As I understand the Medicare rules, physician interpretation of a molecular pathology procedure (e.g., CPT® codes 81161–81408) may be reported with HCPCS code G0452 (molecular pathology procedure; physician interpretation and report) as long as certain criteria are met. What are those criteria?
Can a radiologist bill for the reading of a post breast biopsy/clip/wire-placement mammogram? It is usually a two-view mammogram that indicates the clip/wire placement. Prior to 2016, the National Correct Coding Initiative (NCCI) edits didn’t allow, but I believe this policy was revised. If the radiologist can bill for the reading of the post breast biopsy/clip/wire placement mammogram, would it be a unilateral, diagnostic mammogram?
Palliative care is medical care just as are other medical specialties. I was in the midst of a perfectly comfortable morning, my computer was working,
Best practices are described for eliminating redundancies and easing workloads during the HEDIS season now underway. Healthcare Effectiveness Data and Information Set (HEDIS) reviews are
The 340B drug discount program continues to be in a state of flux The American Hospital Association (AHA) recently filed suit to stop reductions to
The ransomware crisis continues to impact hospitals and health systems with little sign of slowing down. In 2017, IT security in healthcare was in the
Understanding when and how to use clinical documentation integrity internal clinical guidelines (CDI-ICGs) Clinical policies, clinical practice guidelines, best practice advice: there are numerous ways
Healthcare quality and data come from clinical documentation. Bricks and mortar are the foundation of many a structure. Clinical documentation and coding are similar, as
Unfortunately, the quality of data is driven less by opportunity and more by incentives for those creating the data. Prior to the implementation of ICD-10,
CTE is coded as postconcussional syndrome which is F07.81 January 30th is National CTE Awareness Day according to www.stopcte.org. This organization was founded by the
Removal of total knee replacement from the Medicare inpatient-only list will cause major disruptions to the CMS bundled payment initiatives – BPCI and CJR –
If we perform most of the components of an obstetric panel in our hospital lab but we have to send out one component to a reference lab, would we append the modifier 90 to the entire panel, or do we have to report each component separately and append the modifier 90 to only the CPT® code that was sent out?
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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