Key Takeaways Psychotherapy for crisis is billed with 90839 for 30 to 74 minutes and 90840 for each additional 30 minutes, and it cannot be combined with most other psychiatric codes on the same day. Medicare pays crisis psychotherapy furnished in non-office, non-facility settings such as a patient’s home through G0017 and G0018, at 150% […]
Psychological and Neuropsychological Testing CPT Codes, Explained
Key Takeaways Testing is billed in two parts: evaluation services (96130-96133), billed by the hour, and test administration and scoring (96136-96139), billed in 30-minute units. Who administers the tests determines the administration code: 96136 and 96137 for a psychologist or physician, 96138 and 96139 for a technician. Code 96146 covers a single automated test and […]
How to Bill Collaborative Care (CoCM) and Behavioral Health Integration Codes
Key Takeaways Medicare pays for behavioral health integration (BHI) through two models: psychiatric collaborative care (CoCM), billed with 99492, 99493, 99494, and G2214, and general BHI, billed with 99484, or with G0323 when a clinical psychologist, clinical social worker, marriage and family therapist, or mental health counselor is the treating practitioner. The standalone BHI codes […]
CPT 87798 vs. 87801: Why Medicare Is Denying Multiple Units
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 […]
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 […]
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 […]
February 2021 Bulletin – CHANGES TO THE 2021 CPT CODE SET
2021 has arrived, which means so have changes to the code set. The American Medical Association reported that overall there are 328 editorial changes, including 206 new codes, 54 deletions, and 69 revisions. The AMA has also stated that these changes include the “first major overhaul of office visit and outpatient E/M coding” since the […]
November Bulletin – UnitedHealthcare’s COVID-19 Response – Update
UnitedHealthcare’s COVID-19 Response – Update Telehealth Throughout the public health emergency (currently set to end on January 20, 2021), UHC is extending the cost share waiver for COVID-19 in-network telehealth services. UHC will also waive cost share for COVID-19 treatment until December 31, 2020. For out-of-network services, the cost share for COVID-19 testing […]