Topic Archives

The Second Element of MDM: Amount and/or Complexity of Data

There are three elements in medical decision-making and this article describes the second, arguably, the most complex of the three elements When selecting a level of service based on medical decision-making two of the three elements are required CPT® has developed definitions for many of the components in the MDM chart. This article describes the definitions […]

Diagnosis Coding for Suspected Cancer

Diagnosis coding for possible malignancy When coding for a suspected or possible condition in the outpatient setting, follow the guidelines in Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services. “H. Uncertain Diagnosis Do not code diagnoses documented as “probable,” “suspected,” “questionable,” “rule out,” “compatible with,” or “working diagnosis” or other similar terms indicating […]

Modifier 25

Use of Modifier 25 may be applicable when an E/M service is provided on the same day as a procedure, a preventive medicine service, or other medical service or procedure. Use this quick reference sheet to determine when to use modifier 25, and which code to append it to.

Using Modifier 33 | Quick Reference

Modifier 33 is used to identify certain screening and preventive services. This quick reference sheet addresses: when to use modifier 33, why to use it, screening colorectal cancer test, and planned screening colorectal test that converts to a diagnostic or therapeutic service.

Wellness Visits in Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs)

RHCs and FQHCs are paid an all-inclusive rate (AIR) or national prospective payment system (PPS) rate for any service that is defined as a visit to their facility. A visit may be with a physician, non-physician practitioner (NPP), psychologist or social worker. There are some differences in RHC and FQHC rules, but in general, a […]

Top Denied High-Value Inpatient ICD-10-CM categories of 2025 | Webinar

Recorded February 19th, 2026
1 CEU Expires 2-28-2027

Guest presenter Dr. Amarin “Ty” Alexander

This presentation will cover frequently denied ICD-10-CM codes in Inpatient Hospital claims from 2025. Clinical validation considerations and relevant ICD-10-CM Guidelines will be highlighted from the payer perspective.

Psychiatric Collaborative Care Management Services

This resource covers Psychiatric Collaborative Care Management Services 99492, 99493, 99494 and Care Management for Behavioral Health 99484.

Coding Guide – Care Management Services

Updated December, 2025

Coding Guide – Fracture Care Coding Fundamentals

This guide provides rules for reporting fracture care services using CPT® and Medicare guidelines. It details the coding distinctions for closed, percutaneous, and open treatment of fractures, clarifies how casting, splinting, and strapping services are treated within the global surgical package, and addresses the correct use of selected modifiers and radiology and supply codes. The […]

CDI and Coding for Myocardial Injury and Infarction | Webinar

Recorded February 9th, 2026
1 CEU Expires 2-28-2027

Guest presenter Dr. Robert Oubre

Dr. Oubre will provide a practical, clinically grounded review of myocardial injury and myocardial infarction through the lens of accurate documentation and compliant coding

Using Modifier 59 | Quick Reference

Modifier 59 is referred to by CMS as the modifier of last resort. It is often used when modifier 51 is the more accurate modifier. This quick reference sheet explains when, why and how to use it.

Diabetes Coding in V28

This quick reference sheet simplifies coding for diabetes in the HCC system. A must-have resource for clinicians who see patients with diabetes.

Medication Management and Psychotherapy Reference Sheet

This quick reference sheet illustrates the coding and documentation requirements for medication management services with, or without psychotherapy.

Coding Guide – Advanced Primary Care Management

Care management services have played an increasing role patient care management. CMS and other payers no longer pay only for face-to-face services, a concept that would have been unthinkable 15 years ago. CMS began paying for Transitional Care Management Services in 2013, for chronic care management services in 2014. In the 2016 Final Rule, CMS […]

Physician Fee Schedule Final Rule for Calendar Year 2026

2026 conversion factor $33.4009 ($33.5675 for qualifying APM participants) – updated 11/4/2025 Payment policies in the 2026 Physician Fee Schedule Conversion Factor For the first time, there are two conversion factors for services paid under the Physician Fee Schedule. This is a result of a law passed in 2015. The Medicare Access and CHIP Re-authorization […]

In Focus: CPT® Coding for Percutaneous Coronary Interventions (PCIs) | Webinar

Recorded January 22nd, 2026
1 CEU Expires 1-30-2027

Guest presenter Shannon McCall of HCPro

In the 2026 revisions to CPT® codes, there are revised guidelines for the section Coronary Therapeutic Services and Procedures. Six existing add-on codes that reported additional interventions in the coronary branches are deleted, and base codes are revised to include the branches of the same coronary artery within the descriptions of the codes themselves.

Billing Preventive Medicine Services and Problem Visit | Quick Reference Sheet

This quick reference sheet provides guidance for billing preventive medicine services and split visits.

Reimbursement Reality: Navigating the 2026 Payment Landscape | Webinar

Recorded January 15th, 2026
1 CEU Expires 1-30-2027

Guest presenter Elizabeth Woodcock

Change remains the only constant in reimbursement for health care services. Stay ahead in 2026 with this essential payment update for medical practices. This session will break down the latest federal payment policies, emerging reimbursement models, and what they mean for your medical practice’s bottom line.

Teaching Physician Rules | Quick Reference Guide

This quick reference guide breaks down who must document what for which services as outlined in Medicare’s teaching physician rules.

Chronic Care Management | Reference Sheet

This quick reference sheet includes clinical staff time, care planning and billing practitioner work criteria for chronic care management services. When coding for care management services services, practitioners need to distinguish between chronic care management and complex chronic care management, between who does the work, the practitioner or clinical staff, and the amount of time […]

Care Plan Oversight | Coding reference sheet

There are two sets of codes for care plan oversight, CPT® (99374–99380) and HCPCS codes (G0181, G0182). The requirements for each are different, including time thresholds and what activities may be included in the CPO time. RVUs are assigned by Medicare for these CPT® codes. Some have a bundled indicator and some invalid, which means […]

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