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medical coding

Cracking the Code: Qualifying and Quantifying the QZ Modifier

It was called the Enigma machine. During WWII, it was Germany’s fail-safe encryption device that would secure all communications between its fleet of U-boats and the naval high command. A coded message would go out and be received. The message could only be deciphered using the Enigma. If the allies could only get their hands […]

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The Challenge of Anesthesia Charge Capture

In contrast to medical billing in the main, the submission of anesthesia claims in particular is uniquely intricate because of the multiple ways in which reimbursement is determined—starting with what’s found on the anesthesia record. While every other specialist dictates a narrative report describing the services provided to the patient, the anesthesia provider documents multiple […]

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They’re Watching: Federal Enforcement Actions Against Providers

Sometimes, you just get that nagging feeling. Somebody’s watching you. You look over your shoulder, but nobody’s there. That doesn’t mean, however, that you’re not, in fact, under some form of surreptitious surveillance. Medical providers would do well to proceed under the assumption that they are always under the microscope. If it’s not an auditor […]

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Getting Paid for Someone Else’s Work: The Hidden Hurdles of Incident-To Billing

It’s not an unknown phenomenon. Getting paid for something that was at least partially performed or created by someone else is a well-established practice. Thomas Edison was well known for taking the inventions of others, including his employees, and appropriating them as his own, receiving the acclaim and a hefty pay day (Nikola Tesla was […]

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Anesthesia Medical Billing RCM: What to Know

Adhering to the medical billing rules and guidelines specific to anesthesia care is required in order to accurately report anesthesia services and get reimbursed in a timely manner. Anesthesia medical billing can be complex and time-consuming, which is why most facilities choose to partner with a medical billing company to achieve a more efficient workflow, […]

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Why CPT Code Modifiers Are Essential for Anesthesia Billing Claims

Common procedural terminology (CPT) modifiers are special codes – usually numeric or alpha – used by medical billers to indicate additional information or pricing associated with a specific CPT code. Anesthesia billing, like all other medical billing, includes the use of these modifiers, which are critically important for the purpose of reimbursement from payors. What […]

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Coding for Ophthalmology Medical Billing: What You Need to Know

Ophthalmology medical billing, like other medical billing, is essential to ensure that an eye care facility remains profitable and viable to continue caring for patients. Because eye care is unique and unlike other specialties, it requires a strong foundation of knowledge to understand the intricate nature of ophthalmology medical billing services.  From basic vision care […]

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The Difference Between Behavioral Health and Medical Billing

A common misconception about mental and behavioral health is that health insurance covers services the same way other medical services are covered. Unfortunately, this is not the case, and it can cause significant headaches for providers in the mental and behavioral health sphere.  The differences and restrictions related to mental and behavioral health cause some […]

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New Codes Coming: Is Your Practice Ready?

The clock is ticking for 2022-2023 pathology coding changes. Highlights to date include proposed changes to the 2023 Physician’s Fee Schedule and the addition of category 3 (temporary) digital technology codes that will be add-ons to the primary category 1 CPT (eg: 88305, 88342). The 2023 ICD-10 changes are slated to go into effect on […]

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