United Healthcare to Require Anatomical Modifiers

Beginning with claims submitted on or after May 1, 2018, care providers will be required to include an anatomical modifier that identifies the area or part of the body for procedures performed on the eyelids, fingers or toes. This coding edit is consistent with Centers for Medicare & Medicaid Services (CMS) correct coding guidance and […]

Billing for Chronic Care Management

** UPDATE FOR 2017 ** An estimated 117 million adults have one or more chronic health conditions, and one in four adults have two or more chronic health conditions. Chronic disease is prevalent among Medicare beneficiaries, with most beneficiaries having multiple chronic conditions, which increases the risk for poor health outcomes such as mortality and […]

MACRA – Final Rule

Medicare Physician Billing Services for Raleigh, NC & West Palm Beach, FL Breaking: Medicare finalizes sweeping changes to physician payments Today, the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated final rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). With […]

ICD-10-CM Diabetes Mellitus Coding

The documentation of diabetes mellitus has made the classification and diagnosis of the disease easier. Diabetes mellitus is classified using these codes: [1] E08 Diabetes mellitus due to underlying condition: The underlying conditions can be:[1] Congenital rubella Cushing’s syndrome Cystic fibrosis Malignant neoplasm Malnutrition Pancreatitis and other diseases of the pancreas E09 Drug or chemical […]


The Centers for Medicare & Medicaid Services (CMS) recently published some facts about ICD-10 intended to dispel myths and address common questions about the upcoming transition: The ICD-10 transition date is October 1, 2015 – The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the […]

Medicare News!! SGR Repealed, 21% Cut Averted

On Tuesday, April 14th, the Senate voted to approve the Medicare Access and CHIP Reauthorization Act, H.R. 2. This legislation, which passed the House of Representatives on March 26, permanently repeals the Medicare Sustainable Growth Rate (SGR) formula. President Obama will sign the bill into law. In addition to SGR repeal, the law includes three […]


Excerpt from MedLearn Matters article MM9051, revised 12/31/2014, implementation date 2/2/2015 The Centers for Medicare & Medicaid Services (CMS) is updating the Medicare coverage requirements to align with the updated ACIP recommendations. Effective for dates of service on or after September 19, 2014, (and upon implementation of CR9051), Medicare will cover: An initial pneumococcal vaccine […]

CPT 2014 – Stent Placement

There are several new and revised CPT codes that will affect cardiologists and vascular surgeons in 2014.  In particular, we will see changes in how we code stenting in certain vessels.  CPT codes 37205-37208 have been deleted. The RUC Relativity Assessment Workgroup continues their mission of abandoning the component coding concept and bundling certain services […]

CPT Changes 2013 – Carotid Angiography

The RUC Relativity Assessment Workgroup continues their mission of abandoning the component coding concept and bundling certain services into single codes based on their 75 percent rule.  For code pairs that are billed together greater than 75 percent of the time, new CPT codes are created that bundle multiple procedures into one single code.  Consolidation […]

CPT 2013 – Coronary Revascularization

As mentioned in my previous post, here are the new CPT codes for coronary revascularization (Table 1).  The new codes will help support reimbursement for treating sidebranches as well as the more complex interventions involving bypass grafts, chronic total occlusions, and ST-elevation myocardial infarction.  Effective January 1, 2013, you will no longer use 92980, 92981, […]