Key Takeaways Catheterization CPT code selection depends on whether the procedure was diagnostic or interventional and which components were performed — and both have to be right. Errors in this code family are among the most audited patterns in cardiology billing. CPT 93306 requires 2D imaging, M-mode, spectral Doppler, AND color flow Doppler — all […]
Chiropractic Billing Codes: How CPT Selection, Modifiers, and Diagnosis Alignment Drive Denials
Key Takeaways The CPT code for chiropractic manipulative treatment is determined by the number of spinal regions documented as treated — a mismatch between the code and the clinical record is one of the most consistent sources of denials. ICD-10 diagnosis codes must reflect the specific regions being treated; vague or non-specific codes leave claims […]
How to Use a Medical Claim Scrubber: A Step-by-Step Walkthrough
Key Takeaways A medical claim scrubber reviews CPT codes, modifiers, diagnosis codes, and claim structure before submission to flag errors that lead to denials Different specialties produce different types of claim errors — the same pre-submission review process surfaces different issues depending on the claim context AI-powered claim scrubbers identify relationships between coding elements that […]
What Is a Claim Scrubber and Why It Matters More Than Ever
Key Takeaways A claim scrubber reviews coding and claim data before submission to identify errors that lead to denials AI-powered claim scrubber software can detect more complex issues than traditional rules-based tools Effective claim scrubbing improves clean-claim rates and reduces rework across the revenue cycle Early validation supports faster reimbursement and more predictable cash flow […]
Outsourced Medical Billing: The Competitive Advantage Every Healthcare Provider Needs in 2026
Healthcare organizations are under extraordinary pressure as they enter 2026. Declining reimbursements, changing payer rules and tactics, increasing compliance complexity, and workforce shortages are just some of the reasons forcing providers to rethink how they manage every function of their revenue cycle. The message from the market is clear: efficiency and expertise will define success […]
Expert Dermatology Billing Services: Why PGM Is the Trusted Partner for Dermatology Practices
Running a dermatology practice requires more than clinical expertise. Managing coding, billing, and compliance demands precision and time — resources many dermatology practices struggle to spare. That’s where PGM Billing comes in. As a nationwide leader in dermatology billing services, PGM helps practices maximize reimbursements, reduce denials, and achieve stronger financial performance. Key Takeaways PGM […]
Navigating PCR Billing: CMS vs AMA Guidance on Multiplex Testing
Billing for molecular (PCR) testing has become a critical area of focus for clinical laboratories, especially as the Centers for Medicare & Medicaid Services (CMS), Medicare Administrative Contractors (MACs), and the American Medical Association (AMA) offer overlapping — but sometimes conflicting — rules. Understanding the nuances of multiplex PCR billing under CMS/NCCI and AMA guidance […]
Medicare Provides Guidance on Proper Coding of Facet Joint Injections
Over the years, Medicare has provided guidance on how to properly code facet joint injections. This education effort largely began after the Medicare Recovery Audit Program identified facet joint injection claims resulting in overpayments. Medicare has noted that it will consider facet joint blocks to be reasonable and necessary for chronic pain (persistent pain for […]
November Bulletin – Medicare Part B & Tetanus Vaccines
Medicare Part B & Tetanus Vaccines Did you know that Medicare Part B only covers a tetanus vaccine when it’s given as the result of an injury or direct exposure? Medicare Part B does not cover tetanus vaccines when given preventatively. In fact, Medicare Part B doesn’t cover most preventative vaccines, so coding is important […]
November Bulletin – 2023 E/M Coding Updates
2023 E/M Coding Updates On January 1, 2023, several new updates to the Evaluation and Management (E/M) section of the CPT code book will take effect. 25 codes are being deleted, there are revisions to five different coding categories’ introductory guidelines and prolonged services received a complete revision. The codes that are being deleted are […]