IPPS: Planning for the Second Half of 2024

As we begin the second half of the year, it is a convenient time to make plans and take stock of our coding operations. There will be much to do…

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New ICD-10-PCS Codes Are Here

The new ICD-10-PCS codes for the 2025 fiscal year (FY) were posted on the Centers for Medicare & Medicaid Services website on June 6. The Version Summary reflects 371 new…

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CPT Coding for Use of Operating Microscope (+69990)

CPT code +69990 Microsurgical techniques requiring use of operating microscope is assigned when a surgeon uses an operating/surgical microscope to aid in visualizing small/fine structures in the operating field during…

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CMS Proposes Payment Models for Surgical Procedures

The Centers for Medicare & Medicaid Services (CMS) has proposed an episodic payment model, the Transforming Episode Accountability Model (TEAM). This is one of CMS’s “innovation” models. If it makes…

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Understanding Billing Requirements for Caregiver Training Services

As part of the Jan. 1, 2024 Outpatient Prospective Payment System (OPPS) guidelines, caregiver training services (CTS) codes were listed as billable services if provided by physicians and non-physician practitioners…

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Diagnosis Pitfalls to Look for When Seeking to Avoid Denials

A recent study from the healthcare solutions company Premier indicated that $19.7 billion is what hospitals and health systems are spending annually on handling and appealing denials. Yes, that is…

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The IPPS Proposed Rule Demonstrates the Importance of SDoH

The Centers for Medicare & Medicaid Services (CMS) has issued its 2025 Inpatient Prospective Payment System (IPPS) Proposed Rule, through which it proposes to change the severity designation for several…

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Staying Current with Medical Necessity

A new quarter began on Oct. 1, an event that usually brings updates to National Coverage Determinations (NCDs). The coding updates included for Oct. 1 are specified in Change Request…

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2024 CPT Code Set Released: 5 Key Takeaways

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…

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Is Greater UR-CDI Integration on the Horizon?

There has been growing interest in the intersection of utilization review (UR) and clinical documentation integrity (CDI). With greater recent changes, such as more UR and CDI staff going remote…

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