Advanced Search

Revenue Cycle Insider

Compliance:

Make Monitoring a Linchpin of Your Compliance Program

Published on Wed Feb 19, 2025

You’ve reached your limit of free articles. Already a subscriber? Log in.

Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:

Simple explanations of current healthcare regulations and payer programs
Real-world reporting scenarios solved by our expert coders
Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
Instant access to every article ever published in Revenue Cycle Insider
6 annual AAPC-approved CEUs
The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles of

February 2025

Neurosurgery Coding:
Zone in on Key Points to Alleviate the Pain of Arthrodesis Surgery Coding
You’ll filter through complex documentation on these claims. When choosing an appropriate spinal procedure code, [...]

Optometry/Ophthalmology Coding:
Don’t Miss Out on Reimbursement by Skipping Eye Exam Codes
Question: I work for an ophthalmologist who also has a retina subspecialty. The provider wants [...]

Pulmonology Coding:
Know When to Separately Report Spirometry Results Interpretation
Question: A pulmonologist in our practice interpreted the results of a spirometry test performed by [...]

Optometry/Ophthalmology Coding:
Correctly Bill for After-Hours Encounters
Question: A patient presented to an ophthalmologist’s office after regular business hours for an eye [...]

E/M Coding:
Does a New Setting Determine Patient Status?
Question: I have a situation where our nurse practitioner (NP) performed a new visit for [...]

General Surgery Coding:
Review 2 Cases to Polish Your Pressure Ulcer Coding Skills
Coding the 6th character is a must. When your general surgeon treats a patient with [...]

Otolaryngology Coding:
Take These 3 Tips for Flawless Pharyngitis Coding
There’s more to the condition than coding J02.-. Pharyngitis coding seems basic on the surface. [...]

Podiatry Coding:
Scan Your Way to Successful Orthotics Claims
Question: I just want to confirm something. At our podiatry practice (provider not facility), we [...]

Pulmonology Coding:
Can You Report COPD and Chronic Bronchitis Together?
Question: I have a medical report for an encounter with an established patient. The pulmonologist [...]

Pulmonology Coding:
Boost Your Bacterial Pneumonia Coding Knowledge
Find out how to code related conditions. Bacterial pneumonia is the most common type of [...]

Podiatry Coding:
Heed These Heel Spur Coding Tips
Question: I’m relatively new to podiatry coding. Can you explain the different surgical options for heel [...]

Neurology & Pain Management Coding:
Check for CT When Coding PET Scans
Sometimes, the physician will order both tests at the same time. Positron emission tomography (PET) [...]

Pediatric Coding:
Report Vitamin D Drops for Infant, Not Parent
Question: How do I report a nursing infant receiving vitamin D drops? Our provider wants [...]

Path/Lab Coding:
Don’t Let Mistakes Muddle You Modifier 90 or 91 Claims
Here’s how to avoid duplicate billing. Clinical labs frequently reach for modifiers 90 (Reference (outside) [...]

Diagnostic Radiology Coding:
Get a Grip on Your Skier’s Thumb Diagnosis Coding
Question: A patient presented with pain in the right thumb following a fall while skiing. [...]

Oncology Coding:
Take Time to Code Care Management Services Correctly
Know your provider type and bundled services. Oncology stands out as a specialty not only [...]

Neurology & Pain Management:
Medical Device Pain? There’s a Dx for That
Question: Encounter notes indicate that the pain management (PM) specialist saw a patient in the [...]

E/M Coding:
Don’t Let Technical Difficulties Ruin Your Claim
Question: If a telehealth visit was converted to an audio-only visit due to technical difficulties [...]

Path/Lab Coding:
Look to Neoplasm Codes for Inflammatory Breast Cancer Dx
Question: Our pathologist diagnosed inflammatory breast cancer. Should we report this using N61 instead of [...]

Diagnostic Radiology Coding:
Pick the Correct Code for 3-Finger X-Rays
Question: A patient presented with pain in the third, fourth, and fifth digits of the [...]

Emergency Department Coding:
Definitive Dx Changes ICD-10-CM Code Choice
Question: A patient presents to the emergency department (ED) complaining of diarrhea, nausea and vomiting, [...]

Pediatric Coding:
Unlock Better Care With New Childhood Obesity Codes
Question: How will the new ICD-10-CM codes for childhood obesity, which became effective October 1, [...]

Podiatry Coding:
Don’t Cut Yourself Short on This Ingrown Toenail Encounter
Applying modifiers correctly is the key to successful payment on this claim. Surgeries for ingrown [...]

Neurosurgery Coding:
Take These Tips to Tame T Codes
Question: Recently at out neurosurgery clinic, I heard one of the coders tell the other [...]

Urology Coding:
Use Documentation to Correctly Report Bladder Biopsies and Lesion Removals
Learn how to report multiple tumor resections. As a urology coder, you should pay careful [...]

General Coding:
Be Specific, Not Leading, in Query
Question: In a recent encounter, a provider documented that a patient had a patient-health questionnaire-9 [...]

General Coding:
Use These Tips for Finding Information on Payer Policies
Question: Patients in my practice are covered by a few different insurance carriers, and of [...]

Compliance:
Establish Policies to Reach Audit Goals
Question: I know audit policies are part of a comprehensive compliance program, but what should [...]

Path/Lab Coding:
Pick These Codes for Tubal Ligation and Placenta Pathology
Question: A patient had a cesarean section (C-section) and had bilateral tubal ligation during the [...]

Diagnostic Radiology Coding:
Assess Your Image Guidance Coding Knowledge
Find out when you need a guidance code. Knowing how and when to report image [...]

General Surgery Coding:
Code This Breast Cystectomy Case
Question: I need help coding the following procedure notes: A medial periareolar incision was created [...]

Orthopedic Coding:
Code Ankle Arthroscopy With Confidence
Enhance your understanding of descriptor verbiage. Orthopedic surgeons commonly perform ankle arthroscopy surgeries to treat [...]

Compliance:
See What Distinguishes a Diligence Audit
Question: I’m reading more about compliance and recently saw the term “diligence audit.” Is this [...]

Neurology & Pain Management Coding:
Doppler Study Code Gets 2025 Add-Ons
Question: When our neurologist performs a complete transcranial Doppler study (TCD), they sometimes also perform [...]

IN CASE YOU MISSED IT (RCI BONUS CONTENT):
April ICD-10-CM Update Comes in Like a Lamb
Small but significant changes to the code set are on the way. ICD-10-CM has released [...]

Otolaryngology Coding:
Use These Codes to Document Flu With Sinusitis
Question: A patient with congestion, thick nasal drainage, facial pain, and a headache presented to [...]

Emergency Department Coding:
Focus on Details in Lesion Coding
Size, location, complexity all figure into your choices. Coding for lesion removal in the emergency [...]

Cardiology Coding:
Look for Link Before Coding Adverse Effect
Question: We have a patient who presented to the emergency department (ED) with swelling of [...]

Cardiology Coding:
Know These 3 Factors for Coding Heart Catheterizations
Question: Is it appropriate to use the CPT® codes for congenital heart catheterization after a [...]

Orthopedic Coding:
Wrap Your Head Around This Wrist Surgery
Question: I have a surgical note with the following listed as the procedure: 1. Debridement [...]

Orthopedic Coding:
Find Out How to Report Knee Arthroscopy With VMO Plication
Question: An orthopedic surgeon performed knee arthroscopy with lateral release and vastus medialis oblique (VMO) [...]

Compliance:
Make Monitoring a Linchpin of Your Compliance Program
Compliance officers can delegate monitoring processes to managers and supervisors. The U.S. Department of Health [...]

ICD-10-CM Coding:
Grasp the Appropriate Use of Z51 Codes
Question: Can ICD-10-CM code Z51.11 be used when the provider sees a patient in between [...]

General Surgery Coding:
Figure Out This Fissurectomy Frustration
Question: When I attempt to bill a claim for CPT® codes 46505 and 46200 together, [...]

E/M Coding:
Code Level 4 E/M for Strep? Not so Fast
Consider CPT® definitions of systemic symptoms for precise coding. When the AMA revised the office [...]

Gastroenterology Coding:
Solve This Angiodysplasia Coding Query
Question: I have a report for a small intestine endoscopy, where the physician found an [...]

Gastroenterology Coding:
Fix These Capsule Endoscopy Claims
Question: We submitted separate claims for two different patients where one of our gastroenterologists performed [...]

Medicare Regulations:
Medicare Preventive Services Get a Boost for 2025
CMS changes will enable providers to detect problems earlier, when treatment is most effective. In [...]

Practice Management:
Is Time Blocking Beneficial?
Question: Our organization is hiring a practice manager who wants to switch our scheduling model to [...]

Otolaryngology Coding:
Keep Your Eye on This Code for vHIT Procedures
Question: What is the correct CPTÒ code for the video head impulse test (vHIT), which [...]

Practice Management:
Learn the Limit for Medicare Overpayments
Question: What are the guidelines for refunding excess payments if we recently found out that we've [...]

Technology & Innovation:
Administer Epinephrine Without Needles
Question: I have several patients who have severe allergies that always need to carry an [...]

Primary Care Coding:
Understand How Location of Osteoarthritis Narrows Code Choices
Question: There are several types of osteoarthritis (OA), lots of places it can manifest, and [...]

Technology & Innovation:
Screen for Colorectal Cancer With a Blood Test
Question: Physicians in our practice refer several patients for colorectal cancer screenings, but only about [...]

Medicare Regulations:
Find Appropriate Payer Order
Question: One of our patients is 69 but their spouse is 63 and works for [...]

Neurosurgery Coding:
Look Into Interspaces Before Coding PEEK Cage Insertion
Question: Some of my surgeons are inserting polyether-ether-ketone (PEEK) cages bilaterally and wanting to report [...]

Technology & Innovation:
Understand What’s in President Trump’s AI Executive Order
Find out if federal land will open for AI development. On Jan. 23, 2025, President [...]

Primary Care Coding:
Learn this Eating Disorder Acronym
Question: I work at a primary care practice and one of our providers documented a [...]

Primary Care Coding:
Get the Answers to All Your Vanderbilt Assessment Coding Questions
Don’t forget to brush up on your ADHD coding knowledge. If your provider has been [...]

Anesthesia Coding:
Beware Exceptions to Locum Tenens
Question: Some of our staff who help administer anesthesia are taking off on vacation at [...]

Urology Coding:
Assess This Problematic Abscess Procedure
Question: The urologist performed a procedure with operative notes as follows: Following the administration of general [...]

Emergency Department Coding:
Choose Carefully on Refill E/M
Question: A patient with benign prostatic hyperplasia (BPH) without lower urinary tract symptoms presents to [...]

Urology Coding:
Figure Out This French Whistle Tip Stent Scenario
Question: My urologist says he put in ureteral stents for another physician during a diverticulitis surgery. [...]

Anesthesia Coding:
Educate Yourself on Moderate Sedation Documentation, Guidelines
Find clarity when reporting moderate sedation. Moderate sedation is a drug-induced state of depressed consciousness [...]

Gastroenterology Coding:
Learn When and How to Use 43246 for Percutaneous Endoscopic Gastrostomy
Hint: You can’t use the code for every EGD procedure. The CPT® code range for [...]

ICD-10-CM Coding:
See the Difference Between Aftereffect and Sequela
Question: I’m relatively new to coding and my coworker and I are wondering how the [...]

Oncology Coding:
Don’t Take This Advice for PET Scan Dx
Question: I am having terrible issues with referring doctors using R91.8 for 78815/A9552. In the [...]

Oncology Coding:
Use Two Claim Lines in This Bilateral Mastectomy Scenario
Question: We recently had a patient come in for a bilateral mastectomy. The left breast [...]

General Coding:
Differentiate Modifiers GC, GE for Teaching Physician Services
Hint: Mastering the primary care exception rule helps open reimbursement doors. When your provider performs [...]

Pediatric Coding:
Lean On Other Signs/Symptoms to I.D. Viral, Bacterial, or Fungal Rashes
Hint: Sometimes the rash is the first sign, sometimes one of the last. According to [...]

Optometry/Ophthalmology Coding:
Clarify Your Cataract Extraction Coding Knowledge – Part 2
Learn what is needed to report ATIOLs and other procedures to correct cataracts. Last month, [...]

ICD-10-CM Coding:
Reduce Denials by Brushing Up on Excludes1 and Excludes2 Notes
Do you know the difference between an Excludes1 note and an Excludes2 note? Sometimes, it [...]

Cardiology Coding:
Explore Transthoracic Echocardiography and Separately Billable Modalities
Pocket these tips for billing echocardiography services. Echocardiography (“echo”) is a procedure that uses high-frequency [...]

Medicare Regulations:
Look for Payment for Some HIV Drugs as Additional Preventive Services
Question: Does the Centers for Medicare & Medicaid Services (CMS) cover medication for prophylactic transmission [...]

Ob-Gyn Coding:
5 Tips for Reporting 99211 Every Day in Your Ob-Gyn Practice
Here’s what needs to be in the documentation. Having a nurse on staff at your [...]

Ob-Gyn Coding:
Adding 59 to 57500 Means Correct Dx Code
Question: Can we bill 58545 and 57500 together if the surgeon took out a cervical [...]

Anesthesia Coding:
Find Split Billing Payment Answers
Question: Can an AA (anesthesia assistant) bill with a QZ modifier? Does this mean all [...]

Ob-Gyn Coding:
Choose This Code for Aspirated Ectopic Pregnancy
Question: What is the best CPT® code for this case? Cesarean scar ectopic pregnancy at [...]

Practice Management:
Explore These Causes for CHAMPVA Claims Going Unpaid
Tip: Check VA financial enrollment, then evaluate billing. If you are treating patients under the [...]

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.