Coding Decoded
Welcome to the first “Coding Decoded” column of 2025. There are 420 updates to CPT-4 including 270 new codes and 112 deletions. It doesn’t take an epidemiologist to see that the population of codes...
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Coding Update: CMS Code G2211
On January 1, 2024, a new CMS code, G2211, was finalized. According to the CMS.gov website, “This add-on code will better recognize the resource costs associated with evaluation and management visits for primary care...
NCCI Edits
With the April 2024 change that excludes billing a hysteroscopic myomectomy (58561) with an RF ablation of a myoma (58580), now is probably a suitable time to visit the “NCCI edits.” What is an...
Simplifying Office Coding
It’s been a couple of years since the new office-based codes were redefined and revalued by the AMA and CMS. Now that we are all getting more familiar with the criteria, I want to...
Bad News and Good News: Medicare Pay Cuts for Physicians and New Code Updates
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued their “Final Rule” on the 2024 physician fee schedule, including some important changes all US MIGS surgeons should know about. First...
Coding Decoded: Two US Code Updates
Every July, the Centers for Medicare and Medicaid Services (CMS) are mandated by Congress to release the “proposed rule” for the following year physician fee schedule (e.g., 2024 fee schedule proposed rule was released...
IUD and Subdermal Contraceptive Implant Coding
Many of us use long-acting reversible contraception (LARC) as long-acting reversible cycle control (LARCC) in patients with abnormal uterine bleeding (AUB). Proper coding for insertion of LARCs is essential for physicians to get properly...
New Endometriosis ICD Codes for 2023
New Endometriosis ICD codes for 2023 (effective Oct 1, 2022) Previously, the codes for endometriosis were limited. The codes did not specify side, depth of invasion or associated symptoms. As you might imagine, our...
When Can I Bill a 50 Modifier for a Bilateral Procedure?
Understanding when and how to use the bilateral procedure 50 modifier can increase the revenue of your practice as well as decrease the amount of time spent processing your claims, dealing with denials, and...
Disparities in Pay by Gender and Specialty
Previous articles have focused on how to bill for office visits and using various modifiers to get paid for the hard work you are already doing. This month, I’m going to switch gears a...
Coding…Decoded Series: 2021 AMA Coding Requirements
This is the third article on applying the new 2021 AMA coding documentation requirements. This column addresses the “Risk of Complications and/or Morbidity or Mortality of Patient Management.” The options are Minimal, Low, Moderate...
Coding…Decoded Series: How to Code an Office Visit
Welcome to part two of three on how to code an office visit. As is true for all surgery specialties, more surgery results in more RVUs. A day in the operating theater will always...
Coding…Decoded Series Continues
The Centers for Medicare and Medicaid Services (CMS) have put out the proposed rule to begin January 1, 2020. The Correct Procedural Terminology (CPT) code set is a living entity and, like any living...
Decoding Coding: How Does a Procedure Become a CPT Code and Get Assigned a Value? Part 2
As promised last September, I wanted to detail the changes to the CPT Evaluation and Management (E&M) documentation requirements that will be starting January 1, 2021. Those currently practicing telehealth during this Public Health...
Telehealth – A New Reality
Telehealth has become the preferred communication to protect patients and providers and allow for healthcare to continue within the current context of essential trips and surgery as well as social distancing. Telehealth is becoming...
Coding…Decoded
The Centers for Medicare and Medicaid Services (CMS) have put out the proposed rule to begin January 1, 2020. The Correct Procedural Terminology (CPT) code set is a living entity and, like any living...
Decoding Coding: How Does a Procedure Become a CPT Code and Get Assigned a Value? Your Input is a Big Part of it!
Common medical services are assigned a CPT (Current Procedural Terminology) code by the American Medical Association (AMA) CPT editorial panel. The panel consists of 17 members, 11 of which are physicians. Anyone may submit...
Decoding Coding: What is the Best Way to Code for Endometriosis?
The AAGL recently sponsored an online survey to determine the opinion of US physicians on the current state of coding and billing for endometriosis surgery. Unlike hysterectomy codes or open endometriosis codes, the current...
