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Medicare Regulations:

Look for Payment for Some HIV Drugs as Additional Preventive Services

Published on Tue Feb 04, 2025

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Other Articles of

February 2025

Neurosurgery Coding:
Zone in on Key Points to Alleviate the Pain of Arthrodesis Surgery Coding
You’ll filter through complex documentation on these claims. When choosing an appropriate spinal procedure code, [...]

Optometry/Ophthalmology Coding:
Don’t Miss Out on Reimbursement by Skipping Eye Exam Codes
Question: I work for an ophthalmologist who also has a retina subspecialty. The provider wants [...]

Pulmonology Coding:
Know When to Separately Report Spirometry Results Interpretation
Question: A pulmonologist in our practice interpreted the results of a spirometry test performed by [...]

Optometry/Ophthalmology Coding:
Correctly Bill for After-Hours Encounters
Question: A patient presented to an ophthalmologist’s office after regular business hours for an eye [...]

E/M Coding:
Does a New Setting Determine Patient Status?
Question: I have a situation where our nurse practitioner (NP) performed a new visit for [...]

General Surgery Coding:
Review 2 Cases to Polish Your Pressure Ulcer Coding Skills
Coding the 6th character is a must. When your general surgeon treats a patient with [...]

Otolaryngology Coding:
Take These 3 Tips for Flawless Pharyngitis Coding
There’s more to the condition than coding J02.-. Pharyngitis coding seems basic on the surface. [...]

Podiatry Coding:
Scan Your Way to Successful Orthotics Claims
Question: I just want to confirm something. At our podiatry practice (provider not facility), we [...]

Pulmonology Coding:
Can You Report COPD and Chronic Bronchitis Together?
Question: I have a medical report for an encounter with an established patient. The pulmonologist [...]

Pulmonology Coding:
Boost Your Bacterial Pneumonia Coding Knowledge
Find out how to code related conditions. Bacterial pneumonia is the most common type of [...]

Podiatry Coding:
Heed These Heel Spur Coding Tips
Question: I’m relatively new to podiatry coding. Can you explain the different surgical options for heel [...]

Neurology & Pain Management Coding:
Check for CT When Coding PET Scans
Sometimes, the physician will order both tests at the same time. Positron emission tomography (PET) [...]

Pediatric Coding:
Report Vitamin D Drops for Infant, Not Parent
Question: How do I report a nursing infant receiving vitamin D drops? Our provider wants [...]

Path/Lab Coding:
Don’t Let Mistakes Muddle You Modifier 90 or 91 Claims
Here’s how to avoid duplicate billing. Clinical labs frequently reach for modifiers 90 (Reference (outside) [...]

Diagnostic Radiology Coding:
Get a Grip on Your Skier’s Thumb Diagnosis Coding
Question: A patient presented with pain in the right thumb following a fall while skiing. [...]

Oncology Coding:
Take Time to Code Care Management Services Correctly
Know your provider type and bundled services. Oncology stands out as a specialty not only [...]

Neurology & Pain Management:
Medical Device Pain? There’s a Dx for That
Question: Encounter notes indicate that the pain management (PM) specialist saw a patient in the [...]

E/M Coding:
Don’t Let Technical Difficulties Ruin Your Claim
Question: If a telehealth visit was converted to an audio-only visit due to technical difficulties [...]

Path/Lab Coding:
Look to Neoplasm Codes for Inflammatory Breast Cancer Dx
Question: Our pathologist diagnosed inflammatory breast cancer. Should we report this using N61 instead of [...]

Diagnostic Radiology Coding:
Pick the Correct Code for 3-Finger X-Rays
Question: A patient presented with pain in the third, fourth, and fifth digits of the [...]

Emergency Department Coding:
Definitive Dx Changes ICD-10-CM Code Choice
Question: A patient presents to the emergency department (ED) complaining of diarrhea, nausea and vomiting, [...]

Pediatric Coding:
Unlock Better Care With New Childhood Obesity Codes
Question: How will the new ICD-10-CM codes for childhood obesity, which became effective October 1, [...]

Podiatry Coding:
Don’t Cut Yourself Short on This Ingrown Toenail Encounter
Applying modifiers correctly is the key to successful payment on this claim. Surgeries for ingrown [...]

Neurosurgery Coding:
Take These Tips to Tame T Codes
Question: Recently at out neurosurgery clinic, I heard one of the coders tell the other [...]

Urology Coding:
Use Documentation to Correctly Report Bladder Biopsies and Lesion Removals
Learn how to report multiple tumor resections. As a urology coder, you should pay careful [...]

General Coding:
Be Specific, Not Leading, in Query
Question: In a recent encounter, a provider documented that a patient had a patient-health questionnaire-9 [...]

General Coding:
Use These Tips for Finding Information on Payer Policies
Question: Patients in my practice are covered by a few different insurance carriers, and of [...]

Compliance:
Establish Policies to Reach Audit Goals
Question: I know audit policies are part of a comprehensive compliance program, but what should [...]

Path/Lab Coding:
Pick These Codes for Tubal Ligation and Placenta Pathology
Question: A patient had a cesarean section (C-section) and had bilateral tubal ligation during the [...]

Diagnostic Radiology Coding:
Assess Your Image Guidance Coding Knowledge
Find out when you need a guidance code. Knowing how and when to report image [...]

General Surgery Coding:
Code This Breast Cystectomy Case
Question: I need help coding the following procedure notes: A medial periareolar incision was created [...]

Orthopedic Coding:
Code Ankle Arthroscopy With Confidence
Enhance your understanding of descriptor verbiage. Orthopedic surgeons commonly perform ankle arthroscopy surgeries to treat [...]

Compliance:
See What Distinguishes a Diligence Audit
Question: I’m reading more about compliance and recently saw the term “diligence audit.” Is this [...]

Neurology & Pain Management Coding:
Doppler Study Code Gets 2025 Add-Ons
Question: When our neurologist performs a complete transcranial Doppler study (TCD), they sometimes also perform [...]

IN CASE YOU MISSED IT (RCI BONUS CONTENT):
April ICD-10-CM Update Comes in Like a Lamb
Small but significant changes to the code set are on the way. ICD-10-CM has released [...]

Otolaryngology Coding:
Use These Codes to Document Flu With Sinusitis
Question: A patient with congestion, thick nasal drainage, facial pain, and a headache presented to [...]

Emergency Department Coding:
Focus on Details in Lesion Coding
Size, location, complexity all figure into your choices. Coding for lesion removal in the emergency [...]

Cardiology Coding:
Look for Link Before Coding Adverse Effect
Question: We have a patient who presented to the emergency department (ED) with swelling of [...]

Cardiology Coding:
Know These 3 Factors for Coding Heart Catheterizations
Question: Is it appropriate to use the CPT® codes for congenital heart catheterization after a [...]

Orthopedic Coding:
Wrap Your Head Around This Wrist Surgery
Question: I have a surgical note with the following listed as the procedure: 1. Debridement [...]

Orthopedic Coding:
Find Out How to Report Knee Arthroscopy With VMO Plication
Question: An orthopedic surgeon performed knee arthroscopy with lateral release and vastus medialis oblique (VMO) [...]

Compliance:
Make Monitoring a Linchpin of Your Compliance Program
Compliance officers can delegate monitoring processes to managers and supervisors. The U.S. Department of Health [...]

ICD-10-CM Coding:
Grasp the Appropriate Use of Z51 Codes
Question: Can ICD-10-CM code Z51.11 be used when the provider sees a patient in between [...]

General Surgery Coding:
Figure Out This Fissurectomy Frustration
Question: When I attempt to bill a claim for CPT® codes 46505 and 46200 together, [...]

E/M Coding:
Code Level 4 E/M for Strep? Not so Fast
Consider CPT® definitions of systemic symptoms for precise coding. When the AMA revised the office [...]

Gastroenterology Coding:
Solve This Angiodysplasia Coding Query
Question: I have a report for a small intestine endoscopy, where the physician found an [...]

Gastroenterology Coding:
Fix These Capsule Endoscopy Claims
Question: We submitted separate claims for two different patients where one of our gastroenterologists performed [...]

Medicare Regulations:
Medicare Preventive Services Get a Boost for 2025
CMS changes will enable providers to detect problems earlier, when treatment is most effective. In [...]

Practice Management:
Is Time Blocking Beneficial?
Question: Our organization is hiring a practice manager who wants to switch our scheduling model to [...]

Otolaryngology Coding:
Keep Your Eye on This Code for vHIT Procedures
Question: What is the correct CPTÒ code for the video head impulse test (vHIT), which [...]

Practice Management:
Learn the Limit for Medicare Overpayments
Question: What are the guidelines for refunding excess payments if we recently found out that we've [...]

Technology & Innovation:
Administer Epinephrine Without Needles
Question: I have several patients who have severe allergies that always need to carry an [...]

Primary Care Coding:
Understand How Location of Osteoarthritis Narrows Code Choices
Question: There are several types of osteoarthritis (OA), lots of places it can manifest, and [...]

Technology & Innovation:
Screen for Colorectal Cancer With a Blood Test
Question: Physicians in our practice refer several patients for colorectal cancer screenings, but only about [...]

Medicare Regulations:
Find Appropriate Payer Order
Question: One of our patients is 69 but their spouse is 63 and works for [...]

Neurosurgery Coding:
Look Into Interspaces Before Coding PEEK Cage Insertion
Question: Some of my surgeons are inserting polyether-ether-ketone (PEEK) cages bilaterally and wanting to report [...]

Technology & Innovation:
Understand What’s in President Trump’s AI Executive Order
Find out if federal land will open for AI development. On Jan. 23, 2025, President [...]

Primary Care Coding:
Learn this Eating Disorder Acronym
Question: I work at a primary care practice and one of our providers documented a [...]

Primary Care Coding:
Get the Answers to All Your Vanderbilt Assessment Coding Questions
Don’t forget to brush up on your ADHD coding knowledge. If your provider has been [...]

Anesthesia Coding:
Beware Exceptions to Locum Tenens
Question: Some of our staff who help administer anesthesia are taking off on vacation at [...]

Urology Coding:
Assess This Problematic Abscess Procedure
Question: The urologist performed a procedure with operative notes as follows: Following the administration of general [...]

Emergency Department Coding:
Choose Carefully on Refill E/M
Question: A patient with benign prostatic hyperplasia (BPH) without lower urinary tract symptoms presents to [...]

Urology Coding:
Figure Out This French Whistle Tip Stent Scenario
Question: My urologist says he put in ureteral stents for another physician during a diverticulitis surgery. [...]

Anesthesia Coding:
Educate Yourself on Moderate Sedation Documentation, Guidelines
Find clarity when reporting moderate sedation. Moderate sedation is a drug-induced state of depressed consciousness [...]

Gastroenterology Coding:
Learn When and How to Use 43246 for Percutaneous Endoscopic Gastrostomy
Hint: You can’t use the code for every EGD procedure. The CPT® code range for [...]

ICD-10-CM Coding:
See the Difference Between Aftereffect and Sequela
Question: I’m relatively new to coding and my coworker and I are wondering how the [...]

Oncology Coding:
Don’t Take This Advice for PET Scan Dx
Question: I am having terrible issues with referring doctors using R91.8 for 78815/A9552. In the [...]

Oncology Coding:
Use Two Claim Lines in This Bilateral Mastectomy Scenario
Question: We recently had a patient come in for a bilateral mastectomy. The left breast [...]

General Coding:
Differentiate Modifiers GC, GE for Teaching Physician Services
Hint: Mastering the primary care exception rule helps open reimbursement doors. When your provider performs [...]

Pediatric Coding:
Lean On Other Signs/Symptoms to I.D. Viral, Bacterial, or Fungal Rashes
Hint: Sometimes the rash is the first sign, sometimes one of the last. According to [...]

Optometry/Ophthalmology Coding:
Clarify Your Cataract Extraction Coding Knowledge – Part 2
Learn what is needed to report ATIOLs and other procedures to correct cataracts. Last month, [...]

ICD-10-CM Coding:
Reduce Denials by Brushing Up on Excludes1 and Excludes2 Notes
Do you know the difference between an Excludes1 note and an Excludes2 note? Sometimes, it [...]

Cardiology Coding:
Explore Transthoracic Echocardiography and Separately Billable Modalities
Pocket these tips for billing echocardiography services. Echocardiography (“echo”) is a procedure that uses high-frequency [...]

Medicare Regulations:
Look for Payment for Some HIV Drugs as Additional Preventive Services
Question: Does the Centers for Medicare & Medicaid Services (CMS) cover medication for prophylactic transmission [...]

Ob-Gyn Coding:
5 Tips for Reporting 99211 Every Day in Your Ob-Gyn Practice
Here’s what needs to be in the documentation. Having a nurse on staff at your [...]

Ob-Gyn Coding:
Adding 59 to 57500 Means Correct Dx Code
Question: Can we bill 58545 and 57500 together if the surgeon took out a cervical [...]

Anesthesia Coding:
Find Split Billing Payment Answers
Question: Can an AA (anesthesia assistant) bill with a QZ modifier? Does this mean all [...]

Ob-Gyn Coding:
Choose This Code for Aspirated Ectopic Pregnancy
Question: What is the best CPT® code for this case? Cesarean scar ectopic pregnancy at [...]

Practice Management:
Explore These Causes for CHAMPVA Claims Going Unpaid
Tip: Check VA financial enrollment, then evaluate billing. If you are treating patients under the [...]

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