Medical Payers & Insurance Companies

articles, webinars, tips, links, forms, files and other resources related to coding, reimbursement and compliance for medical payers and insurance companies


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recent articles

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2024 CPT Coding Updates...Are You Ready?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Each year the CPT coding updates are published and coders nationwide rush to ensure they understand the impact they will have on their workflow and organization in general. For the first time in three years, changes to the Evaluation and Management (E/M) codes are minimal. However, the Medicine section, specifically the codes and guidelines for reporting COVID-19 vaccines have significant changes and unfortunately they are not reflected in that shiny, new CPT codebook you just purchased.

New ICD-10-CM Codes for Reporting Coronary Microvascular Dysfunction

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Women are more likely than men to be diagnosed with coronary microvascular dysfunction, a micro coronary artery vessel disease that has similar symptoms as coronary artery disease but no detectable coronary disease.

How Much Interaction Do Coders Have with Providers?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

How much interaction do you have with providers in your coding role? This question is interesting in that there are many coding jobs that require day-to-day interaction with providers and many others where the coder never interacts with physicians or nonphysician providers.

Updated ICD-10-CM Codes for Appendicitis

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.

Should I Report the Symptom or Confirmed Diagnoses for Testing?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Knowing when to report symptom codes has always been a conundrum for coders at one point or another in their career but with the complex EHRs and coding systems used today, requiring a diagnosis be submitted with every physician order for a lab test, image request, etc., it isn't a surprise that the question continues to pop up. So when is it appropriate to report symptom codes?

CMS Issues Final Rules for PFS, OPPS/ASCs

by  Mark Spivey

The regulatory changes will create a variety of changes for providers. Amid a flurry of regulatory activity, federal officials late last week issued twin final rules governing changes to the Medicare Physician Fee Schedule (PFS) and the Outpatient Prospective Payment System (OPPS), with the latter also featuring adjustments...

The Trouble with Cookies – and the Civil Liability They Can Present to Providers

by  Geoff Koslig

As a provider, a question worth asking yourself these days is this: what degree of risk is there that you might have something on your website that could lead to a multi-million-dollar class-action lawsuit and a determination by the U.S. Department of Health and Human Services (HHS) Office for...

COVID Vaccine Coding Changes as of November 1, 2023

by  Wyn Staheli, Director of Content - innoviHealth

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.

Medicare Adds Specialties for Behavioral Health Services

by  Wyn Staheli, Director of Content - innoviHealth

Questions and Answers for the changes CMS has made to Medicare Specialties for Behavioral Health Services.

Reviewing the Guidelines for Reporting ICD-10-CM Aftercare Codes

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Understanding the appropriateness of reporting ICD-10-CM aftercare codes related to injuries, degenerative conditions, and postsurgical scenarios can be a bit confusing. Does the injury code suffice or should there be an aftercare code and a postsurgical code added? A quick review of some coding scenarios might help clear up the confusion.
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