcare systems should prepare for a cyberattack with [...]

Diagnostic Radiology Coding:
Find Out How to Report Fluoroscopy That Lasts Past 1 Hour
Question: We have a radiology report where the radiologist performed fluoroscopy during a procedure for [...]

Podiatry Coding:
Learn How to Code a Morton’s Neuroma Excision
Question: I have an op note that describes the removal of a Morton’s neuroma. I’m [...]

Anesthesia Coding:
Focus on Anatomy to Choose Upper, Lower GI Codes
Question: When coding anesthesia services for endoscopic gastrointestinal procedures, what’s the delineation between upper and [...]

Neurology Coding:
Use Specific Dystonia Code, if Possible
Question: A patient is diagnosed with familial torsion dystonia. I can’t find this condition in [...]

Urology Coding:
Remember a 7th Character When Citing Urethral Injury
Question: I have a urology report where the physician diagnosed the patient with acute urinary [...]

Urology Coding:
Learn if TURBT Includes a Biopsy Procedure
Question: I have an op note for a transurethral resection of a bladder tumor (TURBT). [...]

Podiatry Coding:
Who’s Responsible for Sequencing Multiple Diagnosis Codes?
Question: When a physician makes multiple diagnoses on a patient during an encounter, is the [...]

Pediatric Coding:
Get Comfortable Coding These Common Back-to-School Conditions
Hint: Remember to add supplementary testing codes when necessary. Now that children have returned to [...]

Gastroenterology Coding:
How Should I Report Barrett’s Esophagus With or Without Dysplasia?
Question: Our gastroenterologist frequently screens patients with chronic gastroesophageal reflux disease (GERD) symptoms for Barrett’s [...]

Gastroenterology Coding:
Know How to Code a Ruptured Appendix With Open Conversion
Question: During a laparoscopic appendectomy for a patient presenting with classic signs of appendicitis (including [...]

Otolaryngology Coding:
Know the Signs, Code the Symptoms, for This Negative Strep Test Service
Question: A pediatric patient presented to our office with extremely enlarged tonsils, vomiting, fever, and [...]

Otolaryngology Coding:
Determine Sinuses Affected Before Assigning Dx in This Recurrent Sinusitis Encounter
Question: A patient came to our office complaining of headaches, facial pain, and nasal congestion [...]

Medicare Regulations:
Incorporate These Revised Medicare Signature Requirements
Question: We are reviewing policies and procedures to ensure we are compliant with Centers for [...]

Medicare Regulations:
SBIRT Services Expanded for Medicare
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Neurology & Pain Management Coding:
Cover Your Bases by Knowing Parkinson’s Treatment Stages
Patient could report for diagnostic testing, surgical implant, or therapy. When a potential Parkinson’s patient [...]

General Surgery Coding:
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Hint: The reason for the mesh removal determines the code. Hernia repairs are a frequent [...]

Urology Coding:
Bolster Your BPH Coding Knowledge With This Helpful Guide
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ICD-10-CM Coding:
How to Accurately Code Osteoarthritis Diagnoses in Orthopedics
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General Coding:
Count on Pathology Report for Correct Lesion Excision
Question: I’m coding a lesion removal. The provider submitted part of the lesion to pathology [...]

Neurosurgery Coding:
CPT® 2026: New Spinal, Imaging Codes Take Center Stage
Also, remember to note revisions and T code additions. The CPT® 2026 code list is [...]

General Coding:
Find Information on CPT®, HCPCS Code Updates
A new quarter and a new year are approaching, and that means code sets are [...]

E/M Coding:
Determine New vs. Established Patient for E/M Coding
Question: Our providers sometimes request that we bill a new patient evaluation and management (E/M) [...]

E/M Coding:
Know When to Use Modifier 25 With a Minor Procedure
Question: I often see providers performing minor procedures (like lesion removals or joint injections) and [...]

Orthopedic Coding:
Recognize RA Diagnosis Codes and Surgical Procedures
Examine and learn how to report real-world examples. Rheumatoid arthritis is a chronic autoimmune disease [...]

Pulmonology Coding:
Master Pleural Effusion Coding Rules to Ensure Your Claims Are Compliant
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General Surgery Coding:
Solve This Pilonidal Cyst Scenario
Question: Hello, I need help finding the procedure code for a pilonidal cyst debridement. The [...]

Cardiology Coding:
Follow Documentation, Guidelines for Paroxysmal Atrial Fibrillation
Question: I’ve been seeing paroxysmal atrial fibrillation (A.fib) diagnoses all over the place — far [...]

Oncology/Hematology Coding:
Connect to This Leiomyosarcoma Code
Question: I am trying to code leiomyosarcoma (LMS) of the sigmoid colon. I have found documentation [...]

Primary Care Coding:
Add Injection-Only Codes For Allergy Season
Question: We have a patient who receives their allergy medication from an online source to [...]

Practice Management:
Using Personal Laptops Could Prove Problematic
Question: Our office is looking to cut costs but also allow employees to work remotely [...]

Emergency Department Coding:
Check Paralysis Status Before Choosing ICD-10-CM Code
Question: If a patient suffers from “lower paraparesis NOS,” what ICD-10-CM code should I choose [...]

Pediatric Coding:
Don’t Overstuff This Brief Visit
Question: How should I code the following? An established patient was brought into the office [...]

Oncology/Hematology Coding:
Follow this Beginners Guide to IMRT Coding
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Pulmonology Coding:
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Question: I’m new to pulmonology and could use some help with this case. The pulmonologist [...]

Pulmonology Coding:
Don’t Fret About Reporting Stress Tests for Dyspnea
Question: I have a report that states the pulmonologist performed pulmonary stress testing and diagnosed [...]

Emergency Department Coding:
Get Your Documentation Straight for TPI Claims
Question: What CPT® codes should I report for this encounter? Also, I know that this [...]

E/M Coding:
The Documentation Divide: What Separates a 99213 from a 99214
Shoring up your coding with documentation can prevent payer downcoding in acute illness encounters. As [...]

Neurology & Pain Management Coding:
Delve Into Syndrome Symptoms for This Chronic Pain Dx
Question: If a patient has chronic pain syndrome, how is that different from a more [...]

Oncology/Hematology Coding:
Understand Drug Toxicity Monitoring for High-Risk MDM
Question: According to the Risk of Complications element of the CPT® medical decision making (MDM) [...]

Optometry/Ophthalmology Coding:
Learn How to Report an Eyelid Laceration Repair
Question: I have a report documenting the repair of a upper right eyelid laceration as [...]

Optometry/Ophthalmology Coding:
Dig the Diurnal Curve Testing Code Out of the CPT® Code Book
Question: Our ophthalmologist evaluated intraocular pressures (IOPs) over 12 hours and documented the measurements. The [...]

Path/Lab Coding:
Get the Answers to All Your Digital Pathology Digitization Procedure Code Questions
Learn why reporting them is in your long-term best interests. The digital pathology digitization procedure [...]

Orthopedic Coding:
Evaluate Your Options to Report Multiple 28485 Units
Question: I need help with billing multiple units of 28485-LT. We reported the following CPT® [...]

General Surgery Coding:
Cut the Guesswork From This Gastrostomy Tubing Case
Question: Our surgeon performed a percutaneous replacement of a gastrostomy tube. During the procedure, the surgeon [...]

Compliance:
File Paper Records Safely Away Permanently
Question: Because our clinic is relocating in a few months, we are working on digitalizing all [...]

Practice Management:
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Thread the needle on prizes that are fun for kids, tolerable for adults, and compliant [...]

Practice Management:
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Question: There are a few practitioners at our clinic with terrible handwriting and signatures that [...]

Primary Care:
Be Ready for a Return to Prepandemic Telehealth Rules
Requirements regarding originating and distant sites may now determine payment. Telehealth is a boon to [...]

Neurosurgery Coding:
Count Segments to Code Laminectomy Properly
Question: How should I code the following encounter? A patient with lumbar stenosis without neurogenic [...]

Compliance:
Protect Your Practice by Considering These Compliance Tips
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Primary Care:
Use This Modifier for This Common Patient Situation
Question: Our office saw a patient that is a Medicare beneficiary. According to the provider’s [...]

Pediatric Coding:
Improve Your Insight on Eating Disorders
Question: Can you explain the difference between the three different codes related to binging and [...]

Orthopedic Coding:
Use a Joint Code for a Thumb Ligament Sprain
Question: I have a report with a diagnosis of a traumatic ulnar collateral ligament sprain [...]

In Case You Missed It (RCI Bonus Content):
Check Out Medicare’s 2025-2026 Payments for Flu Vaccines
And don’t forget to add those administration codes. On Aug. 13, 2025, the Centers for [...]

Diagnostic Radiology Coding:
Can You Report Pelvis X-rays Separately From 73502?
Question: A 72-year-old patient presented to an imaging clinic with complaints of low back and [...]

Path/Lab Coding:
Code This Lab by Specimen, Not Procedure
Question: I am trying to figure out the correct CPT® code for this specimen. The [...]

Emergency Department Coding:
5 Tips Lead to Stress-Free Wrist and Forearm Closed Fracture Coding
Hint: Don’t forget to consider using modifiers 54 and 57 when warranted. Most fractures treated [...]

Path/Lab Coding:
Use Pathologist Findings for This Definitive Dx Code
Question: Are we as coders allowed to code from the lab results? The ordering physician puts [...]

Otolaryngology Coding:
Listen to This Ear Condition Coding Advice, Part 2
Here are all the codes you need for hearing tests and hearing loss conditions. Last [...]

ICD-10-CM Coding:
Find Out Information on Side Dominance for I69-
Question: A provider documents a patient having hemiplegia after a stroke but doesn’t specify which [...]

Compliance:
Decide on This Date of Service Confusion
Question: We have a provider who saw a patient and recommended surgical intervention. The practitioner [...]

Medicare Regulations:
Attack Financial and Operational Impact of Denials
Question: I’ve read that the Centers for Medicare & Medicaid Services (CMS) is increasingly targeting [...]

Cardiology:
Myth-Busting Guide: Rhythm and Routine ECG Coding for Medical Coders
Do not use 93040-93042 to report review of telemetry strips. Electrocardiogram (ECG/EKG) coding seems straightforward [...]

Ob-Gyn Coding:
Bust 5 Adhesiolysis Coding Myths: When You Can Report It Separately
Think lysis of adhesions is always bundled? Think again. Lysis of adhesions is one of [...]

Ob-Gyn Coding:
Pinpoint the Correct CPT® Code for Induction
Question: I’m having a hard time choosing the correct code for this situation. Intrauterine death [...]

Ob-Gyn Coding:
Use Unlisted Code For JADA® System Removal
Question: How should I bill for JADA® removal? Should I use an unlisted code? If [...]

Gastroenterology Coding:
Crack the Code on ERCP: Demystifying 43261-43265 & 43275-43278
Get the clarity you need to confidently code ERCP procedures and secure proper reimbursement. If [...]

Cardiology Coding:
Does Stent Placement Matter for Angioplasty Code?
Question: A patient was taken emergently to the cardiac catheterization lab due to an acute myocardial [...]

Neurosurgery Coding:
Document Myalgia Dx With Future in Mind
Question: If a patient suffers from myalgia, how do I choose an ICD-10-CM code? I’m new [...]

ICD-10-CM Coding:
Know Your Way Around Coding Transport Accidents
Hint: look for details about the type of vehicle involved in the accident in the [...]

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