Medical Billing Articles

What to Expect from New Pain Management Coding Updates and Guidelines 2022 May 3, 2022

pain management cpt code

The ability to understand medical terminology has always been an essential requirement for medical coders. To better understand the language of the new codes, they should review anatomy and physiology terms.

Troubleshooting is another important recommendation for ICD-10-compatible software and computer formats. This knowledge will assist healthcare providers in resolving any technical problems in time. Thus, healthcare providers must be aware of the potential impact of coding system changes on existing and new insurance programs.

In this article, we’ll find out what to expect from new pain management coding updates and guidelines 2022.

Pain Management Coding Updates 2022

As of 2022, two CPT codes have been deleted and replaced with new ones that provide more detail about procedures.

01935— (Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic)
01936—(Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic) are deleted in CPT®2022.

Moreover, the new codes 01937-01942 identify the type of surgical procedure performed under anesthesia and whether it’s done on the cervical, thoracic or lumbar spines.

New CPT codes for 2022

In the table below, you can refer to the  new CPT code changes for 2022 applicable to anesthesia and pain medicine:

01937Anesthesia for percutaneous image-guided injection, drainage, or aspiration procedures on the spine or spinal cord; cervical or thoracic
01938Anesthesia for percutaneous image-guided injection, drainage, or aspiration procedures on the spine or spinal cord; lumbar or sacral
01939Anesthesia for percutaneous image-guided destruction procedures by a neurolytic agent on the spine or spinal cord; cervical or thoracic
01940Anesthesia for percutaneous image-guided destruction procedures by a neurolytic agent on the spine or spinal cord; lumbar or sacral
01941Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic
01942Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral
64628Thermal destruction of the intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral
64629Thermal destruction of the intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)
933193D echocardiographic imaging and postprocessing during transesophageal echocardiography, or transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echocardiographic imaging)
These codes and other information you need to know for coding/billing in 2022 are copyrighted by American Medical Association.

Likewise, we’ll discuss some other commonly used pain management CPT codes. These include acupuncture, dry needling,  and radiofrequency ablation.


In accordance with NCD 30.3.3, Medicare now covers all types of acupuncture as a treatment for lower back pain. Patients with chronic lower back pain can receive acupuncture treatment for up to 12 sessions within a 90-day period through Medicare.

The purpose of acupuncture is to relieve pain and restore energy flow by inserting tiny needles through the skin. According to the National Center for Complementary and Integrative Health Trusted Source, acupuncture effectively treats back pain, osteoarthritis, and knee pain. Furthermore, it stimulates the body’s natural healing processes and promotes health and happiness.

Acupuncture CPT Codes

97810— Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97811—Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
97813—Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814—Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles

Acupuncture data is reported based on 15-minute increments of personal contact (face-to-face) with the patient, not on the intensity or duration of the acupuncture treatment.

  • When electrical stimulation is not used during a 15-minute increment, report CPT codes 97810 or 97811.
  • Electrical stimulation of any needle during a 15-minute increment are reported by using CPT codes 97813 or 97814.
  • For each 15-minute increment, you should report only one code
  • Use CPT code 97810 or 97813 for the initial 15-minute increment
  • Each day you should only report one initial code

Dry Needling

The following CPT codes are used for dry needling, which is also known as trigger point acupuncture.

20560—(Needle insertion(s) without injection(s); 1 or 2 muscle(s)
20561—(Needle insertion(s) without injection(s); 3 or more muscles)
20551—Origin or insertion of a tendon is injected
20550—Injection of the tendon sheath

The Current Procedural Terminology specifies that CPT codes 20552 or 20553 (trigger point injections) must not be reported with CPT codes 20560 or 20561 for the same muscle group.

Radiofrequency Ablation

The radiofrequency ablation (RFA) procedure involves delivering an electric current to a small nerve tissue area to prevent pain signals from being transmitted through that area. It can relieve chronic pain, specifically in the lower back, neck, and arthritic joints. 

These are the RFA CPT codes 2022:

64625— Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
64999—Unlisted procedure, nervous system
  • If radiofrequency ablation is used with traditional or cooled radiofrequency (80 degrees Celsius), report it with CPT code 64625.
  • Report pulsed radiofrequency ablation by using CPT code 64999.

CPT Code Changes for Important Diagnoses

  • C56.3 Malignant neoplasm of bilateral ovaries (previously only left, right, unspecified existed)
  • C79.63 Secondary malignant neoplasm of bilateral ovaries (previously only left, right, unspecified existed)
  • G44.86 Cervicogenic headache
  • K22.81 Esophageal polyp
  • K22.82 Esophagogastric junction polyp
  • K22.89 Other specified diseases of esophagus (previously codes as K22.8, 5th character added)
  • K31.A—Gastric intestinal metaplasia (code to appropriate 6th character)
  • L24.A- Irritant contact dermatitis due to friction or contact with body fluids (code to appropriate 5th character)
  • L24.B- Irritant contact dermatitis related to stoma or fistula (code to appropriate 5th character)
  • M54.A- Non-radiographic axial spondyloarthritis (code to appropriate 5th character)
  • M54.50 Low back pain, unspecified
  • M54.51 Vertebrogenic low back pain
  • M54.59 Other low back pain

Any ambulatory surgical centers performing pain management procedures need to be aware of these low back pain diagnosis changes. In order to avoid an unspecified diagnosis, surgeons must understand how the revisions affect their documentation. They must be as specific as possible about the type of low back pain treated.

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Medical coders might face some new challenges in light of the new pain management billing codes and guidelines. As a result, healthcare providers should evaluate how medical coding changes will affect their programs and take steps to ensure a smooth transition.

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!

Podiatry CPT Coding Updates for 2022 April 27, 2022

podiatry cpt coding

Every year, the American Medical Association releases a new Current Procedural Terminology set that takes effect on January 1.

Most of this year’s changes come from new guidance language rather than code additions, deletions, or edits for podiatry practices. Let’s first define podiatry care in detail before moving on to the CPT updates.

The Role of Podiatry in Healthcare

The field of podiatry deals with the diagnosis and treatment of diseases, injuries, and deformities of the foot. It involves the diagnosis, medical, and surgical treatment of the foot, ankle, and lower extremity problems. In addition to medical and surgical treatments, mechanical and physical therapies are also available. Like other disciplines, podiatry requires regular collections to survive.

On the other hand, coding is complex in podiatry due to multiple procedures performed on the same structure or organ, requiring various codes.

The Current Procedural Terminology adds the following clarification for 2022: “All services that appear in the Musculoskeletal System section include the application and removal of the first cast, splint, or traction device when performed. Supplies may be reported separately.” 

Several third-party payers, such as Medicare, have long followed this guidance, which applies everywhere CPT codes are used, regardless of the payer.

This guidance does not change based on where you receive your services. If the triple arthrodesis is performed in the operating room, the CPT code representing the cast application should not be submitted.

Similarly, suppose any fracture care code is submitted in an office setting, such as closed fracture treatment without manipulation. In that case, the CPT code corresponding to the cast application should not be submitted.

Podiatrists managing fractures often have to decide whether to perform closed treatment with manipulation or closed treatment without manipulation CPT codes.

The new language in the 2022 CPT code set clarifies what “manipulation” actually means when used in code descriptors in CPT. Manipulation is defined as: “reduction by the application of manually applied forces or traction to achieve satisfactory alignment of the fracture or dislocation.” Usually, this is referred to as closed reduction.

The CPT clarified the following codes for external fixation this year:

“Codes for external fixation are reported separately only when external fixation is not listed in the code descriptor as inherent to the procedure.”

Therefore, providers can only submit external fixation CPT codes. CPT does not include the application of external fixation in its code descriptor for the primary procedure.

Below is the CPT code corresponding to a first metatarsophalangeal joint arthrodesis:

CPT 28750Arthrodesis, great toe; metatarsophalangeal joint

Code descriptor doesn’t include external fixation in the list. Hence, the CPT code for the first metatarsophalangeal joint arthrodesis and the CPT code for the external fixation can both be submitted if external fixation is used. 

In the case of an open reduction and internal fixation (ORIF) of a metatarsal fracture that is fixed with external fixation, the CPT code for the external fixation would be:  

CPT 28485Open treatment of metatarsal fracture, with or without internal or external fixation, each

This is listed in the code descriptor. Thus, if external fixation is used with this procedure, only the ORIF CPT code can be submitted; the external fixation CPT code cannot be submitted as well.  

Foreign Body vs Implant 

If a joint prosthesis becomes loose or isn’t functioning, is it considered a foreign body removal? The CPT clearly answers this question that has been asked for a while now. 

According to the new language on page 525 of the CPT book for 2022, it states that:  

 “An object intentionally placed by a physician or other qualified health care professional for any purpose (eg, diagnostic or therapeutic) is considered an implant.”

“An object that is unintentionally placed (eg, trauma or ingestion) is considered a foreign body.”

“If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes, unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.”

Wound Repair

This year, a new language adds that only one CPT code is required to represent the closure of one wound when multiple products and/or multiple techniques are used to close it. 

Further information on wound repair is provided in the 2022 CPT book, on page 106, where it is stated that wounds treated with chemical cauterization, electrocauterization, or adhesive strips cannot be coded with wound repair CPT codes.

Clarification of simple wound repair is on the list this year:

“Simple repair is used when the wound is superficial (eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one-layer closure.”

Moreover, anesthesia and hemostasis should not be reported separately when combined to treat simple wounds.

Key Takeaway

These are just a few changes relevant to podiatrist practices in 2022’s CPT codes. The podiatry providers who submit CPT codes should know the entire CPT code set or use experts who are familiar with it. From January 1, 2022, they should utilize the most current CPT code set.  

The CPT is a trademark of and copyright (2021) of the American Medical Association, with all rights reserved. 

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What Is Quality Payment Program (QPP)? March 25, 2022

QPP meaning

What is the Quality Payment Program (QPP)?

A vital element of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was the elimination of the Sustainable Growth Rate (PDF) (SGR) formula, which would have led to lower physician payments.

MACRA wants to speed up the transition to a health care system that rewards quality and value rather than volume and improves patients’ health outcomes. Under the new QPP, Medicare reimbursement will undergo the most significant change in decades.

Clinicians have two options for participating in the Quality Payment Program:

  1. The Merit-based Incentive Payment System (MIPS): A performance-based adjustment will be made if you qualify MIPS requirements.
  2. Advanced Alternative Payment Models (APMs): Medicare may reward you for participating in innovative payment models if you take part in an Advanced APM.

Overall, QPP provides an opportunity to drive true health system reform that results in patient- and family-centered care. Thus, this will ensure success in the long run. The Centers for Medicare & Medicaid Services (CMS) expect the Quality Payment Program to evolve. The rule will allow a 60-day comment period to solicit more input from clinicians, patients, and others.

With the new Quality Payment Program website, clinicians can identify the measures and activities most relevant to their specialty or practice. Clinicians and practice managers can use this tool to find the program that best fits their needs.

In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, repealing the Sustainable Growth Rate (SGR) payment system which governed how physicians and other clinicians were paid under Medicare Part B. MACRA replaced the SGR, and its fee-for-service reimbursement model, with a new two-track value-based reimbursement system, called the Quality Payment Program (QPP). This program is the latest in a series of steps the Centers for Medicare and Medicaid Services (CMS) has taken to incentivize high quality of care over service volume.

With the Quality Payment Program, Medicare providers will be paid according to their quality and value.

The MACRA reinstated the Sustainable Growth Rate (SGR) for Medicare payments, thus providing providers with annual payments with a sense of stability. From 2019, payment to health care providers will be tied to either the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). These two tracks make up the Quality Payment Program (QPP).

In 2017, providers will begin reporting QPP performance data, and payment adjustments will start in 2019. Taking time between reporting performance data and making payment adjustments allows adequate time for submission and feedback. As part of the first reporting year, providers will be able to decide how much data to report.

Moreover, the implementing rule for QPP explains how Medicare providers will be reimbursed under both payment systems. While the Centers for Medicare & Medicaid Services (CMS) works with different stakeholders to implement and develop new rules, the requirements for providers are likely to change.

What is a Merit-Based Incentive Payment System?

A key aspect of MIPS is that it builds on the conventional fee-for-service Medicare model while rewarding providers for delivering quality care and improving health outcomes. Even though most Medicare providers will be in MIPS when the program starts, the law intends for them to switch to APMs. So, it opens the way for the healthcare industry to transition from fee-for-service to value-based care.

MIPS evaluates providers in four performance categories: 

  1. Quality. The Quality category will comprise existing Medicare quality reporting programs (including the Physician Quality Reporting System). For 90 days, most providers will report on six quality measures, including one outcome measure, from more than 200 measures. The traditional rulemaking process will define and develop additional evidence-based measures for MIPS, emphasizing outcomes-based measures over time. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS allows providers to get bonus points for reporting on patient experience measures.
  1. Cost. CMS will incorporate the existing Medicare Value-Based Payment Modifier into its cost category. In this way, the modifier provides differential payment based on the quality of care provided compared to the cost. The cost measures are derived from claims data; CMS does not require providers to supply additional data for scoring purposes. This year, the Cost category will weigh 0%, so it will not count towards the MIPS Final Score. CMS says this category’s weight will increase in future MIPS performance periods.
  1. Advancing Care Information (ACI) is the replacement of the Medicare EHR Incentive Program (Meaningful Use). Clinicians’ use of EHR technology will be judged under this category, focusing on interoperability and information sharing. ACI will make up 25% of an eligible clinician or group’s final MIPS score in 2017.
  1. The new performance category is Improvement Activities. The program offers a broader set of activities and rewards to clinicians that focus on beneficiary engagement, care coordination, and patient safety. For MIPS, most providers must complete at least two to four activities for at least 90 consecutive days, depending on their weighting. Furthermore, providers who participate in a patient-centred medical home (PCMH) qualify for the highest score for clinical improvement activities. However, providers enrolled in APMs (that are not PCMHs) will receive half the points toward full credit in this category. There may be some providers eligible for full credit in APMs.

What is an Advanced Alternative Payment Models (APM)?

By taking new payment models one step further, Advanced APMs are payment models in which the organizations share the savings gained from offering high-quality care at low costs while often assuming the downside risk if the care is actually more expensive than the plan.

In an Advanced APM, providers receive an automatic five percent bonus a year. The APM may also give them bonuses or penalties, such as shared savings or losses within an Accountable Care Organization (ACO). 

Among the advanced APMs are:

  • Medicare Shared Savings Program (tracks 2 and 3)
  • Oncology Care Model (OCM)
  • Primary Care First (an evolution of CPC+)

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How to Code for Obesity and Medical Nutrition Therapy March 25, 2022

CPT code for Nutrition and Obesity

The National Institutes of Health (NIH) declares that obesity is a significant public health concern in the United States. Obese individuals are at higher risk of developing heart disease, strokes, and cancer. Furthermore, the number of obese people worldwide has increased from 26 million in 1975 to 422 million. 

Not everyone knows that genetics, environmental, and metabolic factors can contribute to obesity.

We will outline the proper way to code for obesity and medical nutrition therapy (MNT) for healthcare providers.

Coding Medical Nutritional Therapy

The obesity treatment can range from therapy to surgery. It is evident that surgery should be a last resort and only be considered for severely obese individuals. Meanwhile, the following list below contains medical nutrition therapy code(s) that dietitians use. Private insurance carriers, besides public insurers, such as Medicare and Medicaid, can also use these MNT CPT codes.

Passing the midpoint constitutes a unit of time. The billing process for codes 97802 and 97803 would take eight minutes. You can bill a maximum of eight units per code for the same patient on the same day. If a healthcare provider spends 22 minutes with a patient, they can only bill 97802 or 97803 once since they’ve not reached the midpoint of the next 15 minutes.

Code 97804 follows the same rules as MNT CPT codes 97802 and 97803. However, the code 97804 is for 30 minutes each. To bill the first unit of 97804, you must spend at least 16 minutes with the patient. For the second unit, you must spend 46 minutes, and so on. Consider consulting an expert in coding if you find this issue troubling.

You should refrain from making only one common mistake: reporting these sessions as incident-to. That’s why it is not a good idea to report 97802-97804 incident-to-a doctors since they are nutritionist-specific codes. Make sure to use the nutritionist’s national provider identifier. 

The modifier AE Registered dietician can be added to the MNT code. For clarification, this modifier denotes the services of a nutritionist or registered dietitian. Several insurers, including Medicare, may have a policy regarding the frequency of MNTs and how many visits a patient can have. If applicable, check the payer’s policy and require the patient to sign an advance beneficiary notice (ABN).

The dietitian (or qualified nutritionist) reviews the patient’s diagnosis and treatment plan in their changing medical condition. In addition, their job is to perform a nutrition screening and discuss the patient’s specific dietary needs. Including telehealth services, the provider spends 15 minutes with each patient discussing long-term healthy eating. For this reassessment and any subsequent interventions, report this code every 15 minutes. The first year of medical nutrition therapy consists of only three one-on-one sessions.

The rules apply in the same way with the MNT CPT code G0270. However, in a dietitian-led therapy session, there must be at least two people (e.g., a group).

The CPT Codes for Weight Loss and Obesity Screening 

CPT 99401

Description: Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 15 minutes.

CPT 99402

Description: Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes.

CPT G0446

Description: Annual, face-to-face intensive behavioral counseling (IBT) for cardiovascular disease (CVD), individual, 15 minutes.

CPT G0447

Description: Face-to-face behavioral counseling for obesity, 15 minutes.

CPT G0473

Description: Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes.

Codes for Body Mass Index (BMI) Z68.XX

Obesity codes:

Clinicians usually obtain a patient’s BMI while they take their vital signs. The provider needs to code the patient’s BMI with the appropriate obesity code in such cases.

On the other hand, ICD-9 CM 278.00 is a billable medical code that indicates a diagnosis on a reimbursement claim, but it should only be used on claims with a service date before September 30, 2015.


Since it’s easy to get unhealthy foods and there are fewer healthy options available in many places, obesity is likely to remain a nationwide issue. While making the right choices for ourselves, we can also counsel our patients on doing the same.

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Tips for Successful Neurology Billing and Coding February 16, 2022

Neurology Billing and Coding

Neurology practices face challenges because of inaccurate billing and coding. Documentation requirements are specific and complex, which burdens clinicians significantly. That’s why neurology medical billing and coding must be accurate to ensure proper claim settlement and payment.

Don’t worry about it! Here, this article will help you with tips for successful neurology billing and coding.

An Overview for Neurology Medical Billing & Coding Services

Neurology deals with disorders, diagnoses, and treatments of the nervous system. It covers both central and peripheral nervous system diseases.

Neurologists and neurosurgeons treat nervous system diseases either with surgery or non-surgery. In covering more than one aspect of neurology, they demonstrate an incredible level of expertise and attention to detail. Neuromuscular, sleep, stroke, and epilepsy are a few areas that neurologists can handle.

Coding and billing in neurology require a great deal of detail. In a sense, it’s like an extension of Evaluation & Management.

On the other hand, over a hundred codes are available for coding neurology and neuromuscular tests. That’s why coders have a tough time applying the correct code.

Furthermore, billing & coding experts in neurology should be familiar with the codes and rules specific to the field. This is because neurologists see patients in various settings like hospitals, clinics, and offices. Only a company with experts in neurology billing can handle such complexity.

For neurologists, broad and deep expertise are the keys to successful billing. These include collecting all of the money owed to the neurosurgeon, responding to queries from payers, and appealing denied claims.

Check Out These Useful Tips for Successful Neurology Billing and Coding

Courtesy Makes Communication Effective

Medical billers and coders don’t work behind closed doors. These professionals are likely to interact with patients, insurers, third-party vendors, and other stakeholders in the healthcare system. Even so, some of them may find discussions to be challenging.

For example, frustration could arise if the claim isn’t processed or is in process. Therefore, billing and coding teams must always remain courteous with all people they work with, as they act as a ‘bridge’ between insurance companies, physicians, and patients.

Regular Training of Staff Is Important

Your staff needs to be trained in the latest practices for claims settlements to be faster. Be sure it’s being done according to plan so that they are ready to service the needs of patients. If possible, training should be uninterrupted. By training the staff in the fee-for-value model, they will understand how to increase patient satisfaction in the practice.

Verify Patient Benefits

Neurology practices should verify all patient copayments, coinsurance responsibilities, and deductibles before treatment. The registration process should also confirm any necessary approvals and procedures.

Likewise, neurologists must maintain accurate records and medical histories so that timely counseling can occur and reimbursements can be timely processed. It is also essential to follow up on patient prescribed tests and monitor outstanding accounts.

Pay Attention to Details

In neurology medical billing, coders use thousands of different medical codes for various procedures. While it is unrealistic to expect a person (or medical coder) to know every medical code, they should be familiar with where the most common ones are located. Remember that careless errors may delay payment processing and, eventually, cause the payment to be delayed or denied.

Comply With HIPAA

The healthcare professionals also constantly work with the billing department and the patient’s health information. In fact, the (Health Insurance Portability and Accountability Act) HIPAA obligates these professionals to protect patients’ privacy in these cases. For medical billing companies to succeed, they must possess sound judgment and operate with the highest levels of reliability.

Implementation of the ICD-10 Coding System

ICD-10-CM provides greater clinical detail, better specificity, and relevance for managed care and ambulatory encounters. To prevent delays in settling claims, ensure that your coders, billers, and practice staff are up-to-date with the latest codes (including ICD-10) and CPT codes. It will also ensure error-free billing and accuracy in records for future inspections.

Partner With a Reliable Medical Billing Company

By partnering with a reliable billing company, you can eliminate billing errors. Their staff consists of billing experts, who are under their command. They also utilize automation and work with all major health insurance carriers. With them, you can focus more on your patients and reduce the administrative burden.

Coding Levels Should Be Precise

For each patient, it is crucial to use the correct coding level to prevent cloning claims. The coding level should correspond to the level of illness. Otherwise, an audit can result if billing is done for all patients at the same level.

Key Takeaway

In the United States, many neurologists opt to outsource their neurology billing and employment services to overcome payment-related challenges. Our goal at 5 Star Billing Services is to increase revenues, decrease denials, and improve and automate your entire revenue cycle.

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Here’s your chance! At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

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Coding and Billing for Oncology: An Essential Guide February 14, 2022

Coding and Billing for Oncology

Coding is the backbone of medical practices. Oncology facilities are no different, as well. If you need help on coding and billing for your oncology practice, check out this essential guide.

An Overview of Oncology

The field of oncology focuses on diagnosing, treating, and researching cancer. Oncologists are doctors who work in this field. However, some oncologists specialize in only a few types of cancer or treatments. Oncology therapy has three main components: medical, surgical, and radiation. Depending on the type, stage, and location of cancer, a patient may receive treatment from multiple oncology specialists. 

Medical oncologists also develop treatment plans for cancer patients. The oncologist may recommend surgery, chemotherapy, targeted therapy, or hormone therapy while coordinating with other oncologists who play a role in the patient’s treatment. 

Meanwhile, a surgical oncologist uses biopsies and other cancer-related procedures to remove tumors and the surrounding tissues.

Radiation oncologists also specialize in treating cancer with radiation therapy. Doctors can perform a procedure that shrinks or destroys cancer cells if a patient has cancer. They can also alleviate cancer-related symptoms. 

Oncology subspecialists treat many types of cancer. For example, oncologists trained in gynecology treat cancers of the female reproductive system. Neuro-oncologists treat cancer of the brain, spine, and peripheral nerves.

What Makes Coding and Billing for Oncology Practices So Critical?

Correct coding practices are crucial to oncology coding and revenue payments. If there are coding errors, you are sure to lose revenue. Avoid it at all costs.

Moreover, billing and coding errors are a risk for healthcare professionals because oncology drugs are expensive. A lack of accurate and proper oncology coding will significantly impact revenue cycle management.

Every treatment course should be billed from the start and again as needed.

Current Procedural Terminology (CPT) Codes Used in Coding Oncology:

  • CPT code 77332:

CPT code 77332 corresponds to simple treatment devices, designs, and construction that include simple port blocks with one or two premade blocks that can be hand-positioned; simple prefabricated bolus that can be shaped for an individual patient; or independent jaw motion or asymmetrical collimation.   

  • CPT code 77333:

Use CPT code 77333 if you need an intermediate treatment device that includes multiple port blocks, like corner pelvis blocks, beam splitter blocks, midline spinal cord blocks, stents, bite blocks, or a special multi-use bolus.

  • CPT code 77334:

The above CPT code is used for complex treatments, designs, and constructions. It includes customized, one-use bolus, for example, wax molds conforming to particular body parts, along with customized blocks of low alloy, customized compensators, wedges, molds, and casts, including customized immobilization devices and eye shields.

  • CPT code 77336:

The above code is used for continuous medical radiation physics consultation. These include the assessment of treatment parameters, assurance of quality in delivering perfect dosage, and review of patient documentation. A radiation oncologist reports for a week of treatment, including once every five treatments.

  • CPT code 77370:

During radiation therapy, use CPT code 77370 when a problem or a special situation arises. For this code, the requesting physician must provide a detailed description of the problem.

  • CPT code 77387:

Guidance for localization of target volume for radiation treatments, including intrafraction tracking, should use CPT code 77387. Only OPPS uses this code.

Important Note: These codes identify only the technical component of radiation treatment sessions and not any physician involvement.

Only treatment management codes are included in the professional component. In addition, insurance companies agree to pay for these terms and conditions for delivering radiation treatment under CPT codes 77401-77416.

  • CPT code 77401:

The above code is used for superficial/orthovoltage treatment delivery for a day. You cannot submit codes for clinical treatment planning – 77261, 77262, and 77263, for treatment devices with codes – 77332, 77333, and 77334, for isodose – 77306 and 77307, for physics consultation – 77336, and treatment management – 77427, 77431, and 77470 with 77401.

  • CPT code 77407

In the above code, any of the following criteria are met, but not all complex criteria. The criteria include two treatment areas, three or more ports, and three or more single blocks. Please note that OPPS is the only program that uses this code.

  • CPT code 77412:

When there is a need for complex treatment delivery, use the CPT code 77412. There are three or more separate treatment areas, custom blocking, tangential blocks, sedges, rotating beams, or tissue compensation that do not meet guidelines. OPPS uses this code exclusively.

  • CPT code 77295:

A three-dimensional radiotherapy plan that includes a dose value histogram is reported with this code, including procedures performed in coplanar therapy beams. Due to this, the below codes can’t be billed separately on the same date. The codes are 77280, 77285, and 77290.

  • CPT code 77300:

Based on the course of treatment, code 77300 is for radiation dosimetry, calculation, central axis depth, TDF, NSD, gap calculation, off-axis factor, tissue homogeneity factors, according to the order of treatment when prescribed by a health care provider.

Dosimetry recalculation may result from any changes in weight or birth at the time of radiation treatment. Moreover, daily performing this procedure every time a patient receives treatment is unnecessary.

Guidelines for Providing Proper Documentation:

  • Never attach any patient or treatment details to the original claim.
  • Ensure all services are billed with detailed information, itemization, and supporting documentation.
  • Provide clean treatment histories.
  • Document a medical professional’s involvement.

Overall, the CPT codes here are from the Centers for Medicare & Medicaid Services (CMS). We hope you found this Oncology billing and coding information helpful.

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What CPT Codes Mean for Medical Billing January 31, 2022

CPT codes

The Current Procedural Terminology (CPT) codes play a vital role in the medical billing process. The CPT functions as descriptions of the services provided. New CPT codes are added for everything a certified health care provider can do each year.

So, we will discuss what CPT codes mean for medical billing here.

Understanding CPT Codes in Medical Coding and Billing

Current Procedural Terminology (CPT) is a standard code set for reporting medical, surgical, and diagnostic procedures to healthcare providers, insurers, and organizations. In addition to this, CPT codes function in a multitude of ways in the medical field, such as

  • Setting guidelines for clinical care reviews and processing claims.
  • Documenting medical services and treatments provided to patients.
  • Providing an insurance company with the procedures the doctor wants reimbursement for.
  • Incorporating ICD codes into the medical processes provides payers with a complete picture of the operations.
  • Identifying the tasks and services that health care providers offer.
  • Tracking and billing of medical services.
  • A worldwide coding system for medical treatments.

The American Medical Association (AMA) streamlines the CPT manual every year. It also contains extensive requirements for service and procedure coding. Thus, providers are responsible for accurate reporting and documentation of the services.

A Brief Overview of CPT’s History

The American Medical Association manages CPT. In 1966, the AMA published the first edition of its manual of surgical procedures. At the time, terminology and reporting were standardized. 

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 set guidelines for transmitting and storing electronic health records. Also, these codes are required for coding medical terms and billing insurance companies. They provide information about the purpose of the CPT code treatment.

The Three Categories of CPT Codes

Depending on the category, CPT codes can be numeric or alphanumeric. Using CPT code descriptors, diverse users can understand clinical health care and use common standards.

Category 1: Medical procedures and practices

The first category covers widely performed procedures and medical practices. When coders talk about CPT, the Category 1 codes refer to FDA-approved services and procedures performed by healthcare providers nationwide. They are five-digit numeric codes that are proven and documented.

Six sections make up Category 1 codes, like:

  • Evaluation and Management: 99201 – 99499
  • Anesthesia: 00100 – 01999; 99100 – 99140
  • Surgery: 10021 – 69990
  • Radiology: 70010 – 79999 
  • Pathology and Laboratory: 80047 – 89398
  • Medicine: 90281 – 99199; 99500 – 99607

Category 2: Services for Clinical Laboratories

Category 2 CPT codes provide supplementary tracking codes used for performance measurement. Moreover, these codes describe the quality of care your patients receive. However, medical codes are optional and do not replace Category 1 codes.

Category III: Innovative Technologies, Services, and Procedures

Category III codes are temporary Alphanumeric codes for developing technologies, procedures, and services. These codes were created to collect, assess, and in some cases, pay for new services and processes that don’t meet the criteria for Category I codes.

What Are the Uses of Cpt Codes?

Patient costs are directly related to CPT codes. Due to this, offices, hospitals, and other medical facilities are extremely strict about coding. These facilities usually hire professionals to code services correctly.

The initial stage of coding

In most cases, the coding process will begin with your healthcare provider. They will list the CPT codes on paper forms for your visit. Likewise, you will receive a note in your Electronic Health Record (EHR) if they use one during your stay. Staff can often search for codes by service name.  

Validation and Submission

Billers and medical coders look at your records after you leave the office. Indeed, these professionals ensure the correct codes for your records.

After all, your billing department sends a list of services to your insurance company. Medical providers often store and transmit this information electronically.

Processing of Claims

Your insurer or payer processes the claim using the codes. In this case, they decide how much to pay your healthcare provider and owe anything.

Research Purposes

In fact, data coding helps insurance companies and government officials predict future patient healthcare costs. Analyzing data coding by state and federal governments can provide insight into medical trends. It also assists with planning and budgeting for Medicare and Medicaid.

These are the CPT codes commonly used in medical billing and coding processes:

  • New Patient Office Visit Codes: 99201-05. These codes apply to patients who have not seen physicians within the same group in the past three years.
  • Established Patient Office Visit Codes: 99211-15. Patients are seen by a physician in the same specialty within the same group in the past three years;
  • Initial Hospital Care Codes: 99221-23
  • Subsequent Hospital Care Codes: 99231-23
  • Emergency Department Visit Codes: 99281-85
  • Office consultation codes: 99241-45. Often used to obtain a physician’s opinion on behalf of another physician.

Furthermore, the AMA has a complete list of medical billing codes here.


Medical providers submit claims for payment using CPT codes, which the AMA maintains. Therefore, following CPT process recommendations benefits physicians (and their patients).

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A Comprehensive Friendly Guide on No Surprises Act January 31, 2022

No Surprises Act

How well do you know the No Surprises Act? What are the implications of the Act for healthcare providers? If these questions are on your mind, we can provide a comprehensive and friendly guide on the No Surprises Act (NSA). 

What Is the “No Surprises Act”?

The No Surprises Act (NSA) took effect on January 1, 2022. It was signed into law as part of the Consolidated Appropriations Act 

COVID-19, on December 27, 2020. Moreover, the Act prevents healthcare consumers from being surprised by medical bills and shields them from insurance disputes. The Center for Medicare and Medicaid Services (CMS) has created a site for future updates on No Surprises Act implementation documents.

What Is a Surprise Medical Bill?

A “surprise medical bill” refers to unexpected higher charges after receiving care from an out-of-network provider. The out-of-network provider or facility may also bill you for the difference between the billed charge and what your health plan pays unless prohibited by state law. Balance billing also describes this situation. Surprise medical bills can also refer to unanticipated balance bills from out-of-network providers.

Furthermore, these protections are already available to those with Medicare or Medicaid.

Understand the “No Surprises Act” in Terms of Its Applicability

The No Surprises Act applies to all states without a law that prohibits balance billing. Whenever there is an existing law, it will take precedence over the Act. State or federal laws may apply to providers with a multi-state practice regarding insurance reimbursement. Billing companies and providers can benefit from this knowledge in dealing with reimbursements and perceived underpayments.

Surprise bills from healthcare providers must not exceed more than the in-network costs.

Providers cannot charge the patient more than the in-network cost-sharing amount covered by NSA, or a penalty of up to $10,000 may apply.

Nowadays, out-of-network doctors and hospitals are billing their patients directly for their total, undiscounted fees. Thus, the patient needs to submit a claim out-of-network to their insurance company and collect any reimbursement. The process starts this year. First, providers must verify the patient’s insurance status before submitting the surprise out-of-network bill. Providers are also “encouraged” to include information about NSA protections on the claim itself (e.g., whether the patient has waived his balance billing privileges).

On the other hand, the health plan must notify the provider of the applicable in-network cost-sharing amount within 30 days. Cost-sharing generally depends on the plan’s in-network rate and its pay for the service. Consumers will receive a notice that the health plan has processed the claim, along with the amount of in-network cost-sharing they owe to the out-of-network provider. Until then, the out-of-network provider may bill the patient no more than the in-network cost-sharing amount.

How the Act Impacts Physicians

The No Surprise Act prevents providers from surprisingly billing customers. Out-of-network providers must charge the in-network fee from their patient’s health plan.

If physicians are part of a smaller practice and do not have the resources to use the IDR process to ensure fair compensation, the No Surprise Bill law might pose financial difficulties. Physicians may face more financial stress, including the COVID-19 pandemic. 

No Surprises Act: Does It Apply to Clinics?

Some of its rules do. However, many sources claim clinics are exempt from these rules. 

First, it is helpful to think of the Act as having three prongs. The first prong deals with emergency services.

Secondly, it deals with patients undergoing treatment at a hospital or ASC.

The last prong considers estimates for patients who are not using insurance to cover their care. This is either because they are uninsured or refuse to use their insurance.

The third prong refers to clinics; you must provide estimates to patients without insurance. If physicians offer services in a hospital or an ASC, the first two prongs will apply. 

What Is the Good Faith Estimate (GFE)?

From January 1, 2022, patients without insurance can get a good faith estimate (GFE) for any service scheduled within three business days in advance. All practices and facilities must comply with this rule. In addition, GFEs must include details such as diagnosis and procedure codes, as well as your NPI.

The three-day notice applies to every scheduled service, including office visits. If you plan the event between three and nine days ahead, you are required to submit the estimate within one business day after you schedule it. You get three business days to provide the estimate if the event is more than ten days away.

What’s Not Covered by the No Surprises Act?

There is no prohibition against surprise out-of-network billing under the No Surprises Act. However, there are two critical exceptions:

  • Ambulances: The Act covers air ambulances but not regular ground ambulances.
  • Facilities: Hospitals, emergency rooms, and outpatient surgery centers are covered by the Act. There are also plans to include clinics and urgent care centers in the future.

Medicare, Medicaid, TRICARE, Veterans Affairs Health Care, and Indian Health Services are not covered under these provisions since they are already protected against surprise medical bills.

Are There Other Resources Available? 

HHS has released an FAQ on its website: https://www.cms.gov/CCIIO/Resources/Regulationsand-Guidance/Downloads/Guidance-Good-Faith-Estimates-FAQ.pdf  

No Surprises Act Summary

Some of the notable provisions of the Act include:

  • It goes into effect on January 1, 2022, and abolishes balance billing, except in particular circumstances.
  • Balance billing laws apply to Employee Retirement Income Security Act (ERISA) plans and state-regulated plans in states without balance billing laws already in place.
  • Patient deductibles for out-of-network emergency care are the same as for in-network care, and deductibles must be printed on insurance cards.
  • Pay the provider directly or respond with a complete denial within 30 calendar days of receiving the claim.
  • Establishes an Income-driven Repayment (IDR) process for dealing with out-of-network payment disputes.

Throughout 2021, insurers will have to report to state-level all-payer claims databases. Also, rules for qualifying payments (defined as the median of contracted rates as of January 31, 2019, adjusted for inflation from 2019-2021) and the IDR process. 

Because many key provisions of the new law are still unclear, how should a practice prepare for such changes? 

  1. Be familiar with the law in the state(s) in which the practice is located.
  2. Establish a method that identifies current out-of-network payment trends. Next, compare them with payments received after January 1, 2022. 
  3. Prepare to file underpaid claims in the IDR process.

Tap Into Our Expertise

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

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Prepare Your Practice for the New ICD-10 2022 Guidelines January 7, 2022

ICD 10 2022

As fall approaches, not only do the leaves change but healthcare practices should also be prepared for ICD-10 changes, which take effect every October 1. The Big Question: Is Your Practice Already Prepared for the New ICD-10 2022 Guidelines? Worry no more! With this article, you can adhere to the New ICD-10 Coding Guidelines FY 2022.

So, what are ICD-10 Guidelines? 

In every healthcare setting, ICD-10-CM guidelines are used to classify diagnoses, morbidities, and reasons for patient visits. Healthcare providers and coders must use these guidelines and reporting requirements as companion documents to the official version of the ICD-10-CM.  ICD-10-CM and the ICD-10 code set under the new guidelines, including new, revised, and retired codes, are updated.  Also, the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) implement the newly updated International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), and the ICD-10 code set. A total of 72,748 codes are available this year including 159 new codes, 32 deleted codes, and 20 revised codes. 

New Codes for COVID-19 Infection

New codes are available for FY 2022 to report conditions secondary to COVID-19 infection (sequelae):

  • J12.82: Pneumonia due to Coronavirus disease 2019 (MCC)
  • M35.81: Multisystem inflammatory syndrome (CC)
  • M35.89: Other specified system involvement of connective tissue (CC)
  • Z11.52: Encounter for screening for COVID-19
  • Z20.822: Contact with and (suspected) exposure to COVID-19
  • Z86.16: Personal history of COVID-19

Below is the latest code in a series of six codes added on January 1, 2021:

  • U09.9: Post COVID-19 condition, unspecified

New codes for conditions affecting the nervous system

The ICD-10 now includes 10 new codes in this category, with many of them classified as MCC or CC codes (please see above). Some of these new codes include:

  • G04.82: Acute flaccid myelitis (MCC)
  • G44.86: Cervicogenic headache
  • G92.00: Immune effector cell-associated neurotoxicity syndrome, grade unspecified
  • G92.01: Immune effector cell-associated neurotoxicity syndrome, grade 1
  • G92.02: Immune effector cell-associated neurotoxicity syndrome, grade 2
  • G92.03: Immune effector cell-associated neurotoxicity syndrome, grade 3 (CC)
  • G92.04: Immune effector cell-associated neurotoxicity syndrome, grade 4 (CC)
  • G92.05: Immune effector cell-associated neurotoxicity syndrome, grade 5 (CC)
  • G92.8: Other toxic encephalopathy (MCC)
  • G92.9: Unspecified toxic encephalopathy (MCC)


ICD-10 2022: New and Deleted Codes

ICD-10-CM coding guideline changes for 2022 include a number of corrections to spelling errors, as well as significant changes to diseases and conditions. Code additions and deletions are also major areas of change. The table below is a high-level breakdown of additions and deletions to the ICD-10-CM coding guidelines for 2022.

ChapterAction2022 Codes2022 Code Descriptions
1New CodeA79.82Anaplasmosis [A. phagocytophilum]
2New CodeC56.3Malignant neoplasm of bilateral ovaries
2New CodeC79.63Secondary malignant neoplasm of bilateral ovaries
2New CodeC84.7AAnaplastic large cell lymphoma, ALK-negative, breast
3New CodeD55.21Anemia due to pyruvate kinase deficiency
3New CodeD55.29Anemia due to other disorders of glycolytic enzymes
3New CodeD75.83Thrombocytosis
3New CodeD75.838Other thrombocytosis
3New CodeD75.839Thrombocytosis, unspecified
3New CodeD89.44Hereditary alpha tryptasemia
4New CodeE75.244Niemann-Pick disease type A/B
5New CodeF32.ADepression, unspecified
5New CodeF78.AOther genetic related intellectual disabilities
5New CodeF78.A1SYNGAP1-related intellectual disability
5New CodeF78.A9Other genetic related intellectual disability
6New CodeG04.82Acute flaccid myelitis
6New CodeG44.86Cervicogenic headache
6New CodeG92.0Immune effector cell-associated neurotoxicity syndrome
6New CodeG92.00Immune effector cell-associated neurotoxicity syndrome, grade unspecified
6New CodeG92.01Immune effector cell-associated neurotoxicity syndrome, grade 1
6New CodeG92.02Immune effector cell-associated neurotoxicity syndrome, grade 2
6New CodeG92.03Immune effector cell-associated neurotoxicity syndrome, grade 3
6New CodeG92.04Immune effector cell-associated neurotoxicity syndrome, grade 4
6New CodeG92.05Immune effector cell-associated neurotoxicity syndrome, grade 5
6New CodeG92.8Other toxic encephalopathy
6New CodeG92.9Unspecified toxic encephalopathy
9New CodeI5ANon-ischemic myocardial injury (non-traumatic)
11New CodeK22.81Esophageal polyp
11New CodeK22.82Esophagogastric junction polyp
11New CodeK22.89Other specified disease of esophagus
11New CodeK31.AGastric intestinal metaplasia
11New CodeK31.A0Gastric intestinal metaplasia, unspecified
11New CodeK31.A1Gastric intestinal metaplasia without dysplasia
11New CodeK31.A11Gastric intestinal metaplasia without dysplasia, involving the antrum
11New CodeK31.A12Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
11New CodeK31.A13Gastric intestinal metaplasia without dysplasia, involving the fundus
11New CodeK31.A14Gastric intestinal metaplasia without dysplasia, involving the cardia
11New CodeK31.A15Gastric intestinal metaplasia without dysplasia, involving multiple sites
11New CodeK31.A19Gastric intestinal metaplasia without dysplasia, unspecified site
11New CodeK31.A2Gastric intestinal metaplasia with dysplasia
11New CodeK31.A21Gastric intestinal metaplasia with low grade dysplasia
11New CodeK31.A22Gastric intestinal metaplasia with high grade dysplasia
11New CodeK31.A29Gastric intestinal metaplasia with dysplasia, unspecified
12New CodeL24.AIrritant contact dermatitis due to friction or contact with body fluids
12New CodeL24.A0Irritant contact dermatitis due to friction or contact with body fluids, unspecified
12New CodeL24.A1Irritant contact dermatitis due to saliva
12New CodeL24.A2Irritant contact dermatitis due to fecal, urinary, or dual incontinence
12New CodeL24.A9Irritant contact dermatitis due to friction or contact with other specified body fluids
12New CodeL24.BIrritant contact dermatitis related to stoma or fistula
12New CodeL24.B0Irritant contact dermatitis related to unspecified stoma or fistula
12New CodeL24.B1Irritant contact dermatitis related to digestive stoma or fistula
12New CodeL24.B2Irritant contact dermatitis related to respiratory stoma or fistula
12New CodeL24.B3Irritant contact dermatitis related to fecal or urinary stoma or fistula
13New CodeM31.10Thrombotic microangiopathy, unspecified
13New CodeM31.11Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA]
13New CodeM31.19Other thrombotic microangiopathy
13New CodeM35.05Sjögren syndrome with inflammatory arthritis
13New CodeM35.06Sjögren syndrome with peripheral nervous system involvement
13New CodeM35.07Sjögren syndrome with central nervous system involvement
13New CodeM35.08Sjögren syndrome with gastrointestinal involvement
13New CodeM35.0ASjögren syndrome with glomerular disease
13New CodeM35.0BSjögren syndrome with vasculitis
13New CodeM35.0C>Sjögren syndrome with dental involvement
13New CodeM45.ANon-radiographic axial spondyloarthritis
13New CodeM45.A0Non-radiographic axial spondyloarthritis of unspecified sites in spine
13New CodeM45.A1Non-radiographic axial spondyloarthritis of occipito-atlanto-axial region
13New CodeM45.A2Non-radiographic axial spondyloarthritis of cervical region
13New CodeM45.A3Non-radiographic axial spondyloarthritis of cervicothoracic region
13New CodeM45.A4Non-radiographic axial spondyloarthritis of thoracic region
13New CodeM45.A5Non-radiographic axial spondyloarthritis of thoracolumbar region
13New CodeM45.A6Non-radiographic axial spondyloarthritis of lumbar region
13New CodeM45.A7Non-radiographic axial spondyloarthritis of lumbosacral region
13New CodeM45.A8Non-radiographic axial spondyloarthritis of sacral and sacrococcygeal region
13New CodeM45.ABNon-radiographic axial spondyloarthritis of multiple sites in spine
13New CodeM54.50Low back pain, unspecified
13New CodeM54.51Vertebrogenic low back pain
13New CodeM54.59M54.59
16New CodeP00.82Newborn affected by (positive) maternal group B streptococcus (GBS) colonization
16New CodeP09.1Abnormal findings on neonatal screening for inborn errors of metabolism
16New CodeP09.2Abnormal findings on neonatal screening for congenital endocrine disease
16New CodeP09.3Abnormal findings on neonatal screening for congenital hematologic disorders
16New CodeP09.4Abnormal findings on neonatal screening for cystic fibrosis
16New CodeP09.5Abnormal findings on neonatal screening for critical congenital heart disease
16New CodeP09.6Abnormal findings on neonatal screening for neonatal hearing loss
16New CodeP09.8Other abnormal findings on neonatal screening
16New CodeP09.9Abnormal findings on neonatal screening, unspecified
18New CodeR05.1Acute cough
18New CodeR05.2Subacute cough
18New CodeR05.3Chronic cough
18New CodeR05.4Cough syncope
18New CodeR05.8Other specified cough
18New CodeR05.9Cough, unspecified
18New CodeR35.81Nocturnal polyuria
18New CodeR35.89Other polyuria
18New CodeR45.88Nonsuicidal self-harm
18New CodeR63.30Feeding difficulties, unspecified
18New CodeR63.31Pediatric feeding disorder, acute
18New CodeR63.32Pediatric feeding disorder, chronic
18New CodeR63.39Other feeding difficulties
18New CodeR79.83Abnormal findings of blood amino-acid level
19New CodeS06.ATraumatic brain compression and herniation
19New CodeS06.A0Traumatic brain compression without herniation
19New CodeS06.A1Traumatic brain compression with herniation
19New CodeT40.71Poisoning by, adverse effect of and underdosing of cannabis (derivatives)
19New CodeT40.711Poisoning by cannabis, accidental (unintentional)
19New CodeT40.712Poisoning by cannabis, intentional self-harm
19New CodeT40.713Poisoning by cannabis, assault
19New CodeT40.714Poisoning by cannabis, undetermined
19New CodeT40.715Adverse effect of cannabis
19New CodeT40.716Underdosing of cannabis
19New CodeT40.72Poisoning by, adverse effect of and underdosing of synthetic cannabinoids
19New CodeT40.721Poisoning by synthetic cannabinoids, accidental (unintentional)
19New CodeT40.722Poisoning by synthetic cannabinoids, intentional self-harm
19New CodeT40.723Poisoning by synthetic cannabinoids, assault
19New CodeT40.724Poisoning by synthetic cannabinoids, undetermined
19New CodeT40.725Adverse effect of synthetic cannabinoids
19New CodeT40.726Underdosing of synthetic cannabinoids
19New CodeT80.82Complication of immune effector cellular therapy
20New CodeY35.899Legal intervention involving other specified means, unspecified person injured
21New CodeZ55.5Less than a high school diploma
21New CodeZ58Problems related to physical environment
21New CodeZ58.6Inadequate drinking-water supply
21New CodeZ59.00Homelessness unspecified
21New CodeZ59.01Sheltered homelessness
21New CodeZ59.02Unsheltered homelessness
21New CodeZ59.41Food insecurity
21New CodeZ59.48Other specified lack of adequate food
21New CodeZ59.81Housing instability, housed
21New CodeZ59.811Housing instability, housed, with risk of homelessness
21New CodeZ59.812Housing instability, housed, homelessness in past 12 months
21New CodeZ59.819Housing instability, housed unspecified
21New CodeZ59.89Other problems related to housing and economic circumstances
21New CodeZ71.85Encounter for immunization safety counseling
21New CodeZ91.014Allergy to mammalian meats
21New CodeZ91.51Personal history of suicidal behavior
21New CodeZ91.52Personal history of nonsuicidal self-harm
21New CodeZ92.85Personal history of cellular therapy
21New CodeZ92.850Personal history of Chimeric Antigen Receptor T-cell therapy
21New CodeZ92.858Personal history of other cellular therapy
21New CodeZ92.859Personal history of cellular therapy, unspecified
21New CodeZ92.86Personal history of gene therapy
22New CodeU09Post COVID-19 condition
22New CodeU09.9Post COVID-19 condition, unspecified

The deleted codes:

19Deleted CodeT40.7XPoisoning by, adverse effect of and underdosing of cannabis (derivatives)
19Deleted CodeT40.7X1Poisoning by cannabis (derivatives), accidental (unintentional)
19Deleted CodeT40.7X2Poisoning by cannabis (derivatives), intentional self-harm
19Deleted CodeT40.7X3Poisoning by cannabis (derivatives), assault
19Deleted CodeT40.7X4Poisoning by cannabis (derivatives), undetermined
19Deleted CodeT40.7X5Adverse effect of cannabis (derivatives)
19Deleted CodeT40.7X6Underdosing of cannabis (derivatives)
Note: There was no change or deletion to chapters not listed above.

Implementing Diagnosis Code Changes

To ensure your claims are paid, healthcare practices should integrate the 2022 ICD-10-CM coding guideline changes into their system.

Billing/medical records software systems are a huge risk for your practice (if you use them). It can be disastrous if you blindly rely on your software system to implement ICD-10-CM updates in a timely manner. If there is a problem with your system, the software company is not responsible. The responsibility lies with you. Thus, you should compare the current year’s diagnosis code changes with those added to your software system to identify errors as soon as possible.

Lastly, you must teach your staff and providers about the key changes to the 2022 ICD-10-CM coding guidelines – based on your specialty. By doing so, you will be improving efficiency and accuracy when choosing diagnosis codes – either electronically or on paper.

Key Takeaway

To enhance the quality of reported data, the continuity of care, and patient outcomes, we endeavor to improve ICD-10 codes and clinical documentation throughout the process.

Tap Into Our Expertise

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!

The New AMA CPT Release Codes for 2022 January 7, 2022

AMA cpt codes

The American Medical Association (AMA) has released the latest version of the Current Procedure Terminology (CPT) code set for 2022.  AMA made 405 changes to the current procedure code set in 2022, including 249 new codes, 63 deletions, and 93 revisions. These changes will take effect on January 1. 

What is a CPT® code?

Current Procedural Terminology (CPT®) codes provide doctors and healthcare professionals a uniform language to code medical services and procedures to simplify reporting, improve accuracy, and increase efficiency. CPT codes are also used to manage administrative tasks like claims processing and medical care reviews. Electronic medical billing utilizes CPT codes as well as ICD-9-CM or ICD-10-CM numerical diagnostic coding. Throughout the country, CPT terminology is used to report medical, surgical, radiology, laboratory, anesthesia, genomic sequencing, evaluation, and management (EM) services under public and private health insurance programs.

The following AMA CPT codes were announced for new vaccine-specific immunizations against the novel coronavirus. 

With the help of the Centers for Disease Control and Prevention (CDC), the AMA’s CPT editorial panel approved unique immunization codes for two coronavirus vaccines — as well as administration codes unique to each vaccine. In a press release, the AMA stated that the new CPT codes differentiate each coronavirus vaccine for better tracking, reporting, and analysis for data-driven planning and allocation.

The new Category I CPT codes and long descriptors for the vaccine products are:

91300Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative-free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use 
(Report 91300 with administration codes 0001A, 0002A, 0003A, 0004A)
◄ Do not report 91300 in conjunction with administration codes 0051A, 0052A, 0053A, 0054A, 0071A, 0072A)
November 10, 2020 July 30, 2021 

September 3, 2021 
October 6, 2021 
0001A, 0002A, 91300: December 11, 2020
0003A: August 12, 2021
0004A: September 22, 2021 0071A, 0072A: October 29, 2021 0051A, 0052A, 0053A, 0054A: Effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration (FDA)
CPT® 2022/2023
91301Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative-free, 100 mcg/0.5 mL dosage, for intramuscular use 
(Report 91301 with administration codes 0011A, 0012A, 0013A) 
November 10, 2020 

August 16, 2021
0011A, 0012A, 91301: December 18, 2020 
0013A: August 12, 2021 
CPT® 2022/2023


Here are the new Category I CPT codes and long descriptors for vaccines:

To comply with new CPT codes for vaccine-specific products, the CPT editorial panel collaborated with the Centers for Medicare & Medicaid Services. Their purpose is to develop vaccine administration codes that are distinct for each Coronavirus vaccine and the specific dose used in the schedule.

According to AMA, the level of specificity is a first for vaccine CPT codes. However, it allows tracking all vaccine doses, even when the vaccine product is not reported, like when a vaccine may be given free to the patient. Moreover, these CPT codes report the actual act of administering the vaccine and all counseling needed to the patient or caregiver. They also update the electronic records. 

The AMA site provides a number of resources regarding the new vaccine administration CPT codes and long descriptors. As soon as each newly developed Coronavirus vaccine receives Emergency Use Authorization or FDA approval, all the new vaccine-specific CPT codes will be available for use.

AMA’s website offers short and medium descriptors for these new vaccine-specific CPT codes. They also provide recent changes to the set of CPT codes that have streamlined the public health response to SAR-CoV-2 and COVID-19 disease.

In addition to releasing the standard code descriptor PDF of SARS-CoV-2-related CPT codes, we are also providing an easy-to-use Excel file of SARS-CoV-2-related CPT codes. It contains all the SARS-CoV-2 CPT codes, some may not be included in the 2022 CPT data file, and it includes:

  • CPT code descriptors (long, medium, and short)
  • Published date
  • Effective date
  • Type of change. 

AMA will update these files as new CPT codes are approved by the CPT Editorial Panel:

Category I vaccine descriptors

Therapeutic Remote Monitoring New CPT Codes

CPT code set for 2022 includes five new codes (98975, 98976, 98977, 98980, 98981) for reporting therapeutic remote monitoring. These codes reflect the rise of digital care during the pandemic. In a news release, the AMA referred to codes 99453, 99454, 99457, and 99458 as “codes that expand upon the remote physiologic monitoring codes created in 2020.”

According to the AMA, the new code set includes a taxonomy that supports “increased awareness and understanding of approaches to patient care through diverse digital medicine services available for reporting.”

As noted by the AMA, technology continues to influence CPT code changes. In fact, 43% of the latest changes come from Category III codes or the Proprietary Laboratory Section section.

Updates to the Care Management Procedures

As of 2020, new CPT codes also apply to the principal care management program. Patients with a single chronic condition can receive reimbursement under that policy. Whereas before, only patients with multiple chronic conditions were eligible.

The AMA wrote that the new codes – 99424, 99425, 99426, 99427 – and changes to existing codes, “better align with Medicare guidelines.” Thus, a data file can be used to download the codes and descriptors into a provider’s software solution.

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