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Incident to billing

3 Examples Help Strengthen Your Incident To Billing Skills

When a nonphysician practitioner (NPP) sees a Medicare patient at your practice, you can typically plan to collect a reduced rate compared to what a physician would receive for the same service. But one way you can avoid accepting 15% less pay for the same service is by utilizing incident to billing — if you […]
CPT 2024

CPT 2024: Check New RSV, COVID-19 Immunization Codes

If your practice likes to get ahead of the curve, now’s the time to start getting to know the 2024 CPT codes. The American Medical Association (AMA) released the updated code set on September 8, revealing 230 new codes, 49 deletions and 70 revisions. Take a look at some of the highlights you’ll find as […]
Urine drug testing

3 Compliance Tips to Follow When Billing Urine Drug Testing

Because urine drug testing (UDT) codes don’t bring in massive reimbursement on a per-claim basis, many practices think the OIG isn’t paying much attention to these services — but that misconception can get you into trouble. In fact, the OIG frequently comes after practices that incorrectly report drug testing services, not only asking for refunds, […]
JZ modifier

Avoid Oct. 1 Denials: Report Modifiers JW and JZ Properly

When CMS debuted the JZ modifier last November, the agency gave practices until July 1 to start using it, allowing for a brief period so billers could get to know how the modifier worked. Unfortunately, some practices aren’t yet using modifier JZ, which could mean trouble starting in October—at which point Medicare payers will start […]
Time-based coding

9 Things You Can Count Toward E/M Time (and 4 You Can’t)

When the office-based E/​M coding guidelines changed in 2021, coders faced a huge learning curve. It involved transitioning from selecting the right code based on history, exam and medical decision making (MDM) to choosing the most appropriate code based on either time spent or MDM only. And while coders have weathered the change by now, […]
Chronic pain

G89 Series: How to Select the Best Chronic Pain Diagnosis Code

When CMS introduced chronic pain management codes G3002 and G3003 effective Jan. 1, practices rejoiced at the new options. But coverage for these codes, as is the case with all medical claims, hinges on medical necessity. And the best way to demonstrate that is to report the most accurate ICD-10-CM codes. To correctly identify the […]
Modifier 25

Cigna Delays Plan Requiring Medical Records With Modifier 25

UPDATE: Cigna has delayed the requirement described below, and it will no longer take effect on May 25. The company has not yet indicated when it will go into place, so keep an eye on the Healthcare Training Leader website for more information as this story develops. When you perform a minor procedure along with […]
Ambulatory surgery center

CMS Debuts 50 New Codes for ASCs – Here’s How to Use Them

Many practices are so busy trying to incorporate new CPT codes into their systems at the beginning of a new year that they may not notice other codes that have rolled out. Such has been the case for some providers this year, who focused so strongly on the changes to the E/​M code set that […]

G0316: CMS Corrects Time Threshold Errors in 2023 Final Rule

Everybody makes mistakes, but when it’s CMS creating the error, it can create ripple effects through your practice. Hopefully, the agency’s latest mistake provides your practice with a benefit rather than a headache. At issue is the time threshold that must be met to report code G0316, which represents prolonged inpatient/​observation care for Medicare patients. […]

1 Myth and 3 Truths About When to Use CPT Code 99211

You may think you know everything possible about CPT code 99211—or maybe you’re one of the people who thinks there isn’t much to know about this code. After all, some practices simply assign it to every service the nurse provides and move on. This strategy can backfire as audits of 99211 ramp up and payers […]