Key Takeaways Medicare Administrative Contractors are denying claims that bill one unit of CPT 87798 for each organism detected by a single multiplex infectious disease panel. The National Correct Coding Initiative (NCCI) Policy Manual, Chapter 10, says a test for multiple infectious agents is reported with one unit when one procedure, one methodology, or one […]
How to Evaluate an Emergency Medicine Billing Company
Key Takeaways An emergency medicine billing company works the professional claim from hospital-sourced data, since federal rules keep insurance questions from delaying emergency screening and stabilization. Its coders need to level ED visits on medical decision making alone, the CPT standard since 2023. Critical care has to be coded by payer, because Medicare and CPT […]
The Coding and Billing Mistakes Behind Denied Behavioral and Mental Health Claims
Key Takeaways CPT 90832, 90834, and 90837 are separated by strict, non-negotiable time thresholds. Defaulting to 90837 without matching documentation is a common audit trigger. Standalone psychotherapy codes cannot be billed alongside an E/M code on the same date of service. Add-on codes 90833, 90836, and 90838 exist specifically for combined therapy and medication management […]
The Coding and Billing Mistakes Behind Denied Allergy and Immunotherapy Claims
Key takeaways Allergy testing and immunotherapy use separate, non-interchangeable CPT code sets. Billing the wrong code combination triggers denials regardless of medical necessity. Immunotherapy dose miscounting is one of the most common sources of underpayment. Medicare does not cover complete-service immunotherapy codes; component billing is required. Modifier 25 has specific, narrow rules for same-day E/M […]
Nephrology Billing Errors: ESRD Monthly Capitation Payment Rules Practices Get Wrong
Key Takeaways The ESRD Monthly Capitation Payment (MCP) is a single monthly code, not a per-visit fee, and code selection depends on the patient’s age and the number of face-to-face visits completed that month. Only one MCP claim is allowed per patient per month, and the billing physician must personally provide at least one of […]
Laboratory Billing Errors: Panel Coding, Modifier 91, and Consolidated Billing Gaps
Key Takeaways Organ and disease panel codes carry NCCI edits that block separate billing of individual components once the panel’s components have all been performed. Modifier 91 applies only to medically necessary repeat testing performed to obtain multiple results on the same day, not to work-arounds for frequency edits. Laboratories testing specimens for patients in […]
Chemotherapy and Infusion Billing: Coding Errors That Cost Oncology Practices
Key Takeaways Chemotherapy administration must be sequenced before therapeutic infusions and hydration on every multi-service claim. Start and stop times are required for time-based infusion codes — missing documentation forfeits add-on code reimbursement. The JW and JZ modifiers are mandatory on Medicare claims for single-dose vial drugs; missing either causes claims to be returned unprocessable. […]
Orthopedic Billing Denials: Why Claims Fail by Procedure Type
Key Takeaways Joint replacement denials are most often documentation failures, not coding errors — prior authorization and conservative treatment records have to be in the chart before the claim goes out. Fracture care claims fail at the ICD-10 level more than any other orthopedic category; episode-of-care suffix errors and missing laterality are consistent, avoidable denial […]
Orthopedic Billing Codes: The Errors Costing Surgical Practices the Most
Key Takeaways Global period exceptions require specific modifiers, and each carries a documentation requirement that, when unmet, turns a legitimate claim into a denial or a compliance flag. The multiple procedure reduction rule applies automatically to multi-procedure surgical cases; correct sequencing and modifier 51 exemptions still have to be managed manually. Modifier 22 is warranted […]
Cardiology Billing: The Coding Errors That Keep Costing Practices Money
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 […]