Category: Medical Coding

2025 CPT Code Updates

2025 CPT Code Updates: Key Changes in Billing and Coding Practices

Each year, updates to CPT® codes are introduced to reflect advancements in medical procedures and technologies, impacting billing and coding across multiple specialties. Effective January 1, these annual updates encompass new, revised, and deleted codes, along with updated coding guidelines. For 2025 CPT Code Updates, there are 270 new codes, 112 revised codes, and 49 […]
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Historical Medical code set

Mastering Historical Medical Code Sets for Audits, Appeals, and Research

Remaining up-to-date is essential in the healthcare industry, but relying solely on current codes isn’t always the best approach. When auditing, handling appeals, or researching code usage for past encounters, a solid grasp of the descriptors and guidelines applicable during the date of service (DOS) can profoundly impact outcomes. Here’s a concise guide on effectively […]
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Mastering Chronic care management codes

Chronic Care Management Codes: A Comprehensive Guide

Chronic Care Management codes are increasingly being adopted by healthcare providers to address care fragmentation for patients with multiple chronic conditions. However, a recent study published in the American Academy of Family Physicians suggests that while CCM is gaining traction, challenges persist in its implementation and reimbursement. A Growing Trend The study, which analyzed Medicare […]
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Thanksgiving ICD-10 codes

11 Crazy ICD-10 Codes for Thanksgiving

Thanksgiving Day, while a time for celebration and gratitude, can sometimes present unforeseen medical challenges. To assist healthcare providers in accurately coding these instances, we have compiled a list of relevant Thanksgiving ICD-10 codes.  Here are a couple of Thanksgiving ICD-10 codes you might find useful this Thanksgiving season: W61.43: Pecked by a Turkey, Initial […]
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Modifier 25

Understanding Modifier 25: A Comprehensive Guide

Often, a seemingly routine preventive visit or minor surgery can take an unexpected turn when a patient mentions a new concern, such as “Oh, by the way…” If a physician provides additional care beyond the originally scheduled service, you may be able to bill for a separate evaluation and management (E/M) service using modifier 25. […]
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External Coding Audit

The Role of External Coding Audits in Healthcare

The constant updates in medical codes and evolving payer regulations, healthcare providers are increasingly turning to external coding audits. This blog post explores the importance of external coding audits, benefits, and how they support the healthcare industry in minimizing compliance risks, improving revenue integrity, and enhancing operational efficiency. 1. What Is an External Coding Audit? […]
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Debridement Coding

Optimizing Debridement Coding: Tips for Accurate Claims and Payments

The growing U.S. wound care market, fueled by an aging population and rising rates of chronic conditions, presents significant opportunities for healthcare providers. Accurate debridement coding is essential to maximize reimbursement and optimize patient care. Pressure injuries alone affect around 2.5 million Americans each year, leading to more than 60,000 deaths and costing between $9.1 […]
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Modifier 59

How to Use Modifiers 59 and X[ESPU] to Maximize Reimbursement

When you bill for distinct, separate procedures, it’s crucial to know which modifiers will ensure full payment for each service. Modifier 59, “Distinct Procedural Service,” acts as a universal tool to unbundle procedures that are typically included in a larger procedure or “bundled” together. This modifier signals to the payer that specific circumstances justify separate […]
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funniest ICD-10 codes for Halloween

The Funniest ICD-10 Codes for Halloween 2024

Halloween is a time for fun, frights, and… the funniest ICD-10 codes for Halloween? Yes, you read that right! The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a complex system used to classify diseases and injuries. While it’s a serious tool for healthcare professionals, some of its codes can be quite amusing, […]
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Healthcare fraud in medical coding

Healthcare Fraud in Medical Coding: Upcoding, Unbundling, and Emerging Challenges

Healthcare fraud in medical coding, particularly through practices like upcoding and unbundling, has become a major concern for medical coding and billing professionals. A recent healthcare market research survey found that 90% of respondents view upcoding as a significant ethical challenge Upcoding involves assigning higher-level codes to medical services than are warranted, leading to inflated […]
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