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Medicare Regulations:

Follow Guidelines for Beneficiary Referral Visits

Published on Tue Mar 25, 2025

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Other Articles of

March 2025

Urology Coding:
Code This Cystourethroscopy With Lithotripsy Case
Question: A 65-year-old patient presented with recurrent left flank pain and hematuria. The CT scan [...]

ICD-10-CM Coding:
Sequence Is Crucial When Coding Breathing Symptoms
Find out why the order of your symptom codes matters as much as your primary [...]

Optometry/Ophthalmology Coding:
Analyze This Anisometropia IOL Implant Case
Question: A patient with anisometropia in their left eye presented for an intraocular lens (IOL) [...]

E/M Coding:
Update Your Code Books With CPT® Errata and Technical Corrections
Keeping resources current will help prevent inaccurate coding of medical services. The AMA released errata [...]

Anesthesia Coding:
Find Clarity on Appropriate Modifiers
Question: I’m preparing a claim involving a certified registered nurse anesthetist (CRNA) working without the [...]

Neurology & Pain Management Coding:
Ask the Right Questions to Arrive at Menstrual Migraine Dx
Question: If a patient is diagnosed with a menstrual migraine, how should I choose an [...]

Neurosurgery Coding:
Use 1 Code to Represent Several Spinal Nerve Cyst Types
Question: Encounter notes indicate that the surgeon treated a patient with “cyst, lumb nerve root.” [...]

Path/Lab Coding:
Follow 3 Tips for Perfect Prostate Biopsy Pathology Coding
Test yourself with this coding case study. Billing a case for a prostate biopsy pathology [...]

Technology & Innovation:
Add AI to Your Healthcare Organization With These 3 Tips
Show staff how AI can free them up for more valuable tasks. Artificial intelligence (AI) [...]

Neurosurgery Coding:
Prevent Discectomy Coding Slip Ups by Knowing Anatomy
There are different codes for different spinal areas. Patients who report to the neurosurgeon for [...]

Podiatry Coding:
Refresh Your Bunionectomy Coding Skills With 3 Cases
Find out if bunionectomies and sesamoidectomies can be coded together. Within your podiatry practice, you [...]

Optometry/Ophthalmology Coding:
Thrive Under Pressure While Coding Glaucoma Treatments — Part 1
Differentiate open and closed angle glaucoma. Loosely defined, the term glaucoma encompasses a range of [...]

ICD-10-CM Coding:
Check Excludes Notes to Avoid a Denial
Question: I've been getting a handful of denials from Humana about ICD-10-CM codes being inappropriately [...]

Path/Lab Coding:
Look to This Immunoassay Code for Islet Cell Tests
Question: The lab performed an ELISA test for glutamic acid decarboxylase antibody on a serum specimen, [...]

Technology & Innovation:
Identify IBD Flare-Ups Before They Happen With Wearable Devices
Question: I’m a gastroenterologist and have several patients who suffer from inflammatory bowel disease (IBD). [...]

Technology & Innovation:
Upgrade Your OS Before Time Runs Out on Updates
Question: The computers in our organization are running a certain operating system (OS), but our [...]

Optometry/Ophthalmology Coding:
Safely Report a Visual Field Test With OCT Imaging
Question: An ophthalmologist performed a bilateral Humphrey visual field test with the 30-2 pattern. They [...]

Cardiology Coding:
Find Coding Answers for Pericarditis Dx
Question: A patient presented with a sudden onset of severe chest pain, which was less [...]

Emergency Department Coding:
Critical Care Bundles Vary by Age, Code
Question: Encounter notes indicate that the emergency department (ED) physician provided 52 minutes of critical [...]

In Case You Missed It (RCI Bonus Content):
Take a Surgical Report From Chaos to Order
Use these six steps to correctly code complex procedures. Every surgical coder can relate to [...]

Medicare Regulations:
Follow Guidelines for Beneficiary Referral Visits
Question: One of our providers saw a Medicare beneficiary who visited for a problem that [...]

Practice Management:
Incorporate These Strategies for Hiring Top-Notch Coders
Hint: Start at the foundation by focusing on the job description. Organizations can cultivate the [...]

Compliance:
Maintain Office Compliance With These HIPAA Tips
Staff training should be ongoing, not just once a year. As a healthcare professional frequently [...]

Pulmonology Coding:
Precisely Understand ‘Unspecified’ Codes
Question: I’m having trouble understanding how the word “unspecified” differs between diagnosis code descriptors. Could [...]

Primary Care Coding:
Lean on Symptoms Coding Without Definitive Diagnosis
Question: A patient presented with fever, headache, fatigue, muscle aches, and swollen glands. They spend [...]

General Surgery Coding:
Pin Down Panniculectomy and Abdominoplasty Coding
Learn exclusions to Medicare’s cosmetic surgery rules. Patients who undergo significant weight loss, either through [...]

General Surgery Coding:
Don’t Use Lesion Excision Codes for Skin Tag Removals
Question: A patient presented with 20 skin tags on multiple areas of the body. The [...]

Pediatric Coding:
Is Laterality a Necessity in This Sticky Scenario?
Question: My coworker told me that when reporting H61.21 or H61.22, I still must append a [...]

General Surgery:
Pay Attention to Measurement Units for Adjacent Tissue Transfers
Question: What measurements are used when determining the size of the adjacent tissue transfer after [...]

General Coding:
Incorporate These Responsibilities Into the CDI Job Description
Fully utilize the specialized knowledge of your CDI specialist with these tips. Having a team [...]

Cardiology Coding:
Look to These Codes for Primary Arterial Mechanical Thrombectomy
Question: Which code or codes should I use to report a primary arterial mechanical thrombectomy? [...]

Pulmonology Coding:
Verify The Correct Code for a Viral Infection Case
Question: I have a report that lists the diagnosis as viral lower respiratory tract infection. [...]

Podiatry Coding:
Don’t Overdo This Collateral Ligament Repair
Question: My podiatrist performed a primary ankle collateral ligament repair. In the medical documentation, they [...]

Pulmonology Coding:
Build Your Bronchiectasis Diagnosis and Treatment Coding Knowledge
Remember a 4th character for ICD-10-CM codes. Bronchiectasis is a respiratory condition where the patient’s [...]

Compliance:
Reach an Understanding Before Signing Agreements for Audits
Question: We are hiring an external entity to perform an audit to assess the performance and [...]

Path/Lab Coding:
Use This 1 Code to Document 2 Testosterone Tests
Question: Our lab performs tests to assess a patient’s ability to produce testosterone after being [...]

ICD-10-CM Coding:
Figure Out This Fall and Fracture
Question: A patient presented to an outpatient radiology practice after suffering a fall from a stepladder [...]

Emergency Department Coding:
Tread Carefully When Billing ED Transfers to Observation Care
Medicare and CPT® disagree on the rules for ED transfers to observation. Ever since CPT® 2023 [...]

Otolaryngology Coding:
Correctly Code This Postnasal Polyp Patient
Question: Our practitioner saw a new patient for postnasal drip and difficulty breathing through their nose. [...]

Anesthesia Coding:
Don’t Count on Prior Authorizations
Question: I’m soon taking a job at an organization where I’ll be coding anesthesia services. [...]

Medicare Regulations:
Find Clarity on MSP Types
Question: I’m trying to navigate situations in which a patient is a Medicare beneficiary but [...]

Otolaryngology Coding:
Take This Advice to Code Vaping and Related Conditions
Bolster your knowledge of this growing epidemic. Since 2014, e-cigarettes (vapes) have been the most [...]

Otolaryngology Coding:
Effectively Code This Nasal Swell Body Procedure
Question: Can we separately bill code 30117 when our healthcare provider carries out a reduction of [...]

Orthopedic Coding:
Can You Separately Report ID Repair During Spine Surgery?
Question: Our orthopedic spine surgeon performed an extensive spine procedure. Due to a complication, a [...]

Neurology & Pain Management Coding:
Use These Tips for Sure Shot ESI Claims
Code choice will vary depending on spinal area. Epidural steroid injections (ESIs) are commonly used [...]

Oncology/Hemotology Coding:
Know the Dos and Don’ts of Coding Long-Term Cancer Drug Use
Hint: Look at your ICD-10-CM long-term drug use appendix. Whether you’re coding the long-term use [...]

E/M Coding:
Patient’s Decision Doesn’t Change the Work Involved
Question: A provider advised a patient to begin a medication and instructed them on the [...]

Primary Care Coding:
Don’t See All Injections As Prescription Drug Management
Question: One of our clinicians administered a cortisone injection for a patient during an encounter. [...]

Orthopedic Coding:
Decipher This Open Fx Debridement Case
Question: If an orthopedic surgeon documents an open fracture was debrided and copiously irrigated without [...]

Emergency Department Coding:
Get Granular on Diverticulitis Dx
Question: Encounter notes indicate that a patient suffers from diverticulitis of the small intestine. What [...]

Compliance:
Stick to Same DOS to Stay Compliant
Question: Can the time spent by the doctor preparing for a patient’s appointment a day before [...]

General Coding:
Find Clarity on RVU Designation
Question: I’m trying to figure out reimbursement for my provider, who’s a specialist. What exactly [...]

Orthopedic Coding:
Unraveling the Complexities of Coding Carpal Tunnel Syndrome — Part 1
Find out the differences between NCS and EMG tests. The carpal tunnel is a narrow [...]

Gastroenterology Coding:
Does Poor Patient Preparation Warrant Modifier 52?
Question: A Medicare patient came in for a screening colonoscopy, and they had a poor [...]

Pediatric Coding:
Determined Diagnosis Makes All the Difference
Question: A 6-year-old patient was seen for abdominal pain, diarrhea, and nausea with vomiting. My provider [...]

Gastroenterology Coding:
Use an ERCP Code for a Bile Duct Blood Clot Removal
Question: We have a procedure report that indicates the physician performed balloon sweeps to remove [...]

Podiatry Coding:
Try Out This Tendinitis Dx
Question: My podiatrist recently treated a patient for peroneal tendinitis. What is peroneal tendinitis, and which [...]

Neurosurgery Coding:
Look at Modifiers, CPT® Code Before Resubmitting Shunt Claim
Question: We recently had a patient that needed to return to surgery with a complex [...]

Oncology/Hematology Coding:
Heed This Guideline for Complications Treatment Coding
Question: We had a patient come in suffering from nausea and vomiting; they have cervical [...]

Pediatric Coding:
Unlocking Coverage: Tips to Prevent Unnecessary Coding Denials With Well Visits
Gain specifics on how to prevent or minimize unnecessary lost revenue. When billing for a [...]

Oncology Coding:
Look to Treatment and Determine Active or History Dx
Question: Patients who have breast cancer, and who have had the malignancy removed, will frequently [...]

E/M Coding:
Distinguish Between Mentions and Discussions
Question: A provider wrote that they made a diagnosis and then discussed with the patient [...]

Cardiology Coding:
Use These Tips for Reporting US Guidance for Vascular Access
Solid documentation a must for successful US claims. There are several documentation requirements that coders [...]

Practice Management:
You Can Use G2211 for Patients Beyond Medicare Beneficiaries
Question: Can I use G2211 for patients regardless of their insurance or only for Medicare [...]

Primary Care Coding:
Try These Tips to Code Pressure Ulcers Accurately
Code for quality of care, not just reimbursement. According to the Agency for Healthcare [...]

Medicare Regulations:
Beware More Oversight Coming for Remote Patient Monitoring
More remote capabilities may mean more responsibilities — and oversight. In September 2024, the Office [...]

Ob-Gyn Coding:
Here’s How to Report a Revision of Laceration
Question: I need help determining which would be the appropriate code for this. The procedure [...]

Ob-Gyn Coding:
What to Do for ‘Hydrocele Repair for a Female’
Question: I haven’t had any luck finding a code for hydrocele repair for a female. [...]

Anesthesia Coding:
Rely on These 4 Factors When Calculating Time Units
Keep this formula for reimbursement handy. Anesthesia billing is a process that involves several components, [...]

General Coding:
Know These Billing Categories
Question: What’s the difference between self-pay, insured, and institutional billing? Kansas Subscriber Answer: A patient [...]

Ob-Gyn Coding:
Use These 3 Steps to Correctly Code This Amnio Note
Understand why reporting ultrasound guidance is a mistake. When an amniocentesis claim lands on your [...]

Practice Management:
Use These Tips for Scheduling Billing Statements
Question: Are there legal requirements for when a practice needs to collect money owed by [...]

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