Three significant changes that will affect reimbursement rates go into effect January 1, 2026:
Conversion factor changes
Relative Value Unit (RVU) efficiency adjustment
Practice Expense changes
If you're a Find-A-Code subscriber, there's no need to worry. Find-A-Code's fee calculators are ready for the change. You can count on Find-A-Code for the most complete and accurate information you need as a medical coder/biller.
tci E/M Coding Alert - 2017 Issue 10
Reader Question: Know When to Append Modifier 25
Question: If the physician performs a colonoscopy (45380) on the same day as an initial hospital visit (99221), do we need to append modifier 25 to the 99221?
Colorado Subscriber
Answer: The full descriptors for the codes you mention are as follows:
45380 (Colonoscopy, flexible; with biopsy, single or multiple)
99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: s detailed or comprehensive history; a detailed or comprehensive examination; andmedical decision making that is straightforward or of low complexity ...).
According to the Correct Coding Initiative (CCI) Edits...
To read the full article, sign in and subscribe to tci E/M Coding Alert.
Stay informed, get answers to your E/M coding and documentation questions, and find the help you need to bank your deserved pay with your subscription to TCI’s E/M Coding Alert.
Current newsletters added each month
Fully searchable archives - over 500 articles
ALL years/issues back to 2013 organized by year and issue
Codes mentioned in articles are linked to Code Information pages
Code Information pages link back to related articles
This feature is currently unavailable for online purchase. For more information, please call 801-770-4203 or Contact Us.
Quick, Current, Complete - www.findacode.com