The CPT 2026 code set, effective January 1, 2026, delivered 418 total changes — 288 new codes, 84 deletions, and 46 revisions. That's a lot to absorb, so here's a…
There are over 300 changes you need to know. KEY TAKEAWAYS Knowledge of coding updates is essential for everyone from the biller to the revenue cycle leader. The 2024 CPT…
When your job is converting medical documentation into codes, your knowledge of medical anatomy has to be shipshape. But you’ve got the added complication that the code set you’re using…
The "early release" of the Category I vaccine product codes prior to publication of CPT® 2006 was approved by the CPT Editorial Panel. In recognition of the public health interest in…
New codes are coming for the Current Procedural Terminology (CPT) code set to bring more specificity to coding for an expanding range of telehealth services. The American Medical Association, which…
As patients, we don't have the thousands of dollars it costs to tap into the extensive database information required for the entire body of CPT codes. But the AMA does offer us an easy way to look up one code at a time, for free.
The AAFP recently joined several dozen physician and other health care professional organizations, including the AMA, the American College of Physicians and the American Osteopathic Association, in asking CMS to…
Simplify CPT® coding by importing the 2015 CPT code set into your claims and billing software using the CPT® 2015 Data File on CD-ROM. This product consists of easy-to-understand features…
The American Physical Therapy Association (APTA) reports that due to the magnitude of proposed changes to an entire family of physical medicine and rehabilitation codes, the editorial panel of the…
From patient accounting systems to sticky notes and "cheat sheets" posted in exam rooms, ICD-9 codes permeate the health care environment, translating the information in medical records to numbers on…
One question we are asked a lot is "what are the approved manuals for the medical coding CPC exam from AAPC?" The most surprising "non change" is there is no…
The Center for Medicare and Medicaid Services (CMS) has proposed switching wound care reimbursement from the current pay-for-service model, in which the treating physician bills the government based on the…
The numbers are in! According to the American Medical Association (AMA), there will be 329 total code changes in 2014, to include 175 new codes, 107 revised codes, and 47…
Before 2011, hospitalists had only Centers for Medicare & Medicaid Services’ (CMS) specialty-specific CPT distribution data, and no hospitalist-specific data, available when looking for benchmarks against which to compare their…
2011 brings a new coding option when reporting the middle day of observations that last longer than two days. Check out this expert advice on how CPT additions will affect your FP’s observation care services coding starting on Jan. 1, 2011.
Until this point, coding for the “middle days” of an observation service caused problems. Although not the norm, there are times when a physician admits a patient to observation and she remains in that status for three or more days. CPT 2011 addresses these middle days between admission and discharge by introducing three new E/M codes. The additions parallel the hospital subsequent care series in terms of component requirements and time frames:
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Coding is all about applying standardized code sets to situations that don’t always qualify as “standard.” The good news is that authoritative coding resources sometimes address even those encounters you don’t handle on a daily basis. Test your skills with these two scenarios and see whether your responses match the official rules.
Challenge 1: Staff administers a non-chemotherapy therapeutic drug via one IV infusion site, and then following oncologist orders based on protocol, administers chemotherapy intravenously via a second IV site. Should you report the chemotherapy admin or the non-chemotherapy admin as the initial code?
Solution 1: Challenge 1 presents a trick question. You should report initial codes for both the chemotherapy and non-chemotherapy infusions.
CPT guidelines state, “When administering multiple infusions, injections or combinations, only one ‘initial’ service code should be reported, unless protocol requires that two separate IV sites must be used,” notes Gwen Davis, CPC, associate with Washington-based Derry, Nolan, and Associates.
Citing this same rule, Tracy Helget, CPC, in the business office of Medical Associates of Manhattan in Kansas, notes, “The easiest way to think of this is, if we are making more than one stick to the patient, we bill more than one initial code.”
Many payers indicate that when you report two initial codes because each requires a separate access site, you should append modifier 59 (Distinct procedural service). So you may need to append modifier 59 to the secondary “initial” code to indicate the separate IV sites for each infusion in this case. For example, your claim may include the following:
Challenge 2: Documentation indicates your oncologist participated in...