New Cpt Codes 2023: Is Your Practice Ready?

new cpt codes for 2023

CPT codes define the medical, surgical, and diagnostic operations physicians and other health care providers perform. CPT codes are essential for the uniformity of the medical billing process, and insurance companies require them. The American Medical Association (AMA) modifies the CPT code set during its annual meeting. For 2023, a few new codes and minor modifications to both new and old codes and descriptors were noted. Are you aware of the new CPT codes for 2023? If not, then no need to worry as we present to you all the new guidelines related to medical billing for the year 2023.

The CPT code set that is utilized in 2023 has undergone 393 editorial changes. Ninety-three code revisions, 225 new codes added, and 75 deleted codes. More than 40% of the code changes concern new technology services in Category III CPT codes and the expansion of Proprietary Laboratory Analyses (PLA) codes. Also, some code modifications affect how the COVID-19 vaccine is reported, tracked, and administered.

In the following sections of this post, we will discuss the new CPT codes for 2023. It will prepare you for the medical billing procedure.

Enlisting the New CPT Codes For 2023

Below is the list of new CPT codes for 2023 that will help your practice in the medical billing process:

1. Therapeutic Remote Monitoring

There are currently five new CPT codes for 2023 regarding remote therapeutic monitoring. The following are the new CPT codes for 2023:

  • 98975
  • 98976
  • 98977
  • 98980
  • 98981

These new medical billing codes expand on codes for remote physiologic monitoring introduced in 2020. The previous codes were: 99453, 99454, 99457, and 99988.

2. Taxonomy

Appendix R’s Digital Medicine – Services Taxonomy has new CPT codes for 2023 compatible with the following digital medicine services.

  • Clinician-to-patient care
  • Clinician-to-clinician (consultation) services
  • Services devoted to monitoring a patient
  • Services for digital diagnostics

The new medical billing codes for taxonomy services necessitate that synchronous services provide two-way, real-time communication between the parties. It must be accomplished through audio and video. Telephoning, using a patient portal, and sending encrypted emails are all options to communicate with someone when you are not physically present.

3. Primary Care Management

Four new CPT codes for 2023 for care management are:

  • 99490
  • 99491
  • 99439
  • 99487

These new medical billing codes are created for certified medical providers to report care management services for patients with a single chronic disease. Previously, a variety of chronic conditions qualified for reimbursement for these services.

4. Drug-releasing Implants

The new code 68841 is used to describe the eye-related drug-eluting implant operation. The new CPT code for 2023, i.e., 68841, indicates the insertion of a drug-eluting implant into the lacrimal canaliculus. The implant includes punctual dilation. This new medical billing code replaces code 0356T in Category III. The code 68841 is billed for a corticosteroid insert into the canaliculus. It is done to deliver dexamethasone to treat pain and inflammation after eye surgery.

Revised CPT Codes for 2023

The following CPT codes have been revised for the year 2023.

  • Code 99211

The CPT code 99211 was revised by eliminating the following: “Usually, the presenting problem(s) are minimal.” Instead, a new phrase has been added: “Office or other outpatient visits for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional.”

The code 99201 was eliminated in 2021 since it was rarely used.

  • Code 92065

The CPT code 92065 describes orthoptic training, also known as vision therapy. It is crucial to double-check the benefit plan descriptions, as some policies do not cover vision therapy.

  • Codes 67141 & 67145

These two codes for retinal detachment were modified in the section on prevention. In the proposed rule for 2023, the codes were modified to exclude the wording “1 or more sessions.” It allowed the services to be billed as a 10-day procedure instead of the current 90-day operation.

The following modifications have been made to the codes for retinal detachment:

Code Removed Revised
67141 1 or more sessions “Prophylaxis or retinal detachment (e.g., retinal break, lattice degeneration) without drainage, cryotherapy, diathermy.”
67145 1 or more sessions

laser or xenon arc

 “Prophylaxis of retinal detachment (e.g., retinal break, lattice degeneration) without drainage; photocoagulation”

 

88342 CPT Code and Guidelines for 2023

The CPT codes for surgical pathology are structured such that the first code (CPT 88341), CPT 88342, corresponds to a single antibody stain procedure, and each subsequent code corresponds to an additional single antibody stain procedure.

The plus sign next to CPT 88341 indicates that it is an add-on code that can be billed only in conjunction with the 88342 CPT code.

Code Description
88341 Immunohistochemistry or Immunocytochemistry, per specimen; each additional single antibody stain procedure
88342 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure
88344 Immunohistochemistry or Immunocytochemistry, per specimen; each multiplex antibody stain procedure

 

It is not permissible to utilize more than one unit of CPT 88341, 88342, or 88344 per specimen for each antibody.

  • CPT 88341, CPT 88342, or CPT 88344 should not be reported with CPT 88360 or CPT 88361 if each procedure involves a different antibody.
  • When multiple antibodies that may be distinguished are used on the same material, one unit of CPT 88344 is used. It is known as “multiplex antibody staining.”
  • When multiple antibodies that cannot be found individually are placed on the same slide, CPT 88342 should be used. CPT 88344 should be utilized if an additional antibody that can be purchased separately is also used.

After implementing these new regulations, pathologists and laboratories must specify whether a multiplex or cocktail stain technique was employed.

  • The terms “single antibody stain procedure” and “multiplex antibody stain procedure” will have an impact on both the units of service and the code(s) selected. Staining antibodies is a component of both of these procedures.
  • The term “single stain process” indicates that the code for the “multiplex stain method” must be assigned to the same stain, which may comprise multiple distinct antibodies.

The procedure likewise determines the unit of service for the in-question multiplex stain. If all antibodies are stained using the same method, only one service unit is required for the multiplex stain. It is crucial to note that the 88342 CPT code requires billing a modifier 59.

See Also: New ICD 10 Codes for Pathology Billing – Is Your Practice Ready?

Conclusion

Coding is one of the most difficult aspects of running a practice because it directly impacts the revenue cycle and the bottom line. Precision Hub helps reduce the stress associated with coding by ensuring that your claims are processed accurately from the outset. Our team of experts is up-to-date with the new rules and regulations regarding the new CPT codes for 2023. So, contact Precision Hub immediately if you have any queries concerning the professional coding assistance we offer. Schedule your demo now and learn how we can boost your earnings by optimizing your coding procedures.

New ICD 10 Codes for Pathology Billing – Is Your Practice Ready?

pathology billing

ICD-10-CM codes are the most critical evidence that the services your practice provides are medically necessary, so it is crucial to know them. Your reimbursement request will be denied if you cannot provide evidence that the treatment was medically necessary. Hence, you will have to pay for it.

Being familiar with the new ICD 10 codes for pathology billing is essential.

This post sheds light on different aspects of pathology coding and billing codes.

Pathology Billing

On July 7, the Centers for Medicare & Medicaid Services (CMS) released a proposed Medicare Physician Fee Schedule for 2023. The purpose of these modifications is to ensure that next year’s compensation for the technical aspect of pathology is more precise. Between 2022 and 2023, they wish to reduce payments for pathology by approximately 1%. There will be a reduction in the conversion factor by 4.4% to compensate for eliminating the 3% fee increase for 2022.

Pathology processes include the evaluation of blood, bodily fluid, or tissue samples taken from a patient and utilized to advise the treating physician. Typically, lab staff is responsible for preparing pathology and lab specimens and screening and testing them. However, it is the pathologist’s responsibility to ensure that lab results are accurate. The pathologist will examine or determine the significance of specific materials and tests. Such examples are blood and urine samples. For pathology billing, a pathologist can record the correct code from the E&M part of the CPT Manual if they meet CMS and AMA E&M guidelines and perform meaningful, individually identifiable face-to-face patient care services.

In 2023, there will be 78,496 ICD-10-PCS codes in use. It includes 331 new codes and the removal of 64 codes. Due to these changes’ impact on reimbursement, medical billing and coding services providers will need to get familiar with the new regulations.

According to the College of American Pathologists, thirteen (13) new CPT codes for digital pathology in Category III will be implemented on January 1, 2023. The CPT category III codes are a collection of temporary codes that can be used to collect data regarding services and procedures.

As per the new guidelines for pathology coding, codes 0751T through 0763T will be utilized to describe what clinical personnel performs when digitizing glass slides for the first diagnosis.

By digitizing glass microscope slides, a pathologist can do an examination remotely, alone, or with the assistance of artificial intelligence (AI) techniques. The Category III add-on pathology billing codes 0751T-0763T may be reported in addition to the right Category I service code when digitizing glass microscope slides and reporting the Category I code for the primary service. These add-on codes can be reported alongside the Category I service code.

Suppose a code from Category III is available. In that case, it should be reported in place of an unlisted code from Category I. Using Category III codes. Physicians, other qualified healthcare professionals, and insurers can identify services and procedures for clinical effectiveness, utilization, and results.

The new digital pathology add-on codes are related to CPT 88305, and 12 other commonly reimbursed pathology procedures (Level IV-Tissue Exam). Only cases in which the newly introduced add-on codes were used for clinical diagnosis should be reported.

The below table shows important codes related to pathology, digitization of glass microscope slides, and microscopic and gross examinations:

Codes Level or Groups Usage in Conjunction with
+0751T Level II

 

 Separately with the primary procedure code

OR

With 88302
+0752T Level III

 

 Separately with the primary procedure code

OR

With 88304
+0753T Level IV

 

 Separately with the primary procedure code

OR

With 88305
+0754T Level V Separately with the primary procedure code

OR

With 88307
+0755T Level VI

 

 Separately with the primary procedure code

OR

With 88309
+0756T Group I Separately with the primary procedure code

OR

With 88312
+0757T Group II Separately with the primary procedure code

OR

With 88313
+0758T Histochemical stain on frozen tissue block Separately with the primary procedure code

OR

With 88314
+0759T Group III Separately with the primary procedure code

OR

With 88319
+0760T Immunocytochemistry or immunohistochemistry Separately with the primary procedure code

OR

With 88342
+0761T Immunocytochemistry or immunohistochemistry per specimen Separately with the primary procedure code

OR

With 88341
+0762T Multiplex antibody stain procedure Separately with the primary procedure code

OR

With 88344
+0763T Single antibody stain procedure Separately with the primary procedure code

OR

With 88360

Pathology Coding

More than 1,400 new diagnostic codes are added to the ICD-10-CM codes for 2023. All payers must be provided with the new mandatory codes. Since these codes suggest the necessity of seeking medical treatment, inappropriate use of the codes may result in claim denial and loss of reimbursement for services rendered.

Here are important highlights of the new pathology billing codes:

  • Expansion of the OB/GYN code (over 400 new codes)
  • Code for concussions and other brain injuries as well as dementia (over 100 new codes)
  • Code for methamphetamine overdoses, indicating new Category for meth poisoning
  • Codes for electric bike injury, allowing for additional information about the accident

In addition to the above-described code extensions, the following specialty and conditions will be coded significantly differently:

Code Series Description
I25.- Atherosclerosis
F10.9 Alcohol and other substance use
C84.4 T-cell lymphoma
G71.03 Limb-girdle muscular dystrophy
B37 Candidiasis (vulva and vagina)
E87.2 Acidosis
D68.0 Von Willebrand disease
M93.0 Slipped upper femoral epiphysis
E34.3 Short stature
M62.5A Back’s Muscle wasting
P28.- Newborn sleep disorders
D59.3 Hemolytic-uremic syndrome

Preparing for New ICD 10 Codes for Pathology Billing

Utilizing the appropriate diagnostic and procedure codes when submitting claims to insurance companies for pathology-related medical services is crucial. Outsourcing your pathology billing to Precision Hub is the best approach to fulfilling any new ICD coding regulations for pathology billing. We have years of experience in the business, allowing us to monitor all aspects of the pathology coding process and assist you in better managing your revenue cycle.

See Also: Preventive Medicine Services Coding Guidelines

Conclusion

There is no practice where coding does not significantly influence the revenue cycle and bottom line. With the assistance of Precision Hub’s coding services, you can rest assured that your claims will be processed correctly from the beginning.

Precision Hub provides ICD-10-compliant coding services to its customers as a medical billing and coding outsourcing leader. Our coders apply the ICD 10 Pathology Billing Codes that best depict the patient’s treatment. We provide you with the most recent medical codes for the services you provide to your patients per AMA and CMS regulations.

Schedule your meeting with us to learn more about our professional coding assistance.

 

Preventive Medicine Services Coding Guidelines

cpt preventive codes

Preventive care, designed to prevent problems can aid in detecting or preventing significant diseases and health problems before they become major issues. Examples of preventative care include annual checkups, vaccinations, flu injections, and participation in specific screenings and exams. This type of preventive care is also referred to as routine care.

In diagnostic care, a physician searches for a specific condition. For instance, a radiologist may recommend a patient for follow-up mammography. This follow-up will determine if anything was discovered during the normal or preventative mammography. After the initial screening for preventative treatment, diagnostic mammography is not covered by insurance.

Let’s learn more about the preventive medicine coding guidelines for 2022. The post details CPT preventive codes.

CPT Preventive Codes

Comprehensive preventive medicine services include counseling, anticipatory guidance, and risk factor reduction strategies. They are typically distinct from disease-related diagnoses and entail a patient-specific history and physical examination.

CPT preventive codes include 99381-99387 and 99391-99397.

  • 99381-99387: CPT preventive codes for the preventive exam of new patient
  • 99391-99397: Codes for the preventive exam of an established patient.

During a preventive visit, an unexpected item is discovered, an old problem is resolved, and essential E/M, i.e., Evaluation and Management services, are provided. It is known as “E/M service in a single visit.”

The diagnosis codes for the preventive coding include the following:

  • 00: General medical checkup of an adult with no abnormal findings
  • 01: General medical checkup of an adult with abnormal findings
  • 110-Z00.129: Newborn, infant, and child health checkups
  • 411: Gynecological checkup with abnormal results
  • 419: Gynecological checkup without abnormal results
  • 011-Z30.9: Contraception management

Use the corresponding Z code from the list alongside the CPT preventive code as the primary diagnosis code. The next step is to arrange by the time all of the short-term, long-term, and health status concerns that the physician discussed and recorded throughout the examination. In addition to the Z codes, documenting and coding any new or existing conditions present at the annual preventive exam will not result in claim denial.

Suppose a new abnormal discovery or an existing problem is significant enough during a preventive exam to necessitate additional work. In that case, the appropriate CPT preventive code from 99202-99215 with modifier 25 should also be reported. Modifier 25 indicates that the work was performed due to a current issue. In this instance, the documentation from the provider describing the new or old finding must be distinguishable from the documentation from the preventive exam. The member may be required to pay copayments or split the cost of insurance to receive these additional services. It is improper to submit a separate fee for prescription refills or medical conditions that do not require further work.

Preventive Medicine Coding Guidelines 2022

Below are the important guiding points for preventing medicine coding:

  • Doctors use measurements such as height, weight, body mass index, head circumference, and blood pressure as part of preventive medicine. Additionally, they conduct age- and gender-appropriate tests and histories.
  • Since CPT preventive codes are not time-based, the duration of the patient’s visit should not be considered while selecting the correct code.
  • Suppose an illness is discovered or any pre-existing problem is addressed during a preventive medicine service that requires additional work. In that case, the appropriate CPT preventive code (99202-99215) should be reported in addition to the preventive CPT codes. Add modifier 25 to any outpatient code (e.g., 99392 and 99213 25).
  • No separate report is required for any sickness, abnormality, or condition discovered during the preventive medicine service deemed minor.
  • Immunization materials and administration, as well as supplementary investigations requiring laboratory, radiological, or other procedures or screening tests (such as for eyesight, development, or hearing), are recorded and reimbursed separately from the preventive medicine service code.

Preventive Medicine Coding Guidelines and Abnormal Findings

When an ICD-10 code, such as Z00.121, is assigned to an abnormal finding, it does not indicate that an additional E/M service is necessary or even permitted. Even if abnormal findings are minor and do not necessitate additional examination, the condition may be documented as a contributing factor. Abnormal findings include abnormal screening results, new acute conditions, and deteriorating chronic illnesses. Stable chronic conditions do not require an abnormal results code, even if they are being treated. Even if the screening was normal, you could relate it to a code for abnormal findings under ICD-10. The incorrect item will be labeled with the correct ICD-10 code to alert the payer.

Modifier 25

Extra billable services comprise independent, significant physician evaluation and management (E/M) work. It is often performed as part of preventive medicine treatment or small surgical procedures. Modifier 25 informs the insurance company that payment is required for both procedures. When utilized properly, it can generate more revenue.

Modifier-25 indicates that the assessment and management service was significant and distinguishable from a small procedure performed on the same day. If you apply modifier 25, you may be able to receive payment on the same day for both the preventative visit and the problem-oriented E/M service or procedural service. Including a modifier 25 regarding the second service reduces the likelihood of incorrect bundling or denial.

See Also: Know your DME HCPCS Codes

Conclusion

The CPT preventive codes 99381–99397 report newborn, child, adolescent, and adult preventative evaluation and management (E/M). These codes are billed alongside the ICD 10 codes. A modifier 25 is often billed with these codes in case additional service is billed. You can increase your likelihood of receiving the correct insurance reimbursements by reviewing the payer’s coding guidelines and reimbursement criteria. Alternatively, you can outsource these complex tasks to professionals like Precision Hub for improved cash flow.

Precision Hub is a leading organization that assists the medical industry with its billing and coding requirements. We assist you with medical billing and coding for your practice. So, schedule your meeting with our expert manager to sort out your medical billing or coding issues.

Know your DME HCPCS Codes

hcpcs codes for wheelchairs

For claims to be paid, selecting the correct code of the Healthcare Common Procedure Coding System (HCPCS) is crucial. Using the valid HCPCS code when processing claims ensures that the claim is reviewed accurately and that the correct reimbursement amount is granted. Conversely, incorrect coding could result in improper payments that must be recouped and could lead to false claim actions. Therefore, all sellers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must take the appropriate measures to ensure claims are appropriately coded.

An essential component of medical care is using DME, including a wheelchair. Knowing HCPCS codes for wheelchairs is crucial for timely reimbursement. We enlist HCPCS codes for wheelchairs and discuss DME coding in the present post. Moreover, the post also sheds light on the guidelines related to the CPT code for wheelchairs. So, keep reading to learn about DME HCPCS codes. 

HCPCS Codes for Wheelchairs

The Healthcare Common Procedure Coding System, or HCPCS, is a standard set of codes used to bill for services by all payers, including Medicare and Medicaid. The HCPCS is subdivided into two principal subsystems, levels I and II. Current Procedural Terminology (CPT), i.e., numerical coding scheme comprises Level I of the HCPCS. CPT’s primary objective is to catalog the medical treatments, dental services, and procedures provided by physicians and other health care providers. The HCPCS Level II is a standardized coding system used primarily to identify products, suppliers, and services not covered by CPT codes. This is when ambulance services and DMEPOS, including wheelchairs, are utilized outside a physician’s office. Medicare and other insurance companies cover treatments, supplies, and equipment not expressly identified by CPT codes. 

Medicare and other health insurance companies are required to utilize the E1130-E1161 code set to process healthcare claims.

Description of HCPCS Codes for Wheelchairs

Here is the range of HCPCS codes for wheelchairs: E1130-E1161.

HCPCS Code Description 
E1130 A standard wheelchair with fixed or swing-away detachable footrests, fixed full-length arms,
E1140 Wheelchair, desk or full length, detachable arms, swing away detachable footrests
E1150 Wheelchair, desk, or full-length swing away detachable elevating leg rests, detachable arms
E1160  Wheelchair, swing away detachable elevating leg rests, fixed full-length arms
E1161 Manual adult-size wheelchair includes tilt in space

Medicare and other health insurance companies require a set of standardized codes for wheelchairs, components, and accessories. This set of HCPCS codes for wheelchairs ranges from K0001 to K0195 to pay for health treatment. Some of these codes are listed below:

HCPCS Code Description 
K0001 Standard wheelchair
K0002 Standard Hemi (low seat) wheelchair
K0003 Lightweight wheelchair
K0004 High-strength, lightweight wheelchair
K0005 Ultralightweight wheelchair


DME Coding and Modifiers 

When it comes to medical billing for DME, your DME coders must be familiar with the correct HCPCS codes and modifiers, which provide additional information about the device. The insurance company may only accept the claims if your medical coders know how to utilize modifiers or apply them correctly. 

The common modifiers used in DME coding with HCPCS codes for wheelchairs are: 

  • RR represents renting equipment 
  • UE means buying used equipment
  • NU represents the purchase of new equipment

Many HCPCS codes for wheelchairs require the addition of a modifier before they may be used to indicate DME. When modifiers are applied, extra information can be provided about the DME item. It can suggest whether an item is brand-new or rented. For clarity, modifiers determine which month’s rent is billed for capped rentals.

Your claim will be denied if any of these modifiers are used incorrectly. You can expedite the processing of your claims by providing proof of the first month’s rent and billing your shares in the order they were received. The correct modifier code must be entered.

CPT Code for Wheelchair 

In addition to the HCPCS codes for wheelchairs, there is a CPT code also. It describes the evaluation and training processes for the use of the wheelchair.

CPT 97542 is used to describe the procedure of an evaluation to determine whether a patient requires a wheelchair. This may include the patient’s strength, location, weight, skin health, and other similar factors.

After determining the patient’s demands, the following step is to obtain measurements to acquire the appropriate equipment.

During determining how to fit the wheelchair into the patient, the patient’s abilities are evaluated, the patient’s mobility skills are assessed, and the patient is instructed on how to alter and operate the wheelchair.

Most examinations and fittings can be completed in one or two visits. If medically necessary, more sessions may be scheduled.

The wheelchair management CPT code 97542 includes training patients to do functional tasks that enhance safety and mobility.

People who use wheelchairs may occasionally require positioning assistance from a qualified specialist to minimize pressure sores, contractures, and other health issues.

The reimbursement for wheelchair coding includes all labor expenses involved with wheelchair assembly. The amount reimbursed may also include support services such as emergency services, wheelchair delivery, and setup and training.

Medical Necessity and CPT Code for Wheelchair

CPT 97542 is deemed medically necessary only when it requires the skills of a licensed therapist, is intended to fulfill specific patient needs, and is a part of an active treatment plan to attain a particular outcome. 

It is also important that the patient must have the ability to follow the instructions related to wheelchair use. A patient requires 3 to 4 sessions to master these skills. If medically necessary, more sessions may be scheduled.

See Also: Improving Coding for Diabetes with Hypertension Associated

Conclusion 

Accurate claim processing requires the use of the correct HCPCS code. However, if the codes are entered incorrectly, it could lead to erroneous payments that need to be recovered and even fraudulent claim actions. As a result, every DMEPOS vendor must take the necessary steps to guarantee that claims are correctly coded. Wheelchairs and other DME play an important role in medical treatment. Sufficient knowledge of HCPCS codes for wheelchairs helps in timely payment. 

Claims must be appropriately coded to be paid correctly. Precision Hub provides clinicians with accurate and efficient medical billing and coding services. You can call us at (888) 454-4325 if you have questions about HCPCS codes for wheelchairs. You can also book your free demo to learn how we help physicians streamline their practice.

How Accurate Coding Can Save Your Revenue?

accurate coding

The goal of the revenue cycle is to be paid. Now the concern is how to ensure prompt and appropriate payment. The solution may appear challenging, but it is only a matter of accurate coding.

Billing and coding for medical services are two of the most vital aspects of the revenue cycle. However, the significance of accurate billing services is only sometimes monitored, reviewed, or supported to the extent it should be. When medical coding is performed correctly, claims are error-free, payments are expedited, and the bottom line is healthy. Money can be lost if there are errors in the coding of medical invoices.

Coding accuracy is crucial when submitting a claim for services rendered to a patient’s insurance company. The profitability of medical practices is ultimately determined by the claims that patients and their insurers pay. However, medical practices may only receive payment for a few weeks or months. It is contingent upon the nature of the patient’s sickness, the diagnosis, the treatment, the selection of medical codes, and the time spent dealing with the likelihood of claim denials due to coding errors. It is essential to provide the relevant codes from the outset to receive the whole amount owing to you as quickly as possible.

Continue reading to find out why accurate coding is important and how it helps in saving revenue.

Accurate Coding

The overall cash flow of a medical practice is primarily dependent on the proficiency of its coding and billing specialists. The main objective of all healthcare workers should be to provide quality treatment to patients. However, as the number of patients increases, so does the documentation or the administrative work. A streamlined billing and accurate coding ensure that your medical practice has a constant revenue flow. By remaining current on the most recent innovations and best practices in medical billing, you can reduce the number of refused claims, thereby enhancing the overall efficiency of the process.

Benefits of Accurate Coding

Coding accuracy, essential for practice cash flow, involves comparing the number of errors with the number of codes. Official manuals and online resources for coding can help coders improve their productivity and serve as standards.

Here are a few advantages that can be attributed to the fact that billing and coding are completed accurately and promptly:

  • Decreases the Physicians’ Workload

The majority of health care and medical professionals are perpetually rushed. If they must additionally file claims, they may be overburdened with work—incorrect coding or missing required documentation results in denials, which decreases revenue. Accurate coding service by professionals ensures claim quality and precision. As a result, there will be no payment delays, and the healthcare staff will be able to focus more on the patients.

  • Prevents Medical Billing Errors

When assigning a medical code to a provider’s specific therapy, a biller must pay great attention to the specifics and search for the code that best fits the service. Even the tiniest error in assigning a code to a medical procedure can result in a payment delay or claim denial. Coding errors could be prosecuted as crimes. If you have access to efficient and accurate billing services, you will be less likely to run into a conflict.

  • Improves Patient Satisfaction

When patients visit your clinic for treatment, their primary objective is to receive the suggested therapy. However, they prefer payment methods that are simple and feasible. Most people who receive therapy are covered by insurance; therefore, they wish that their claims be paid in full without any problems. If your billing system is efficient, your patients will experience fewer problems, and your clinic will be compensated properly for its services.

  • Assists Verification Process

A competent medical billing system verifies the patient’s eligibility information in advance to prevent claims from being denied. Verification also ensures that the correct amount of money is returned. Therefore, you must have extensive knowledge of the regulations and the most recent information on how insurance payments operate. An expert biller must double-check the accuracy of the information to be efficient to ensure that when claims are submitted, there will be few denials.

  • Ensures Steady Cash Flow

For a medical practice to remain in operation, money must continue to flow in. It is only possible if a few claims are denied. A good system for coding and billing ensures that claims are accurate and complete. It ensures consistent and prompt claims payment and improves the practice’s overall health.

coding accuracy

Tips for Assuring Coding Accuracy

The following tips are useful for accurate coding and medical billing:

  1. Correct and full claims must be submitted, which entails inputting data correctly and checking claims for problems before submission.
  2. Technology must be integrated to select the appropriate codes based on the accompanying papers.
  3. EHR systems must be adjusted to the coding updates to maintain transparency and improve compliance.
  4. A coding audit must support the practice’s quality compliance activities.
  5. Documentation should be accelerated to boost coding productivity and reimbursements.

Why do you need Accurate Billing Services?

If claims are to be reimbursed on time, medical professionals must ensure that they are accurate. Even if the doctor provides the requested treatments, the claim may be denied due to insufficient documentation or improper data handling. Under-coding is an additional issue. Your coding practices could also be detrimental to the reputation of your medical practice. You may lose money and get into legal trouble if convicted of fraud. If the medical billing department is careless, the medical practice may not be able to remain open, resulting in revenue loss.

Hiring a reputable medical billing service to handle the coding and billing is the best way to ensure that the revenue cycle runs smoothly. Coding and billing tasks are unlikely to be performed in-house because they are costly and consume time that could be spent on patient care. However, medical billing companies with dedicated personnel can effectively manage these tasks with the expertise needed for accurate billing services.

Precision Hub is a reputable service that assists practices in enhancing their revenue with accurate coding and billing. Our experts at Precision Hub have helped hundreds of practices improve their revenue cycle with their expertise and knowledge.

See Also: Guide to Medical Billing and Coding Best Practices

Conclusion

Accurate coding and billing procedures are essential to the revenue cycle and should always be a top priority. It benefits the patient as well as the practice. Outsourcing to medical billing services is the most effective strategy to ensure consistent revenue. When there are patients to care for, it is impossible to keep track of administrative information and tasks, so employing individuals with sole responsibility to perform these responsibilities is a wise idea. Precision Hub is a professional medical billing company that has helped hundreds of physicians optimize their revenue cycle for years. Our team of specialized coding experts is here for your practice revenue to improve. Schedule your free demo now to learn more.

Guide to Medical Billing and Coding Best Practices

practice medical billing

Precision is crucial when it comes to medical billing and coding. Even little errors can result in a payer rejecting a claim, causing delays and lost revenues. Since coding regulations are frequently updated, healthcare experts can avoid under or over-coding or using outdated codes. Due to denials, billions of dollars are lost annually.

The practice’s medical billing can be improved with automation. Using software-driven and automated methods can aid in simplifying the already complex field of medical coding or billing. Claims processed correctly on the first attempt expedite the settlement process, resulting in faster and greater reimbursements. Providers can generate more accurate financial estimates, spend less time reworking denied claims, and inform patients more precisely of their out-of-pocket costs.

This post intends to offer guidelines for best practices for medical billing. Let’s explore important aspects of medical billing for private practice.

Coding and billing are essential components of the revenue cycle in the healthcare industry because they ensure that patients and payers pay for the services providers render. Depending on the intricacy of the services, how organizations handle claim denial management, and how a patient’s financial obligations are collected, medical billing and coding can take anywhere from a few days to many months.

Comprehending the fundamentals of medical billing and coding assists doctors and other personnel run a seamless revenue cycle. It also helps in getting compensated for the excellent treatment they provide.

Stress, rage, and other negative emotions can result from billing issues affecting patients and doctors. When a provider fails to provide the correct demographic information about a patient or verify that the patient is eligible for the treatment, expensive denied claims may occur. Errors can cause delays and additional labor when claims must be resubmitted. So, adhering to the best practices for medical billing is crucial to limit the likelihood of making errors.

Let’s examine some of the most effective approaches for your practice’s medical billing process.

Best Practices for Medical Billing

The following are the important areas to focus on for improving your practice’s medical billing process.

practice medical billing

Make Patient-Friendly Medical Billing statements

Patients are likely to find the medical billing procedure difficult to comprehend. Since industry expectations have shifted in a way that makes it essential for doctors to take a patient-centric approach to this process, you must remain accessible and make your statements patient-friendly.

Maintain a 95% Clean Claim Rate

Your clean claim rate is the proportion of your medical practice’s claims that are approved and paid on the first try. When the percentage of clean claims increases, practice will spend less time determining why claims were denied, organizing payments, and resubmitting claims.

Analyze your Payer Reimbursements

Numerous medical practices rely excessively on payers to pay the entire amount on each claim they submit. Unfortunately, this is only sometimes true. Contrary to what you may believe, underpayments occur frequently. If you invest time and money into determining whether your payments are accurate, you will minimize revenue loss and learn a great deal about how your practice handles revenue.

Ensure Accurate Claim Submission

If you double-check your claim before submitting it for the first time, you will save time editing and resubmitting it. It is estimated that up to 80% of medical invoices contain errors, which take a few weeks to resolve and resubmit and result in unpaid medical providers. You may improve the efficiency of your practice’s medical billing process by ensuring that claims are accurately filled out and eliminating typical errors, such as providing the incorrect patient or insurance information and submitting duplicate claims.

Maintain Medical Billing Regulations

It is essential to have a thorough awareness of the current standards governing the process to ensure that medical billing and coding procedures are of the greatest quality. Keeping up with the ever-changing standards enables the creation of a streamlined approach that reduces the likelihood of rejections and medical billing changes. If you remain current on medical billing regulations, your ability to generate revenue from your medical practice may improve.

Look for Improvement

Your healthcare practice will continue to expand if you discover new ways to improve your skills. Finding ways to enhance the medical billing process continuously is one strategy to maximize revenue. It is crucial because the healthcare industry is constantly evolving. It’s important to remain current on the latest medical billing laws, but it’s equally important to analyze past performance to identify areas of inefficiency and devise solutions. Using key performance indicators (KPIs) to monitor performance can help determine how precise and effective past performances were and where they could have been improved.

Medical Billing for Private Practice

Accuracy is required to ensure that medical claims are completed, sent, and paid within the allotted time frame. Having best practices improves accuracy, which in most cases results in shorter collection times and a higher claim approval rate. It is crucial to plan to investigate your current billing practices to determine if there are ways to enhance the relevant KPIs. Identify improvements that reduce billing times, increase cash flow, and make it simpler for insurance companies to approve claims.

See Also: Advance Radiology Medical Billing Guide

Conclusion

Your medical practice cannot provide quality patient care if it cannot generate sufficient revenue. Suppose you have an efficient medical billing system in place. In that case, your medical practice will remain financially stable, allowing you to focus on your primary objective, improving your patient’s health. As technology and payer expectations evolve, the practice’s medical billing processes must also evolve. If your medical practice fosters a culture of adaptability and continuous improvement, it will be able to adapt to the changes in the healthcare system.

If you are running behind on billing or can’t keep up with the current rules, consider outsourcing your billing. Medical billing companies are an excellent resource for practices that want to ensure claims are submitted in the correct format, as they are aware of the most recent billing regulations.

Precision Hub’s services help you reduce overall expenses and increase profits. The expertise of our team assists you in overcoming the obstacles associated with establishing a successful private practice. Our comprehensive and expert services enhance your practice’s medical billing process and efficiency—our service of medical billing for private practice aids in resolving the most significant billing-related issues.

CPT Code 99465 – Delivery/birthing Room Resuscitation

cpt code 99465

CPT code 99465 is used for billing the procedure performed on newborns in the delivery room. The American Medical Association (AMA) maintained two codes for billing delivery-related procedures for newborns. These newborn CPT codes include 99464 and 99465 under the “Delivery/Birthing Room Attendance and Resuscitation Services category.”

The medical coding method uses multiple codes to determine the newborn’s health status soon after birth. These codes depend on various factors, such as the baby’s health, the location where the service was performed, etc. It is essential to stay current and adhere to neonatal coding guidelines to ensure accurate medical billing and coding.

Today’s post is all about CPT code 99465. Various aspects related to the newborn CPT codes, including 99464 and 99465, are highlighted in this post. So, read on to familiarize yourself with these codes performed in the delivery or birthing room.

CPT Code 99465

The CPT code 99465 is billed to get the payment if the other physician was present during delivery and performed resuscitation. Billing CPT code 99465 requires proper documentation to demonstrate whether or not the infant was in distress.

CPT 99465 Description

The code description for CPT 99465 is Delivery/birthing room resuscitation, provision of positive pressure ventilation, and chest compressions in the presence of acute inadequate ventilation and cardiac output.

Resuscitation of the newborn is the procedure of providing:

  • Ventilation or breathing
  • Chest compression

The services rendered as part of the Attendance at delivery (CPT 99464) code include the following:

  • Obtaining fetal and maternal histories
  • Examining labor records and mother’s charts
  • Providing the care needed for the newborn’s health

Attendance at delivery does not consist of endotracheal intubation (31500). In case newborn resuscitation is performed, then 99464 is not billed. Instead, the CPT code 99465 is billed for the procedure of newborn resuscitation.

Newborn CPT Codes

Newborn CPT Codes

In the Current Procedural Terminology (CPT) system, being present at the birth of a baby and being present at the birth of a baby requiring resuscitation each has unique codes.

CPT 99464 represents being present for the birth (where requested by the delivering physician) and ensuring the newborn’s immediate stability.

CPT 99465 represents resuscitation in the delivery room, involving chest compressions or ventilation in the case of acute inadequate ventilation or cardiac output.

Both codes are similar; however, CPT 99464 cannot be billed alongside 99465. The primary distinction between these two newborn CPT codes is whether resuscitation was attempted.

The primary distinction between the two codes is whether the patient has been stabilized or revived. Attendance at delivery (99464) includes the use of blow-by oxygen or continuous positive airway pressure (CPAP) if positive-pressure ventilation (PPV) is unavailable.

One of the most notable differences between CPAP and PPV is the timing of therapy administration.

PPV should be utilized if the infant’s heart rate is below 100 beats per minute and is fighting to breathe or has apnea. It involves using a mask, an inflating bag, or a resuscitator with a T-piece to provide air to the newborn. This procedure allows the lungs to exchange more air with the outside air.

Newborns with a heart rate of more than 100 beats per minute, difficulty breathing, or cyanosis can be treated with supplemental oxygen and CPAP. CPAP therapy should be utilized if any of the following conditions exist:

  • Respiratory distress syndrome
  • Atelectasis
  • Respiratory acidosis
  • Apnea of prematurity

Even if the other physician arrives a few seconds or minutes later than anticipated, the CPT code 99464 should not be utilized, per AAPC regulations. In this instance, a code for critical or neonatal care that is more accurate or specific must be utilized. For CPT code 99464 to be applicable, the accompanying physician must be in the operating room at the delivery time. The CPT code 99464 should only be billed if the physician who delivered the infant specifically requested a pediatrician. This is one of the most crucial things to know. In addition, the paperwork must indicate that the OB requested the page so that the pediatrician may be present in the surgery room.

For the use of an AAD, there must be a medical need that is backed by evidence. If the practice or provider requires pediatricians to be in the operating room during deliveries or C-sections, their presence is not a medical requirement. The infant must be distressed and stabilized immediately after birth to qualify for CPT 99464.

The following are included in the stabilization of the newborn:

  • Stimulation
  • Initial drying
  • Apgar (Appearance, Pulse, Grimace, Activity, and Respiration)
  • Suctioning
  • Visual inspection
  • Blow up
  • CPAP
  • Discussion with OB and parents

Billing CPT Code 99465

Billing CPT Code 99465

CPT 99465 is for resuscitation, and for billing this code, either one of the below two procedures must be performed:

  • Positive pressure ventilation (PPV)
  • Cardiopulmonary Resuscitation (CPR)

Resuscitation is the act of combining the following:

  • CPR
  • Mask and bag usage
  • Ventilation and intubation

For billing of CPT code 99465, the newborn must be in distress, which must be evidenced through documentation. Any of the following is used for the documentation purpose depending on the medical condition of the newborn:

  • Acute inadequate cardiac output or ventilation
  • Acute respiratory failure or distress
  • Any other cardiopulmonary distress

The CPT code 99465 may only be billed to get the payment if the other physician was present during delivery and performed resuscitation. Effective billing of this CPT code requires proper documentation to demonstrate whether or not the newborn was in distress. It is important to remember that resuscitation and AAD (attendance at delivery) are different services that cannot be billed on the same day.

See Also: All You Want to Know About custom CPT codes for Orthotics.

Conclusion

The Current Procedural Terminology (CPT) system has various codes for newborns, including 99464 and 99465. CPT 99464 requires attending the birth when requested by the doctor in charge of the delivery and guaranteeing the baby’s immediate stability. CPT code 99465 is for resuscitation. In the labor room, resuscitation comprises chest compressions or ventilation in the event of a sudden loss of breathing or heart activity. Despite their similarity, you cannot simultaneously bill for CPT codes 99464 and 99465. The primary difference between these two neonatal CPT codes is whether or not resuscitation was attempted. So, these two codes cannot be billed on the same day.

Do not let coding or billing affect your practice’s revenue. Rely on the professionals at Precision Hub to provide you with billing services that are precise and efficient. Schedule your free demo today to learn more.

All You Want to Know About custom CPT codes for Orthotics.

cpt code for orthotics

Orthotics are integral to podiatry practice, providing potential treatments for various disorders. Orthotics have fixed charges, which might be a financial strain if they are not paid on time. The staff should be familiar with the coverage standards established by the major insurance companies with whom the practice frequently works to receive payment for the service. It saves much time determining whether the patient’s insurance supports orthotics. It is critical to have sound knowledge about eligibility conditions and coverage limits. Moreover, it is also important to know billing rules and CPT codes for orthotics. Many offices have difficulty receiving payment for custom orthotics due to incorrect billing of the CPT code for orthotics.

Most professionals in the field of orthotics are concerned about the billing of orthoses. Modern medical facilities must seek compensation from the patient’s insurance provider. It involves submitting a formal claim for payment to the appropriate person. Due to this, it is essential to understand how to bill for custom orthotics in every way, including using the CPT code for orthotics.

This blog sheds light on the CPT code for orthotics. So, let’s learn everything about custom orthotics CPT codes.

CPT Code for Orthotics

Depending on the insurer and policy, custom orthotics may be covered in various ways. Before prescribing custom orthotics to a patient, verifying coverage with their insurance provider is important. If you have patients without network insurance, you should request cash payments and submit a letter justifying the medical necessity. Other alternatives include flexible spending arrangements and accounts for tax-free healthcare bills. Inform the patient, if they are paying cash for their orthotic, of the services included with their purchase (fitting, follow-up visits, training, adjusting, etc.).

The CPT codes 97760 and 97762 define the evaluation, care/fitting, training, and management of orthotic services. Let’s explore these CPT codes for orthotics in detail.

Orthotics CPT Code 97760

Custom orthotics CPT code 97760 is for examination, casting, education and training.

  1. This method can be considered acceptable and necessary if there is a need for orthotic education and evidence that it is being utilized for its intended purpose.
  2. Typically, completion of orthotic training requires three sessions. If the orthotic must be altered due to tissue healing, edema alteration, or skin integrity loss, the patient may be required to return for additional sessions.
  3. It is required to document each orthotic treatment for the upper and lower limbs in the patient’s medical record.
  4. The patient can receive instructions on how to utilize the recommended medical equipment.
  5. Suppose there is a purpose to learning how to use a prosthesis, and there is proof that it is being utilized beneficially. In that case, this therapy and training may be judged appropriate and necessary.
  6. The medical record should indicate the various goals pursued and the services provided when prosthetic training is performed for the upper and lower extremities.

Orthotics CPT Code 97762

Custom orthotics CPT code 97762 is for orthotic check-in, fitting and dispensing.

  1. When a recently issued device needs to be altered or reissued, or when a recently issued device requires a second look, these evaluations are acceptable and required.
  2. When a patient claims that a device caused them any issue like pain, falls, or skin breakdown, it may be appropriate and required to conduct the assessment.
  3. These assessments may be necessary to determine how the patient reacts to wearing the device, whether the patient requires socks, cushioning, or under wraps and how well the patient can tolerate dynamic forces being applied.

To draft a perfect claim, one must have a high level of precision and a thorough awareness of billing standards and procedures. A “perfect” claim is comprehensive and accurate, which the insurance company will not deny.

There are many additional aspects to consider. Orthotics for the right and left foot must be coded and billed on different lines of the claim form using the correct code and the “-RT” or “-LT” modifiers.

For instance, L3000RT is used for billing for the right foot orthotics. Similarly, L3000LT is used for billing for orthotics for the left foot.

See Also: Common ICD 10 Codes for Gastroenterology

Conclusion

The CPT codes for orthotics are 97760 and 97762. These codes represent every aspect of orthotic services, including the evaluation, training, management, and fitting of orthotics. For profitability and revenue of the practice, it is crucial to use the correct CPT code for orthotics with the appropriate modifier. Failure to do so results in a claim denial, negatively impacting the revenue cycle.

Coding errors can result in lost revenue, and if they occur frequently enough, they can significantly impact a practice’s capacity to generate income. Service providers know this reality and try to find and retain trained employees to manage billing and coding for custom orthotics to minimize financial losses. Regarding invoicing and coding, many orthotics clinics seek assistance from third-party professionals.

If important custom orthotics billing tasks are outsourced to specialized billing professionals, it can do wonders for reducing operational expenses and producing superior results. The most significant advantage of using a billing organization for custom orthotics is that providers have instantaneous access to a large pool of trained billing experts at a substantially cheaper cost than they would pay for in-house labor.

Precision Hub provides expert and specialized assistance for custom orthotics billing and coding, which can be advantageous across the revenue cycle. It is particularly effective for raising collection rates, which can result in substantial cost savings. Additionally, denial rates are reportedly substantially lower, which has led to a significant increase in the number of passed initiatives. It is because of fewer code errors and other issues, which is a natural advantage of having experienced and focused team members. So, call us now to achieve the maximum revenue for your practice.

Understand CPT Codes for Orthopedic Medical Billing and Guidelines

orthopedic medical billing

Managing the revenue cycle is essential in any medical practice, including orthopedics. The orthopedic practice will continue to be paid on time, and delays will be reduced due to how well it handles all the orthopedic medical billing operations. The cash flow issues will also improve.

Practitioners must consider several factors besides the orthopedic billing guidelines when charging for orthopedic medical services. This will assist them in billing accurately and reduce the likelihood that their claims will be denied.

This article provides practitioners with advice that will assist them in better managing their income-derived resources. The article explores CPT codes for orthopedic medical billing. Moreover, the post also presents important guidelines related to orthopedic billing codes. Let’s find orthopedic billing guidelines in the subsequent sections of this article.

Orthopedic Medical Billing

Claims are less likely to be denied if the information is analyzed accurately and the appropriate codes and modifiers are applied. This assists the practice in generating a continuous stream of money and maintaining its smooth operation. The transition to ICD-10, 264 new codes, the deletion of 143 codes, and modifications to 134 codes have altered orthopedic coding practices. With the new rules for modifier 59 and the addition of relevant modifiers XE, XP, XU, and XS, orthopedic medical billing is undergoing a significant transformation.

Orthopedic Billing Guidelines

Orthopedic Billing Guidelines

Here are simple orthopedic billing guidelines for your practice.

Benefit and Coverage Verification 

Among essential aspects of orthopedic medical billing is ensuring and verifying that all insurance-related aspects have been addressed. It is essential to review the patient’s insurance coverage. Determining whether their insurance companies would cover the planned services is also important. Verifying insurance coverage at the start helps reduce the chances of billing errors and subsequent claim denial.

Patient Information Confirmation 

An important orthopedic billing guideline is verifying the accuracy of all patient information, including spelling, address, contact information, demographic information, and other specifics. Claim denials can result from something as basic as an overlooked misspelled word. So, it is essential to examine every detail before processing the claim.

Timely and Specific Coding 

Your practice must have all the information about codes and covered diagnoses to authenticate the coding in your claims. Moreover, you must ensure that the codes you use correspond with  the diagnosis. Ensure that your billing staff has all the necessary information and tools to record claim codes promptly.

Orthopedic Billing Codes

CPT describes medical, surgical, and diagnostic services. It intends to provide physicians with uniform information regarding medical services and procedures. The below table illustrates the CPT codes for orthopedic medical billing:

Services Codes
E/M or Evaluation and Management 99201 – 99499
Anesthesia 00100 – 01999; 99100 – 99140
Radiology 70010 – 79999
Medicine 90281 – 99199; 99500 – 99607
Pathology and Laboratory 80047 – 89398
Surgery 10021 – 69990
Hand Surgery (Repair of Nail Bed) 11760
Hand Surgery (Carpectomy; all bones of proximal row) 25215
Hand Surgery (Neuroplasty/carpal tunnel release) 64721
Endoscopic Carpal Tunnel Release 29848

Modifiers

The term “modifier” refers to a two-character code that indicates how the treatment or services code should be utilized on the claim. When modifiers are utilized effectively, they can increase the accuracy and detail of a medical transaction record. When used improperly, they can result in the denial of claims.

Level I Modifiers are referred to as CPT Modifiers. They are used to add to or modify care descriptions to provide a patient with extra information about an operation or service received.

Level II HCPCS Modifiers consist of two numbers (Alpha/Numeric characters) ranging from AA to VP. CMS, which stands for the Centers for Medicare & Medicaid Services, updates these modifiers annually.

The most common modifier used is the 59 modifier.  Modifier 59 is used to identify procedures or services that are not normally reported together but are appropriate under the circumstances.

Extensive knowledge and the ability to apply modifiers where required are essential for the steady influx of cash flow. In the main procedure code, modifiers indicate that a change was made to the method due to a certain factor. Modifiers can impact reimbursement.

Bundling

A bundling package determines the surgical CPT codes that may be reimbursed individually or collectively. For example, CPT 29880 describes both a medial and lateral meniscectomy. Therefore, numerous surgeries may be invoiced as a single procedure, or the package that unites them disallows additional charges. These procedures are performed concurrently:

Codes Rules
29881 medial OR lateral meniscectomy is included with medial AND lateral
28982 the medial OR lateral meniscal repair cannot be reimbursed in case of meniscectomy
28983 the medial AND lateral meniscal repair cannot be reimbursed in case of meniscectomy

Unbundling

Unbundling occurs when multiple CPT codes are billed for the component parts of a procedure when there is a single code available that includes the complete procedure.

Unbundling errors—coding separately for procedures that should have been bundled— are a frequent cause of claims denials and negative audit findings. Conversely, unnecessary bundling harms reimbursement.

Global Period

090 – Major surgery with a 1‐day preoperative period and 90‐day postoperative period included in the fee schedule amount.

Code 99024 – There is a 90-day post-operative period where all follow-up services are considered part of the global fee and cannot be billed separately

Complexities in Orthopedic Medical Billing

The orthopedic medical billing team is responsible for accurately recording and pricing all given services. Before, during, and after patient visits, complete documentation is required to bill for services. A denied claim could result from errors such as submitting insufficient patient information or verifying the patient’s eligibility beforehand. In addition to authorization verification, knowing the insurer’s preferences and deadlines might make it easier to get paid.

Compared to other specialties, orthopedic medical billing is more difficult and requires a deeper understanding of the services rendered. A high number of denials could force your orthopedic clinic to lose money, provide substandard patient care, or even close down.

While hiring an in-house billing team and providing them with the proper training may help you avoid expenses and penalties, the orthopedic billing process is too complex for an in-house billing team to handle alone. Outsourcing your billing and coding needs to a billing expert, such as Precision Hub, is one approach to alleviate stress on your staff and maximize the amount of money you are paid for your services.

See Also: Improving Billing and Coding Optometry Practice and Considerable CPT Codes for Claim Collection

Conclusion

Despite the importance of understanding the complexity of orthopedic medical billing and coding, most orthopedics still need to understand these issues. Lack of knowledge and experience in medical billing seriously threatens the practice revenue. Guidelines about orthopedic billing codes are essential for a practice to thrive and prosper. Outsourcing orthopedic medical billing to Precision Hub can help physicians run their revenue cycle smoothly. Our team of highly skilled coders and billers will maximize reimbursement for the services you render. Book a free demo with us to see how we can assist you.

What are the Challenges of Interventional Radiology Coding? How is it Different from other Medical Coding?

radiology coding

Interventional radiology (IR) is among the most difficult clinical subspecialties to code. It encompasses neuro-interventional treatments and endovascular surgery. Since technology is constantly improving, the number of available treatments is perpetually increasing. The American College of Radiology anticipates that interventional radiology and other high-tech services will rise at an annual pace of 8%.

This shift will exacerbate the scarcity of interventional radiology coders with the required expertise. It also implies that the rules and regulations for interventional radiology coding continue to evolve; hence, the coders will have to work harder every day to keep up with the rapid evolution of science and coding. Every day, interventional radiology coders must exert significant effort to keep up with science and radiology coding advances. This post sheds light on the challenges of radiology coding.

Radiology Coding

Interventional radiology is often difficult to code. The greater the number of cutting-edge treatments that can be performed due to technological advancements, the more likely the norms and procedures governing interventional radiology will alter. In this setting, it would be challenging to perform radiology coding.

There are much more errors in interventional radiology coding and billing than in other medical areas. Stacie Buck, an expert and auditor in radiology coding estimates that up to 60% of all treatments provided by interventional radiology are incorrectly documented.

Interventional Radiology Coding vs. Medical Coding

Radiology coding is different from other medical coding. The diagnostic radiology coders cannot do the tasks performed in interventional radiology.  Radiologists are physicians responsible for diagnosing patients’ ailments. Interventionalists, on the other hand, are patient-treating specialists. Interventionalists are physicians who are educated to perform a variety of intricate treatments throughout the body. They can treat a variety of health conditions. They perform various gastrointestinal, neurosurgical, and gynecologic procedures in addition to the following:

  • Incorporating vascular filters
  • Widening and stenting distal arteries
  • Kyphoplasty
  • Balloon occlusions
  • Chemo-embolization
  • Thrombolysis and ablations

In contrast to diagnostic radiology reports, where coders’ main issue is discovering a diagnostic statement that can be typed down, interventional radiology reports tend to be lengthy and frightening.

Consider the procedure of vascular catheterizations. It involves:

  • Identifying the catheterization access point(s) and each blood vessel to be catheterized
  • Categorizing if the catheter is inserted through a sheath that had previously been inserted
  • Determining whether the left or right side is more advantageous
  • Recognizing the body part (arterial, venous, lymphatic, portal) being catheterized
  • Explaining the operation of the catheter (antegrade, retrograde, ipsilateral, contralateral)
  • Classifying the aberrant anatomy

Even though interventional radiology technicians comprehend the complexity of the procedures, they frequently need to gain knowledge of the rules, regulations, and changes that affect coding, billing, and payment.

coding interventional radiology

Coding Interventional Radiology is Challenging

Interventional radiology requires knowledge of coding as well as training and organizational resources. Interventional radiology, particularly the coding for neuro-angiographic treatments, features some of the most complex and challenging codes ever created. There are numerous blood vessel families and levels, in addition to transcatheter and endovascular operations and intraoperative radiography. All of these factors contribute to the complex mix of difficulties.

Coding interventional radiology, particularly for neuro-angiographic procedures, is one of the most challenging tasks. Transcatheter, endovascular treatments, and intraoperative radiography all contribute to the extensive array of complications that can result from this illness.

CPT modifiers are more frequently used for billing interventional radiology procedures than other medical services. Consequently, this further complicates the process.

Besides the complexity of coding interventional radiology, other challenges associated with radiology coding are labor shortage, lack of resources, and financial burdens.

It can be difficult to locate a qualified interventional radiology coder due to the labor shortage in this industry. They are costly to recruit and hire, and their costs can significantly drain a company’s finances.

As a result of the continual lack of interventional radiology coders, there is a high turnover rate. In addition to the numerous problems it might bring, employee turnover can generate a whiplash in cash flow, leading to backlogs and lost revenue.

The facility must be sufficient for a clinic to afford an interventional radiology coding specialist. Most practices, particularly those in tertiary medical facilities, do not have sufficient patient volume to warrant employing an interventional radiology coder.

Other identified challenges in interventional radiology coding are:

  • Lack of physician documentation
  • Keeping up with the insurance rules
  • A high volume of work
  • Inadequate training
  • High level of claim denials

See Also: How is Dermatology Medical Billing different from any other Medical Billing and Coding

Conclusion

Interventional radiology coding is one of the most challenging tasks because of the many different therapy options. The number of options for care grows as technology develops. This move has made it even harder to find qualified interventional radiology coders. They must work daily to keep up with the rapid advancement of technology and coding as the rules, regulations, and modifications for interventional radiology coding continue to evolve.

Precision Hub’s radiology coders are experts in the subspecialties of interventional radiology. Our interventional radiology coders are up-to-date on the ever-changing coding standards, regulations, and updates—consequently, the number of costly denials and rebills and your risk of noncompliance decrease.

Since our designated division of coders solely codes for interventionists, their abilities are always current and refined. Contact Precision Hub if you want your interventional radiology coding experience to surpass your expectations.