Navigating the world of medical billing and coding can be tricky, especially when it comes to modifiers. Getting them right is crucial for accurate reimbursement and compliance. This guide will walk you through two of the most important modifiers: Modifier 51 and Modifier 59. We’ll explain what they are, how to use them, and the […]
The world of medical billing and coding is not what it used to be—and that’s not necessarily a bad thing. As healthcare continues to evolve into a more digital, value-based, and patient-centric system, the role of coders and billers is more important—and more regulated—than ever. If you’re a coder or biller, you’re not just crunching […]
For anyone involved in rehabilitation, physical therapy, or occupational therapy, CPT code 97110 is a crucial identifier. This code represents therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility. But what exactly does that mean, and why is it so important for both […]
H5N8 Avian Influenza Vaccine: The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include new codes for vaccines protecting against the H5N8 strain of avian influenza. This update follows a recent global outbreak of avian influenza, particularly the H5N1 strain, which has affected wild birds, poultry, dairy cows, and […]
New billing codes: Medical experts might consider creating new billing codes for the time doctors and their support staff spends working on prior authorizations. The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Board meets May 9-11 in Chicago. On the meeting’s agenda are three potential new CPT codes “for reporting services (physician, QHP, […]
Preventive Services Vs Office Visits: It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services Vs Office Visits is […]
The American Medical Association (AMA) Current Procedural Phrasing (CPT)* code set is overhauled every year. This year, numerous of the upgrades are time-based codes, which may influence when they may be detailed. This article depicts CPT 2024 Coding Updates that are pertinent to common surgery and related specialties. Hyperthermic Intraperitoneal Chemotherapy in CPT 2024 Coding […]
It is expected that the Centers for Medicare & Medicaid Services (CMS) will release a completely revamped version of the evaluation and management (E&M) codes by 2021, particularly for the office visit codes (999201-99205 and 99211-99215). In addition to the changes to the office visit codes, there were significant changes to the 2023 guidelines. These […]
In the healthcare industry, accurate coding is crucial for ensuring proper reimbursement, maintaining patient records, and conducting data analysis. This becomes particularly important when dealing with complex procedures, which often involve multiple steps, specialized equipment, and nuanced documentation. Errors in coding for complex procedures can lead to a cascade of issues, including delayed payments, inaccurate […]
Find out what you must do to get significant, separately identifiable E/M services paid. The Cigna Group recently updated its reimbursement policy for modifier 25. Effective May 25, if you are billing this health insurance company for an evaluation and management (E/M) service and a minor procedure, you may need to do more than append […]










