Category: Blog

CPT code 99214

99214 CPT Code Explained: A Complete Guide for Accurate Medical Billing

Every Medical service provided, every interaction with a patient, must be accurately translated into a standardized medical code for proper reimbursement and data tracking. Among the vast array of Current Procedural Terminology (CPT) codes, 99214 CPT Code stands out as one of the most frequently utilized for established patient office visits. Understanding its nuances, the […]
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CPT Code 96372

CPT Code 96372: Guide to Therapeutic Injections Billing

Among the many Current Procedural Terminology (CPT) codes used in medical billing, CPT code 96372 plays a significant role, especially when it comes to therapeutic, prophylactic, or diagnostic injections. If you’re a healthcare provider, medical biller, or practice manager, understanding how and when to use this code is vital for proper reimbursement and compliance. In […]
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GY modifier

Mastering the GY Modifier: A Guide for Anesthesia Providers

Every code, every modifier, plays a crucial role in ensuring accurate reimbursement for services rendered. For anesthesia providers, understanding and correctly applying modifiers is particularly critical, as their services often involve complex scenarios. Among these, the GY modifier stands out as a powerful, yet often misunderstood, tool for ensuring proper payment for non-covered services. If […]
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CPT Code 83036

Ultimate Guide to CPT Code 83036: Accurate HbA1c Test Billing & Coding

83036 cpt code description CPT code 83036 refers to the Hemoglobin A1c (HbA1c) test, which measures the average blood glucose levels over the past two to three months. This laboratory test is essential for diagnosing and managing diabetes mellitus and assessing long-term glycemic control. It evaluates the percentage of glycated hemoglobin in the blood, indicating […]
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Endoscopy billing

Don’t Make These Mistakes When Billing for Endoscopy Services

In the complex world of medical billing, few specialties present as many coding challenges as gastroenterology. Endoscopy billing—covering a wide range of procedures from colonoscopies to upper GI endoscopies—is a cornerstone of diagnostic and therapeutic care. However, the intricate rules governing their billing can be a minefield for healthcare providers and billing professionals. A single […]
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Z-Codes in Documenting SDOH

The Pervasive Underutilization of Z-Codes: A Crisis in Healthcare

In the complex world of modern healthcare, a patient’s journey is shaped by more than just their medical diagnosis. Factors like housing stability, access to nutritious food, reliable transportation, and social support networks—collectively known as Social Determinants of Health (SDOH)—are increasingly recognized as powerful drivers of health outcomes. While healthcare systems have the tools to […]
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Electronic Claims Management

Electronic Claims Management: Overcoming ERA and PA Challenges

The U.S. healthcare industry continues its digital transformation, with providers and payers embracing electronic transactions to streamline revenue cycle management (RCM) processes. According to the CAQH Index, adoption of electronic claims management transactions—such as eligibility verification, claim submissions, and claim status inquiries—has reached or surpassed 80% for many transaction types. However, significant gaps remain in […]
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Outpatient CDI Program

Why Outpatient CDI Programs Are Essential for Accurate HCC Coding and Risk Adjustment

Healthcare is an ever-evolving landscape. In this era of value-based care, accurate documentation and coding are important for financial stability and quality patient care. Hierarchical Condition Categories (HCCs) are crucial for risk adjustment and reimbursement, especially in the outpatient setting. This is where Outpatient CDI programs come into play. They are not just beneficial but […]
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AI in Payment Integrity

What AI Can and Can’t Yet Do in Payment Integrity

The landscape of payment integrity, particularly within complex sectors like healthcare and financial services, is constantly evolving. As organizations grapple with escalating costs, intricate regulatory frameworks, and the persistent threat of fraud, waste, and abuse (FWA), Artificial Intelligence (AI) has emerged as a powerful ally. While AI’s capabilities in enhancing payment integrity are undeniably transformative, […]
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