Medical Billing Articles

Common Medical Billing Errors in Pain Management for 2023 January 26, 2023

medical billing errors

Errors in medical billing may be more common than you think. For most patients, mistakes in billing cause frustration, annoyance, and financial problems. Meanwhile, medical billing errors for practices can lead to payment delays and denials, which negatively impact their bottom line.

If we’re going to talk about pain management practices, dealing with “chronic pain” isn’t something ordinary. According to the Centers for Disease Control (CDC), over 50 million people suffer from chronic pain, which equates to 20.4% or one in five adults. It has become a significant public health issue affecting people’s lives and costing society billions of dollars – and medical coding and billing are contributing factors.

Common Medical Billing Errors in Pain Management for 2023

Since over 50 million Americans suffer from chronic pain, there is plenty of room for growth in pain management facilities. That’s a much higher percentage than people suffering from diabetes, heart disease, and cancer. Although there is a lot of growth potential, specific pain management medical billing and coding requirements make it challenging to succeed. 

Coding and billing are only half the battle if you are trying to increase your practice’s revenue. Check out these two common medical billing errors in your pain management practice and develop solutions to make your practice prosper.

1. Failure to Capture Patient Data or Information

Patient registration and scheduling are typically the first steps in medical billing. It is essential to obtain accurate patient information at the beginning so that you can bill claims and collect payment most efficiently. However, if there is lacking information on patient demographics, it might lead to claims being denied. Any problems can arise when patient names, addresses, birth dates, and insurance information need to be corrected or added. 

According to Change Healthcare, their report found that $262 billion of $3 trillion in medical claims were initially denied. In total, $8.5 billion in appeals-related administrative costs were incurred even though 63% of those claims were recoverable.

2. Insufficient Disclosure of Patients’ Financial Responsibilities

Standardizing patient rights across healthcare fields helps patients have uniform expectations and helps standardize care. However, high-deductible plans have led to greater patient responsibility. According to TransUnion Healthcare analysis, most patients likely felt the pinch of higher out-of-pocket costs across all care settings in 2018.

If physicians do not inform their patients in advance of their financial responsibilities, it may cause reimbursement problems. Furthermore, medical practices may need help collecting what they owe.

That’s why all practices should establish proper workflow processes and methods to collect advanced payments from patients with high-deductible health plans. Here are some expert tips to help pain management practices improve collection:

  • Inform patients in advance about the costs of services

You should clearly explain the cost of each service at the time of booking. This will help patients understand what is expected of them.

  • Provide out-of-pocket and insurance education at hand

It’s all about how much insurance they will cover and how much they’ll have to pay for their care.

  • Make it easy for patients to pay

It needs to be more than sending patients a statement and hoping they pay. For your pain management practice to thrive, ensure it tailors patient financial engagement strategies to the demographics it serves. 

3. Billing of Fluoroscopy Can Also Lead to Errors in Pain Management

The most common mistake in pain management billing is charging fluoroscopy separately. Most spinal, endoscopic, and injection procedures involve fluoroscopy for radiological supervision and interpretation. Furthermore, it contains a variety of codes for pain management, such as discography, intra-articular joint procedures, facet block medial branch surgeries, epidural steroid injections, and radiofrequency ablation. In many instances, billing fluoroscopy separately leads to duplicate claims made for the same procedure, resulting in denials that can negatively impact the bottom line.

Remember Modifier 50. The Modifier 50 Bilateral Procedure indicates that bilateral procedures were performed at the same time. Before applying this modifier, a coder should confirm that bilateral is not included in the CPT code’s descriptor. If you plan to inject the sacroiliac joint bilaterally, apply modifier 50.

On the other hand, the non-spinal joints and ligaments such as hips, shoulders, iliolumbar ligament, and troch bursa are reported separately using fluoroscopic guidance codes (77002 for non-spinal).

4. Inability to Specify the Type and Degree of Pain

Pain may be tingling, stabbing, throbbing, dull, or sharp. In addition, it can be acute, chronic, or sudden in onset. Its characteristics can vary from time to time. The nature of pain can be difficult to translate into codes, and the inability to do so may result in errors and discrepancies in documentation and billing.

In this situation, pain management physicians should assess the exact type and severity of the patient’s pain. Pain assessment and documentation are crucial and should be as precise as possible. As a result, coders can choose the appropriate code for the pain and avoid unnecessary complications. 

Codes in ICD-10-CM describe the pain according to its nature.

Refer here for pain management codes 

5. Not Aware of the Updates to Payer Policies and Guidelines

The Centers for Medicare & Medicaid Services (CMS) and other insurance providers constantly update their payer policies. As soon as the updates are released publicly, providers and coders must stay up-to-date with changes in insurance payer policy to ensure maximum reimbursement. If pain management physicians fail to comply, they will suffer.

Often, this requires detective work to piece together information from updates and documentation provided by payers. With medical coding and billing, significant changes typically take effect on January 1 of the following year. However, it is essential to note that information can change throughout the year. 

Tap Into Our Expertise

Despite regular changes in reimbursements, the documentation procedures that pain management physicians used in the past may now result in denials. Documentation requirements are increasing and becoming more specific. The coding staff at your practice must also maintain up-to-date procedures to accommodate each payer’s needs, along with changing policies and codes. However, keeping your revenue cycle moving throughout all the changes can be challenging.

Many pain management practices partner with a professional billing and coding company to resolve issues. At 5 Star 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!

Best Medical Coding and Billing Solutions for 2023 December 29, 2022

medical coding and billing

There is much complexity in medical billing and coding. No matter how well-organized a billing department is, dealing with the discord of codes can be challenging. Moreover, untrained staff who file claims can make inadvertent errors that result in substantial financial and time losses. 

Medical billing and coding errors account for most claims denials and payment delays. Another issue is that frequent errors can have a negative impact on the relationship between you and your patient.

The issue of medical coding and billing is pervasive. Why is this so? Is there a way to avoid medical billing and coding errors?

As we move into 2023, we’ll discuss some common challenges and the best medical coding and billing solutions.

Three Common Challenges In Medical Billing and Coding

According to BMC Health Services Research, medical coding errors could lead to revenue loss. Simple mistakes can occur; human error must be allowed for, but lost fees drain the finances of a healthcare facility, which is why medical billing departments must minimize them.

Below are three common challenges that medical billers and coders face:

1. Usage of Outdated Coding Guides

To accurately bill for services and assign diagnosis codes, it’s crucial to have the latest coding materials. Each year, medical billing companies and practices should update or purchase the latest coding publications to ensure accuracy in billing and coding.

AMA, CMS, and WHO are the organizations that maintain and update the three principal medical coding codes every year. Coders are responsible for learning any new codes or reorganizations as they become available and using them correctly. This is partly because professional organizations like the AAPC and AHIMA require members to complete a certain number of education credits every two years.

However, failing to append the correct codes illegally inflates your practice’s revenue.

2. Improper Coding

The following reasons contribute to claims being coded incorrectly:

  • The unbundling of charges that need to be handled under the same procedure code
  • The practice of upbilling and underbilling
  • Inconsistencies in codes
  • Missing codes
  • Billing CPT codes that are not on your insurance provider’s list

Upbilling and underbilling can be fraudulent acts, but they may also be accidental. 

In the same regard, erroneous coding leads to poor patient care and trouble with reimbursements, but how does the responsible party address these issues? Those medical practices with a history of coding mistakes may be subject to fines and/or federal penalties.

The False Claims Act (FCA) enters at this part. It provides enforcement for false claims, and the consequences may include monetary penalties or legal issues. 

3. Missing Documentation

To pay claims, all insurance providers require documentation. If you don’t provide it, they may deny your claim and send it back to you, in which case you will have to resubmit it with the necessary documentation. The American Medical Association (AMA) estimates costs between $21 billion to $210 billion in claims processing inefficiencies each year.

At the same time, medical billing specialists need help assigning the right codes and billing patients correctly when physicians or other healthcare providers turn in sloppy paperwork. 

Best Medical Coding and Billing Solutions for 2023

There is a great deal of interest among healthcare firms and organizations in finding the best coding and billing solutions for 2023. With these features, they know that their practice will be able to advance faster than their competitors. 

1. Medical Practice Management Solution

A practice management software serves as a lifeline for medical practices. It enhances the efficiency of your practice by satisfying customers. Among the core capabilities of practice management software are:

  • Adding patient information to the database
  • Recording patients’ demographics
  • Managing billing operations
  • Streamlining billing processes
  • Processing and submitting claims for payment

Hiring a third-party service provider’s medical coding and billing services, streamlining all these tasks so healthcare practices can focus more on patients.

Furthermore, you should choose a practice management system with coding automation that meets current coding requirements. With software that allows you to list only the codes specific to each medical insurance carrier, you can easily reduce billing time and prevent errors. It is much less likely that your staff will make mistakes when they can quickly look up diagnosis and procedure codes.

2. Medical Coding and Billing Training/Education

Medical billing and coding are becoming increasingly complex for clinics dealing with different insurance companies. As complexity rises, coding certification becomes increasingly valuable.

Your clinic will reap several benefits from medical coding training from a certified professional. For example, ensure your staff is properly trained to recognize medical documentation needs. Your billing software should allow you to attach documents to your claims simultaneously. In this way, you’ll experience an increase in the efficiency of the workflow in your office.

Similarly, well-trained employees will code more accurately, easing the process of filing claims and receiving reimbursements. You will increase revenue and reduce refilling and appealing costs by minimizing claims rejections and denials.

3. Medical Outsourcing

Medical coding outsourcing refers to contracting the work to a third-party company instead of completing it in-house. Depending on your agreement, many medical billing and coding companies may handle all or most of your medical coding needs. They must also ensure that their staff is up-to-date on the latest coding requirements and skills. Medical coders often work remotely, but you can hire them in your practice.

Outsourcing medical coding has some major advantages, including:

  • Keeping Up-To-Date With Certifications.

It takes much time to keep up with certifications and updates. Medical coding can undergo substantial changes when a major update occurs. For example, ICD-10 led to a significant increase in codes. If you hire a third-party medical coding company, they will handle these issues for you. Having the right coders working on your charts ensures that their skills, certifications, and knowledge are up-to-date.

  • Cost-Effectiveness

It can be more cost-effective to outsource your medical coding than hire and maintain an in-house team. The price will be higher if you hire medical coders with specialization and superior skills. By outsourcing, you can employ top-level coders at a lower cost.

  • Flexibility 

The flexibility of contract medical billing and coding companies can be superior to hiring an in-house team. Outsourcing provides you access to an extensive network of coding experts. Moreover, the coding company can assign more employees to do your work on a busy day so you can submit claims and receive payments quickly.

  • Transparency

Your coding company is the one to provide you with detailed performance reports about your medical billing. They may send you these reports automatically or upon request. This way, you can get a clear view of your practice’s coding and billing, which helps you gain a more comprehensive understanding of your practice’s operations. 

  • Security and Compliance

Regulatory compliance and security are major concerns for healthcare organizations. To protect against data loss and other cyber incidents, you need robust disaster recovery plans for medical coding and billing. Additionally, you need to ensure that you comply with HIPAA regulations.

Medical coding firms specializing in security and compliance will understand your coding concerns. You can always trust your coding company to take the appropriate precautions.

Furthermore, medical coding outsourcing companies can also conduct coding audits, provide research support, and improve clinical documentation. 

You should consider outsourcing if you’re looking for an easy, hassle-free way to improve medical coding and billing. Many healthcare organizations can benefit from this approach in a variety of ways.

Tap Into Our Expertise

Indeed; many healthcare establishments struggle with common coding and billing issues. To ensure your practice’s prosperity in 2023, we offer the most effective solutions mentioned above.

These medical coding and billing solutions will help your medical practice compete in an increasingly competitive market.

At 5 Star 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!

Benefits of Outsourcing Medical Billing Management for 2023 December 22, 2022

medical outsourcing

The billing and coding staff drive the healthcare system behind the scenes. It’s also their job to ensure that all medical codes are up-to-date, so patients are fully reimbursed.

Likewise, medical billing is challenging for firms and medical practitioners without skilled personnel. Therefore, doctors, professionals, and healthcare providers prefer to outsource medical billing to third-party service providers.

So why choose to outsource medical billing? Besides saving time and money, healthcare outsourcing services are advantageous in many ways. For your medical practice, carefully consider all the benefits of outsourcing in healthcare. 

This article will discuss the benefits of outsourcing medical billing management for 2023 and why it is often a better option.

5 Major Benefits of Outsourcing Medical Billing

1. It Provides Efficient Cost Management

Regarding infrastructure modifications and overhead payroll expenses, and medical outsourcing is more cost-effective than hiring more staff in-house to handle the billing processes. An in-house billing system allows you to tightly control upfront expenses, including labor, hardware, software, training, and ongoing expenses for maintaining the system. Updates and changes to billing software can also be complex and expensive.

By outsourcing the process, you can invest in value additions for your clinic, which reduces operating expenses. It is possible to make use of the backend office space for treatment rooms and diagnostic areas, which can increase your practice’s profitability. 

2. It Increases Your Revenue

According to the news, the global medical billing outsourcing market will be worth US$ 25.7 Billion by 2028, growing by 12.2% over this period (2021-2028). Outsourcing in healthcare improves the profitability of many organizations. For example, RCM outsourcing is responsible for 5.3 percent of revenue increases among hospitals with more than 200 beds. In the same regard, nearly 80% of those with less than 200 beds attribute 6.2 percent of their revenue increases to medical billing outsourcing.

Another benefit of outsourcing in healthcare is that it increases income for physicians. Medical practices lose a significant amount of money annually due to denied claims. Using outsourced clinical services from medical billing companies prevents revenue leakage and facilitates the flow of payments. Take note that your bottom line and the success of your practice depend on a constant cash flow.

Furthermore, healthcare organizations must select a billing company with care to ensure quality, compliance, and performance are not at risk. 

3. It Reduces Billing and Coding Errors

Professional environments are not immune to mistakes. Despite this, you cannot blame your employees for the increasing billing, coding errors, and fraudulent activity your practice could experience if they are not adequately informed.

That’s why it’s easy to reduce errors with medical billing outsourcing companies. With their experience and training centered around medical billing codes, professional medical billers can submit your claims accurately and on time. Medical billing outsourcing companies continuously stay up to date on code changes and fraud prevention

They are responsible for ensuring that the billers they hire are trained and equipped to submit medical claims. As a result, they can minimize the number of denied and rejected claims due to billing errors and provide feedback to help maximize reimbursements in the future.

4. It Offers Flexibility

Traditionally, medical billing outsourcing has been known for its flexible pricing and delivery models, and most vendors customize their solutions for each company. Therefore, smaller practices can choose transactional RCM services instead of paying a percentage of collections to cover the cost of the work performed. For example, providers may require a fixed monthly fee per account, claim, CPT code, or location.

Additionally, you can outsource various billing functions to different providers, leaving your internal staff to handle other billing functions. Using a flexible delivery model, you can utilize the billing specialist’s knowledge without giving up complete control. Of course, due to ever-changing needs, your practice can re-bundle services from only one service provided together with your own staff later on.

5. It Offers Security & Guaranteed Compliance

Healthcare compliance and data security knowledge are essential. Medical billing staff must stay up to date with new rules and protocols constantly, which makes compliance even harder. As standards change, it is crucial to have a dedicated expert who stays up to date with new developments. Another primary concern is the patient’s health privacy. It may be risky to keep records in-house. In some cases, office computers and servers crash, erasing all data.

An established medical billing company can provide security during and after the billing process. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations require them to invest in security measures. By keeping up with all changes, their services remain competitive.

Reasons to Outsource Medical Billing

If your medical practice often has revenue cycle leaks, outsourcing may be the most appropriate solution for you. With medical outsourcing, you can see steady and noticeable growth in your practice’s revenue. Below are the reasons to leave your medical billing to the experts: 

  • There is a shortage of skilled medical and non-medical personnel to meet the growing demand
  • A lack of staffing or the inability to add a full-time specialist
  • Regardless of the size of a business, budget constraints influence capital investment decisions and operation costs
  • Compliance requirements that are constantly changing and complex
  • Healthcare is increasingly competitive, not only between providers but also with peripheral businesses;
  • Concerns relating to non-medical issues include cyber-attacks on digital health records and other patient information.

The Digital Journal reports that revenue from medical billing outsourcing will increase by 16 percent from 2022-2032.

Tap Into Our Expertise

Outsourcing your medical billing depends on your needs. The capacity and finances of your practice are important factors to consider. To experience the benefits of outsourcing, you should look for a medical billing company with a team of expert medical billers. 

At 5 Star 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!

Urgent Care Coding Guidelines 2023 December 16, 2022

urgent care

You’ve successfully reached your desired number of patients, your online reviews overflow with positive feedback, and your providers offer top-tier patient care. However, your profit margins need to catch up to expectations. If your urgent care practice’s revenue struggles in this aspect, you may need help with your current billing processes. 

The solution to this problem is learning the essentials of urgent care billing. You must know the best ways to enhance your billing process and boost your revenue with the right approach.

So, without further delay, let’s discuss the urgent care CPT guidelines for 2023.

Understanding the Urgent Care Billing Process

The urgent care billing process begins at the front door. The billing cycle starts by creating a comprehensible billing policy right at the beginning. 

Most urgent care clinics do not have a pre-registration process. However, basic information is collected by the clinic receptionist. The collected data includes the patient’s name, address, DOB, and reason for visiting the clinic. The policy number, primary care provider, and insurance company are also collected. 

Data collected from the registration process is used for electronic health records (EHR). All parties involved, such as providers and staff, will work within the EHR to efficiently manage information regarding patient records. Moreover, it makes the billing process smooth and simplified. 

The general goal is to increase revenue while spending less on costly collection processes. 

Urgent Care CPT Codes

Urgent care facilities are rapidly growing, as reported by Medical Economics. Clinics increased to staggering numbers from 6946 in 2016 to 8285 in 2018. The growth shows providers should stay updated on billing guidelines and coding changes. 

Urgent Care Billing Guidelines

Urgent care and primary care offices treat many similar health conditions. Therefore, their billing and coding processes use almost the same codes. However, urgent care uses a specific code starting with the letter S

S Codes belong to Healthcare Common Procedure Coding System (HCPCS). These codes were primarily assigned by Blue Cross Blue Shield (BCBS). But nowadays, many payers accept them. Moreover, the S Codes are used only by urgent care offices. 

The Two Main Options for Urgent Care Coding and Billing Services


The code S9088, or services provided in an urgent care center – list in addition to the code for service, allows the providers to bill the treatment and evaluation of medical conditions. The code S9088 should always be used with a proper evaluation and management (E/M) code. 

Additionally, this code allows urgent care providers to get at least a portion of reimbursement for the increased cost of an Immediate Care office. 


This code is for charging a global fee for the services rendered. Urgent care uses this code regardless of the treatment the patient receives. Some managed care organizations (MCO) may bill a facility under the code S9083. 

States that require MCOs to bill providers under S9083

  • Florida
  • Arizona

Generally, avoiding S9083 is ideal. The reason is based on the global fee-for-service scale. For example, your practice will get the same reimbursement for minor and major cases. The codes S9088 and S9083 account for urgent care visits. You can use these two codes in almost all urgent care encounters. 

Medicare is the only exception. Medicare codes depend on reimbursement rates, established medical necessities, and geographic location.

Urgent Care Guidelines

A coder records all diagnoses and procedures once a patient encounter completes. Coders typically use universal medical codes. ICD-10 codes for diagnosis. In addition, the current procedural terminology (CPT) codes for delivering care.

The Three Categories of CPT Codes

Category 1 CPT Code

These codes are the most popular. Their coverage includes the evaluation and management of the following:

  • Disease management
  • Surgery
  • Radiology
  • Pathology
  • Laboratory testing
  • Medicine and anesthesiology

Category 2 Codes

These codes are secondary quality assurance codes that are typically optional. Moreover, they are not used as a replacement for the Category 1 CPT codes.

Category 3 Codes

These codes are used for new and emerging procedures. The category 3 codes still need to be approved by the FDA

Common Urgent Care CPT Codes

Most CPT codes used by urgent care consist of evaluation and management codes (E/M). Below are the typical urgent care CPT codes.


This code is for a clinic or outpatient evaluation and management of an established patient. Moreover, the patient requires two of three components, such as 

  • A detailed examination
  • Medical decision-making of moderate nature
  • A detailed patient history


The 99213 is for existing patients that need treatment. However, the patient should have a similar complexity, like 99214. This code is used frequently because the criteria for reimbursement are easier to complete. On the other hand, it doesn’t reimburse as much as the code 99214.


99204 is the code typically used for new patients in urgent care. It requires three criteria to fulfill, such as

  • Comprehensive patient history 
  • Comprehensive exam
  • Medical decision-making of moderate complexity

The code 99204 has a significant reimbursement rate with a comparable rate of non-compliance.

The CPT assistant reported that the most urgent care CPT codes fall under 99202- 99205 and 99211-99215. 

Urgent Care CPT Coding Changes

Urgent care CPT codes update every year. Non-compliance could negatively impact claim submission for urgent care providers. Here are the latest changes you should be aware of this coming 2023.

History and exams are not used for E/M service. But it should still be performed to report the CPT codes 99202-99215. E/M code selection is based on the following: 

1. The medical decision-making (MDM) level. 

2. The time spent doing the service on the same day of the encounter.

The time associated with the CPT codes 99202-99215 changed from the typical face-to-face time to the total time spent with the patient on the day of the visit.

The medical decision-making (MDM) associated with the codes 99202-99215 now has three updated components. 

They are:

  • The number and complexity of problems managed. 
  • The amount or complexity of information reviewed and analyzed.
  • Two components must be reached or surpassed to select a level of E/M service.

The significant changes in urgent care billing codes include codes and modifiers for the COVID – 19 vaccines.

The CPT codes for this service structure are based on the following:

  • The use of intramuscular or subcutaneous injection
  • Treatment and management of vaccination complications

Additional Info

Here are the updated modifiers for reporting the activities mentioned above.

  • Right side – R
  • Left side – L
  • Vaccines for children program patients only – VFC

Changes were also made to the HCPCS Level II code set.

Updates for 2023 E/M changes should be your top priority this coming 2023. Remember, the CPT code for an urgent care visit can affect your practice significantly. Find a team that can tap into your true potential. 

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!

Flu Vaccination Coding and Billing for 2022 – 2023 November 9, 2022

flu vaccine 2022-2023

The Food and Drug Administration (FDA) Vaccines, and Related Biologic Products Advisory Committee selected vaccine strains for the 2022–2023 influenza vaccine. Also, the World Health Organization recommended the Northern Hemisphere as the basis for the 2022-2023 influenza vaccine composition.

Want more details? Visit the Centers for Disease Control (CDC) Flu Season web page for more information about the flu vaccines for 2022-2023.

Billing/Reporting Influenza Vaccines for Medicaid Beneficiaries 

Depending on the age of the beneficiaries and vaccine formulation, the vaccine codes listed below may either be reported (with no charge) or billed (with a charge as usual and customary). The tables also show the administration codes that may be billed, depending on the beneficiaries’ age and vaccine(s) provided to them.

Vaccine CPT Codes to Report

Source: North Carolina Department of Health and Human Services (NCDDHS).

Table 1. A list of influenza billing codes for Medicaid beneficiaries under 19 years of age who receive the VFC influenza vaccine. The reporting of these codes results in a 0.00 dollar amount.

Providers should use the NDC on the actual vial used for administration listed at the bottom of this bulletin when processing claims.

Important Note: In the Health Check Billing Guide, you can find specific information about billing immunization administration codes for Health Check beneficiaries. 

Source: North Carolina Department of Health and Human Services (NCDDHS)

Table 2: Influenza Billing Codes for Medicaid Beneficiaries 19 to 21 Years of Age

Providers should use the following codes to bill for influenza vaccines purchased and administered for Medicaid beneficiaries between the ages of 19 and 21. 

Important Note: The VFC/NCIP provides influenza vaccines only to recipients between the ages of six months and 18 years old. However, those 19 years and older will not receive the influenza vaccine.

Vaccine CPT Codes to Report

Source: North Carolina Department of Health and Human Services (NCDDHS)

Administrative CPT Codes to Report

Source: North Carolina Department of Health and Human Services (NCDDHS)

Table 3: Influenza Billing Codes for Medicaid Beneficiaries 21 Years of Age and Older

The administrative CPT code 90472 will only be used if another vaccine is also administered along with the influenza vaccine. Moreover, it’s possible for providers to bill 90472 in more than one unit, if necessary.

In the event that beneficiaries 21 years of age and older purchase or receive an influenza vaccine, providers should use the following codes to bill Medicaid.

Important Note: Only VFC-age beneficiaries (6 months through 18 years of age) are eligible for influenza products under the VFC/NCIP. However, those 19 years and older will not receive the influenza vaccine.

Vaccine CPT Code to Report

Source: North Carolina Department of Health and Human Services (NCDDHS)

Administrative CPT Code(s) to Bill

Source: North Carolina Department of Health and Human Services (NCDDHS)

The administrative CPT code 90472 will only be used if another vaccine is also administered along with the influenza vaccine. Moreover, it’s possible for providers to bill 90472 in more than one unit, if necessary.

For beneficiaries 21 years or older receiving an influenza vaccine, an evaluation and management (E/M) code cannot be reimbursed to any provider on the same day that injection administration fee codes (e.g., 90471 or 90471 and +90472) are reimbursed.

Any healthcare provider cannot reimburse an evaluation and management (E/M) code for beneficiaries 21 years and older who are receiving influenza vaccinations on the same day as injection administration fee codes (e.g., 90471 and +90472). For billing a separately identifiable service, the provider must add modifier 25 to the E/M code.

Flu Vaccination Coding and Billing for 2022-2023

As shown in Table A, Medicare Part B payment allowances increased slightly for the 2022-2023 flu season.

Table A: Comparison of CPT® code and Medicare Part B payment allowances for 2021-2022 and 2022—2023 flu seasons

Medicare Part B payment allowances are 95 percent of the average wholesale price (AWP) for influenza vaccines, except in cases where vaccines are provided in outpatient departments of hospitals, rural health clinics, or Federally Qualified Health Centers.

Important Note: In one calendar year, Medicare patients can receive two fully-covered flu vaccinations due to the annual flu season that runs from Aug. 1 to July 31.

When a patient receives a flu shot on Jan. 5, 2022, and again on Aug. 29, 2022, Medicare will pay for both vaccinations. 

As usual, vaccinations against the influenza virus do not apply toward the annual Part B deductible or coinsurance amounts.

In accordance with Medicare guidelines, providers must report ICD-10-CM code Z23 Encounter for immunization together with administration code G0008 Administration of influenza virus vaccine.

While vaccine product pricing is updated on Aug. 1, G0008’s pricing is effective Jan. 1 through Dec. 31. Physicians can now download the 2022 Medicare Physician Fee Schedule (MPFS) payment rates file from the Centers for Medicare & Medicaid Services (CMS), which includes locality-adjusted payment rates for influenza, pneumococcal, and hepatitis B vaccine administration.

Important Safety Information for Physicians Administering Flu Vaccines

It is not recommended to administer Fluzone Quadrivalent, Flublok Quadrivalent, or Fluzone High-Dose Quadrivalent to anyone who has had a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccines (including egg protein for Fluzone Quadrivalent and Fluzone High-Dose Quadrivalent) or after a previous dose.

It is also not recommended to administer Fluzone Quadrivalent or Fluzone High-Dose Quadrivalent to anyone who has had an allergic reaction to any influenza vaccine in the past.

The Fluzone Quadrivalent injection site reactions in pain, tenderness, erythema, and swelling in children 6 months to 35 months of age. Acute injection-site reactions (pain, erythema, and swelling) are the most common in children 3 years through 8 years of age. Systemic adverse reactions include myalgia, malaise, and headaches. The most common solicited systemic adverse reactions in adults 18 years, and older were myalgia, headache, and malaise.

There was a higher frequency of pain at the injection site in adults 65 years of age and older, as well as headache, malaise, and myalgia in systemic adverse reactions to Fluzone High-Dose Quadrivalent.

It is possible that other adverse reactions will occur with Fluzone Quadrivalent, Flublok Quadrivalent, and Fluzone High-Dose Quadrivalent.

For all Fluzone Quadrivalent, Flublok Quadrivalent, and Fluzone High-Dose Quadrivalent vaccine products, please see the complete Prescribing Information. Also, you can check out the complete Patient Information for Fluzone Quadrivalent or Fluzone High-Dose Quadrivalent.

Influenza Vaccine Products for the 2022 – 2023 Influenza Season

Source: Immunize.org

Get ready for the 2022-2023 influenza season!

Using this article as a guide, we hope you will be able to administer flu vaccination codes more easily. For more information, you can also refer to this source.

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!

Facility-based Coding Changes for 2023 November 9, 2022

ama coding guidelines

Using facility-based coding guidelines is essential to consistently provide codes for hospital visits and encounters. Furthermore, the facility-specific guideline also captures all reimbursements owing to the organization.   

This article covers the major changes in Evaluation and Management (E/M) coding for facility-based services for 2023 based on the American Medical Association (AMA) announcement.

Facility-Based E/M Changes Announced by AMA

The AMA CPT Editorial Panel recently added some changes to its Guidelines for E/M Services. Moreover, the update consists of code revisions, additions, and deletions that will take effect on January 1, 2023.

The change affects the following services:

  • Hospital Inpatient and Observation Care Services 
  • Consultation Services
  • Emergency Department Services 
  • Nursing Facility Services
  • Home or Residence Services 

The AMA coding guidelines provide physicians and medical practices a head start in preparing for the 2023 E/M coding changes. These guidelines also provide authoritative resources to anticipate the operational, infrastructure, and administrative adjustments that will result from the coming transition.

By doing so, physicians and other users will benefit from the administrative relief from the E/M code changes.

To align with new E/M coding standards, the AMA revised the CPT coding guidelines across all care settings and services. 

Hospital Inpatient and Observation Care Services

Consultation Services

Emergency Department Services

Nursing Facility Services

Home or Residence Services

Prolonged Services

There are two ways to choose the level of E/M services for the above categories of codes: based on medical decision-making or by time. Time does not play a role in selecting ED visits. 

The basis for code selection is the three elements of medical decision-making (MDM):

  • The number and complexity of problems discussed during the encounter.
  • The analyzing and reviewing of a large amount or complexity of data.
  • The patient’s risk of complications, morbidity, or mortality. 

Current Procedural Terminology (CPT) Code 99223 

The Comprehensive Error Rate Testing (CERT) reviews have revealed significant improper payments resulting from incorrect coding or inadequate documentation of CPT code 99223. It also has the highest level of initial inpatient hospital care.

The evaluation and management of a patient’s first initial hospital care require three key components:

  • A comprehensive history
  • An in-depth examination
  • High-level or complex medical decision-making

Are you looking for more details? 

These code sets will be in effect on January 1, 2023. Print out the AMA guidance and keep it next to your CPT® book for 2022. You can also see what the changes are for those sections that are included.

With the aid of the downloadable CPT Data File 2023, healthcare providers can import the updated codes into their existing IT systems.

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ICD-10, and CPT E/M Code Updates for 2023 September 30, 2022

2023 e/m changes

Do you want to learn more about the 2023 CPT® Evaluation and Management (E/M) changes? In the CPT® book, the E/M section has been updated significantly.

This article discusses the ICD-10 and CPT E/M Code Updates for 2023.

CPT® Evaluation and Management (E/M) Code Updates

As of January 1, 2023, changes have been made to the CPT Evaluation and Management (E/M) codes by the American Medical Association (AMA). Moreover, E/M codes for office/outpatient visits were updated in 2021 to reduce documentation and focus on medical decision-making. The full details have not yet become public, but a summary of proposed changes is listed below:

The tables below include the following CPT E/M code changes, effective January 1, 2023:

Deleted CPT E/M Codes

AMA 2023 E/M Updates

Evaluation and Management (E&M) Visits

With the continued update of CPT® coding and related guidelines, the AMA CPT® Editorial Panel approved revised coding and updated guidelines for Other E&M visits that will take effect on January 1, 2023. The AMA proposes adopting most of these changes in coding and documentation for other E&M visits, which include:

  • Hospital Inpatient/Observation
  • Emergency Department
  • Nursing Facility
  • Home or Residence Services
  • Cognitive Impairment Assessment

These changes will be effective January 1, 2023, similar to the final rule they approved in the CY 2021 PFS final rule for office/outpatient E&M visits. Among the changes to this revised coding and documentation framework are changes to CPT code definitions, including: 

  • New description times (where relevant).  
  • Interpretive guidelines for medical decision-making at different levels have been revised.  
  • Code level selection for medical decision-making (except for emergency department visits and cognitive impairment assessments, which are not timed).  
  • The history and exam to determine code level will no longer be used (instead, a medically appropriate history and exam will be required).

The AMA proposes maintaining the current billing policies that apply to E&Ms while considering any revisions necessary for future rulemaking. Furthermore, they suggest introducing Medicare-specific coding for payment of Other E&M prolonged services, as the Centers for Medicare & Medicaid Services (CMS) did for Office/Outpatient prolonged services in CY 2021.

The following list below contains some “key” revisions to the 2023 E&M code descriptors and guidelines.

  • There will be a deletion of observation CPT® codes (99217-99220, 99224-99226) and a merging of them with the existing hospital care codes (99221-99223, 99221-99233, 99238-999239) and updated code descriptions.
  • With the removal of some confusing guidelines, including the definition of “transfer of care,” consultations will get a facelift. In keeping with the deletions at level one due to MDM duplication, the low-level office (99241) and inpatient (99251) consultation codes will be deleted to align with the four levels of MDM.
  • As with the revisions to office visits in 2021, nursing facility and home and residence services will also undergo modifications.

The AMA says E/M code changes will simplify physician notations and reduce burnout. With the new code changes, finding the correct code should be more accessible, streamlining administrative processes. Consequently, direct care workers and facility staff can interact with patients more.

To help with the impending changes, the AMA also offers several resources

Summary of the 2023 ICD-10-CM Code Updates

Furthermore, the Centers for Disease Control and Prevention (CDC) recently released the ICD-10-CM code set for the fiscal year 2023, along with the ICD-10-CM Official Coding and Reporting Guidelines, which introduce new codes and guidelines for reporting dementia, head injuries, and long-term drug treatment. The 2023 ICD-10-CM update will add 1,176 new codes, revise 28, and delete 287. For patient encounters and discharges, physicians must use these codes between October 1, 2022, and September 30, 2023.

Eighty-three new ICD-10 codes were added to Chapter 5 (Mental, Behavioral and Neurodevelopmental disorders [F01-F99]); the table below shows a sample of its code updates.

In total, 69 new codes are available for dementia associated with or without psychological symptoms. Here are a few of the new dementia codes:

Other Examples of ICD-10-CM Code Updates for 2023

Stay On Top of ICD-10 and CPT E/M Code Updates

Whenever codes are revised, and new rules come into effect, it is crucial that providers check with their EHR vendors to ensure that their systems are aligned. Make sure your EHR vendor’s coding applications will adhere to the new evaluation and management code updates for 2023.

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Best Guide to E-Visit Documentation, Coding, and Billing August 3, 2022


The American Academy of Family Physicians (AAFP) encourages safe, secure online interactions between physicians and patients, such as electronic visits or “virtual e-visits.” In non-emergency situations, e-visits can substitute for office visits with primary care providers. It is a fast and easy online procedure for patients to receive a diagnosis and treatment plan.

This article will give you the best guide to e-visit documentation, coding, and billing.

What Should Providers Know About E-visits? 

An encounter must meet the following criteria to be considered an e-visit:

  • The practice must have a well-established relationship with its patients.
  • E-visits require patient consent and a communication request.
  • The patient must initiate non-face-to-face electronic communication. For example, patient portal systems.
  • Patients must not have seen an office visit to a physician or therapist for the same clinical concern in the past seven days.
  • It is only possible to report e-visits every seven days.
  • An e-visit is not the same as typical therapy sessions.

For e-visits, the following documentation requirements are needed:

  • The main complaint with all evaluation and management services (E/M).
  • The specifics of treatments, assessment of diagnoses or symptoms, evaluation, and conversation.
  • An official patient consent record is backed up by a signature and captured in the clinical note. Moreover, e-visit software platforms accept scanned copies of signed consents. Some systems allow electronic signatures.
  • The total time recorded over the seven days supporting the billable service.

List of Current Procedural Terminology (CPT) Codes That Require Providers to Follow Policies Set by Payers

The codes for online digital evaluation services (e-visits) used by doctors are complex. Below are the codes used:

Medicare uses the following HCPCS codes and descriptors for qualified non-physician professionals for its online digital evaluation service (e-visit):

Private payers and workers’ compensation are using the following online digital evaluation service (e-visit) CPT codes and descriptors:

Do’s and Don’ts in Billing E-Visits

When the following conditions are met, you can bill an e-visit:

  • The provider establishes a relationship with the patient.
  • Response time by the provider is longer than five minutes.
  • A provider responds through the patient portal to a message initiated by the patient.
  • A visit meets the 2021 E/M guidelines. 
  • It has been seven days since the clinician last saw the patient.
  • There is no global period for the same or similar condition for the patient.
  • In this case, the provider is making a clinical decision that would normally be performed in the office (e.g., medication dose adjustment, ordering a test, or prescribing a new medication).
  • A patient has consented to the e-visit and understands that he may be billed.
  • For online digital E/M services, the service period includes all related work done within seven days by the reporting individual and other registered healthcare providers (RHPs) in the same group practice.
  • The 7-day period begins when the reporting provider reviews the patient’s inquiry personally for the first time.
  • A new/unrelated problem from the patient arises within seven days of the previous E/M visit for a different issue.

Do not bill an E-visit in the following situations:

  • During the 7-day period, the provider may bill for other separately reported services (such as care management, INR monitoring, remote monitoring, etc.)
  • The same or similar condition was billed to the patient for an e-visit within the past 7 days. 
  • The patient inquires about a surgical procedure that happens during the surgery’s postoperative period (global).
  • Providers are simply disseminating results, processing medication requests, or scheduling appointments (for billing, E/M services must be performed).
  • A separate face-to-face E/M service (either in person or via telehealth) happens (included in the E/M) during the 7-day period of the e-visit.
  • Besides clinical staff time, only provider time can be included.

The AAFP published an algorithm in response to the growing number of virtual visits. It was developed by James Dom Dera, MD, FAAFP, to determine which code should be used for virtual services.

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Tips to Increase Your Clinic’s Collections August 3, 2022

patient collections

Patient collections are a constant headache for many physicians. Most clinics have difficulty collecting payments, especially if the collection process takes too long or becomes complicated. Due to this, clinics may miss payments, resulting in a reduction in income. 

For the clinic to succeed, improving the payment collection process is crucial. So, what can you do to increase your collection rate and shorten the time between payment collection and care delivery?

This article will discuss tips to increase your clinic’s collections.

Enhance the Collection Process

Reviewing current billing and collections processes can help reduce payment timelines. Patients often receive bills months after the procedure, making it less likely for them to pay. 

After the services are rendered, send out the patient’s invoice as soon as possible. Automate as much of the process as possible to shorten timelines. 

Provide e-statements and other electronic invoice delivery methods to reduce payment processing time. Furthermore, you can increase payment frequency and reduce receipt time by automating services. 

Gather payments in Advance

Patients who do not have insurance should pay on the day of their clinic appointment. This way, you won’t have to waste staff time chasing patients down for payments or establishing a payment plan after they leave. If a patient has insurance, it’s critical to remind patients about their copay obligations before the appointment. If you want, you can text them a reminder, “Don’t forget your Copay?”

Patients will know their expected copay (from the information you sourced, or it will be printed directly on their insurance identification card). They should not request you to submit the copay portion to insurance for processing instead of paying on the spot.

Manage Bills and Payments via the Patient Portal 

It can be challenging to collect patient payments. Making your payment process easy to access is the best way to ensure that your patients can pay their bills on time. To maximize revenue cycle management, providers need all the help they can get. Due to the decline of in-person appointments and payments, online payments through patient portals are becoming even more vital to the bottom line of medical practices and clinics. It not only helps practices financially, but it also helps improve patient satisfaction.

A quality patient portal should offer a fully integrated billing interface, which allows patients to view and understand their bills, ask questions, and process payments. Patients who understand their bills and payments better are more likely to pay.

Provide Payment Plans

In cases where patients are motivated to pay but cannot pay the entire bill upfront, payment plans may be a better choice. The availability of flexible payment plans will help your practice increase collections and assure patients that they can afford the treatments they require.

Patients receiving large bills and who say they can’t pay the whole amount right away may benefit from these payment plans. Ensure that your staff knows how to explain these options and track them appropriately. Payment plans should comply with all state and federal regulations. 

Prepare an Emergency Plan

Even if you implement new collection strategies to speed up payment processing, you will still experience a delay in payments. If cash flow is tight, a medical clinic still needs to be able to operate and pay its bills.

If accounts receivable are behind, a proactive cash management plan should be a backup. Fortunately, clinics and medical practices can get a healthcare business loan to fund expenses until invoices are paid. 

When you use this strategy, you can wait until the last minute to collect invoices and request only the amount you need for expenses. Improving your collection methods will allow you to require fewer loans as your clinic continues to grow. 

Invest in the Technology Systems and Software

Technology solutions can help you maximize patient collections. Examine the latest medical billing software to ensure that it contains all the features your staff needs to perform the billing process effectively.

This is a situation in which online capabilities are crucial. Since more and more patients are accustomed to doing everything online, including paying their bills, you should take advantage of that. A few clicks on the web browser are enough for them to pay their bills via the Internet.

Providing patients with easy access to bills and a quick, digital way to reimburse your practice can make a big difference in the bottom line.

In addition to letting your employees work more efficiently, technology will allow them to track how long people have owed money. This will enable them to track denied claims due to staff coding errors.

A secure email may increase the likelihood of reimbursement for a patient receiving a late payment reminder. When a paper statement gets buried in junk mail, it may not be noticed for months, resulting in payment delays.


Although medical practices and clinics provide a service to patients, they must view their processes from the perspective of a business. Thus, it is crucial to ensure that patients pay their invoices on time to ensure the success of your clinic.  

Tap Into Our Expertise

Feel free to contact us for assistance with medical billing and coding during this uncertain time. 

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!

2022 Coding and Billing Updates for COVID-19 Services and Testing June 29, 2022

covid testing cpt codes

Many things have changed in the healthcare industry since the emergence of COVID-19 (2019-Novel Coronavirus). Besides straining medical supplies and personnel, it also sped up the process of producing and publishing coding guidelines. 

This blog article provides a guide to 2022 coding and billing updates for COVID-19 services and testing.

When to use the cs modifier for COVID-19? 

We use modifier CS on visits related to testing for COVID-19. The latest COVID-19 billing guidelines also state that physicians can apply it to two contexts relating to coding and billing.

  • The visit could be virtual or in-person for suspected or probable exposure to COVID-19.
  • Tests for diagnosing COVID-19 without including a COVID-19 test

Let’s examine each case individually.

Suspected or Probable Exposure to COVID-19 

When billing for virtual/in-person for suspected COVID-19 exposure, you typically use the following E/M codes:

  • ICD-10 codes Z03.818, Z20.822, and Z20.828
  • Modifier CS
  • If the patient is receiving virtual care, append the modifier GQ, GT, or 95

Modifier CS can also apply for these services:

  • If the result of the service involves the order for or the administration of a COVID-19 test
  • If the service relates to delivering or administering tests
  • If the purpose of the service is to evaluate and determine if the patient needs COVID-19 testing

The cost-share will be waived through April 20th, 2021. Thus, providers need to understand that the cost-share will be waived only when they bill the correct ICD-10 code and modifier CS.

What is Modifier CR? 

It indicates whether Medicare payment for a service is subject to the Centers for Medicare & Medicaid Services (CMS) approval. As a reminder, the CMS has informed us that the CR modifier does not apply to claims recently added to the CMS list of services that may be provided by telehealth.

It is also possible to bill modifier CR or condition code DR in place of modifier CS. Also, a customer cost-share will apply to services unrelated to COVID-19.

Tests for Diagnosing COVID-19

These are the common codes used for tests relating to COVID-19:

  • ICD-10 codes Z03.818, Z20.822, or Z20.828
  • Modifier CS

These codes are used for laboratory tests in cases where COVID-19 may be suspected. These tests must be reasonable practices to rule out the presence of COVID-19.

Only the code for the panel test will be reimbursed if the COVID-19-related test is part of the laboratory panel code.

If the test is not part of a laboratory panel but rather part of a series of pathogen tests, the relevant unbundling edits may be applicable.

Source: Journal of Ahima, 2021

Monoclonal Antibody Treatment Administration for Commercial Health Plans 

  • This billing guidance applies only to urgent care facilities with an all-inclusive rate per case, per diem, per visit, and per unit.
  • We are following the place of service testing and case rate guidelines per the Centers for Medicare & Medicaid Services (CMS).
  • An in-network urgent care center must bill with the place of service 20 on a CMS-1500 form
  • Accordingly, we will pay 100% of the CMS allowable rate for the codes below.

Service: COVID-19 Testing at Urgent Care Facilities

ServiceCodes to billAdditional Information
COVID-19 testing at urgent care facilities*87635
Through the end of the Public Health Emergency (PHE), COVID-19 testing at urgent care facilities will be reimbursed if billed with a COVID-19 procedure code along with one of the appropriate Z codes (Z20.828, Z03.818, and Z20.822). Whenever a health care professional bills a visit code on the same date of service as a COVID-19 testing code, the assigned medical practice will deny the testing code with remark Code: I4.
COVID-19 vaccine administration at urgent care facilities*0001A 
Through the end of the public health emergency, COVID-19 vaccine administration will be reimbursed for in-network health care professionals if billed with the appropriate codes.
Whenever a health care professional bills a visit code on the same date of service as a COVID-19 vaccine code claim for the same patient, the assigned medical practice will deny the vaccine code.
Monoclonal antibody treatmentCodes available through Jan. 31, 2022: 

M0247 (Outpatient) 

Codes available through April 5, 2022: 
• Q0247 
• M0247 (Outpatient) 
• M0248 (Home) 

Codes available after April 6, 2022: 

Bebtelovimab HCPCS code: Q0222 

Administration code: 
• M0222 (Outpatient) 
• M0223 (Home Infusion)

Evusheld HCPS Code: 
• Q0220 

Administration Code:
• M0220 (Outpatient) 
• M0221 (Home)

*These codes will price at $0 because of funds provided by the government.
Whenever a health care professional bills a visit code on the same date of service as a COVID-19 monoclonal antibody treatment claim for the same patient, the assigned medical practice will deny the vaccine code.

Newly Added Vaccine and Administration CPT Codes 2022

CPT CodeDescription
0074AAdministration, booster dose
91309Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use 
(Report 91309 with administration code 0094A) 
(Do not report 91309 in conjunction with administration codes 0011A, 0012A, 0013A, 0064A) 
0094AAdministration, booster dose
91310Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, for intramuscular use 
(Sanofi Pasteur)(Report 91310 with administration code 0104A)
0104AAdministration, booster dose

New Guidelines for Outpatient Services Under COVID-19 Cost Share Waiver

Use the CS modifier on appropriate outpatient claim lines for services provided through the end of the Public Health Emergency (PHE). This illustrates that the service is eligible for a cost-share waiver for COVID-19 testing-related services contracted for and related to the provision or administration of a COVID-19 test. 

Providers will receive a waiver of cost-share when they: 

  • Submitting a claim line with CS modifier (professional, facility, telehealth) with a specific outpatient E&M or HCPCS code and when billed of probable or suspected exposure to COVID-19: ICD Z20.822 as the primary diagnosis, as needed.
  • Submits a COVID-19 CPT/HCPCS claim line testing for preoperative procedures. 
  • Z01.810 – preprocedural cardiovascular examination 
  • Z01.811 – preprocedural respiratory examination 
  • Z01.812 – preprocedural laboratory examination 
  • Z01.818 – other preprocedural examination
  • For each additional lab test other than the COVID-19 diagnostic test, a CS modifier must be added to each claim line. If the lab test was ordered specifically to determine a diagnosis of COVID-19 and if billed with probable or suspected exposure to COVID-19, a primary diagnosis of Z20.822 should be put forth.
For Billing Guidelines
Dates of service on or after March 1, 2020, and for the duration of the PHEEffective January 1, 2022 

The POS 02 description was revised and a new code, POS 10, was developed. The place of service billed is dependent on where the patient is located during the telehealth service. When billing for telehealth services, use: 

POS 02: Telehealth Provided Other than in Patient’s Home 
Patients are not located in their homes when they receive health services or related services via telecommunication.

POS 10: Telehealth Provided in Patient’s Home 
In the case of receiving health services or health-related services via telecommunication, the patient is located at home (other than a hospital or other facility where they receive care in a private residence).

We hope that this guide to COVID-19 updates in coding and billing for 2022 has been useful to you. Visit the American Medical Association (AMA) for more information on COVID-19 codes, services, and vaccine updates.

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