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Healthcare RCM Insights

Expert perspectives on revenue cycle management, risk adjustment, quality improvement, and the technology shaping the future of healthcare operations.

279Articles
9Topics
2026Updated
Featured Articles
276 articles
4 Tips to Be a Pro in Medical Billing
Revenue Cycle May 22, 2026

4 Tips to Be a Pro in Medical Billing

Four core competencies separating billing professionals from beginners: payer-specific expertise, denial management, AR follow-up discipline, and data-driven improvement.

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NCCI Edits Guide: Understanding Medicare's National Correct Coding Initiative and Modifier Overrides
Medical Coding Aug 17, 2026

NCCI Edits Guide: Understanding Medicare's National Correct Coding Initiative and Modifier Overrides

NCCI Procedure-to-Procedure (PTP) edit pairs and modifier indicator 0 vs. 1, correct use of Modifier 59 and X-modifiers (XE, XS, XP, XU) with documentation requirements, Medically Unlikely Edits (MUEs) and MAI adjudication indicators, correct coding principles for comprehensive vs. component codes, and NCCI compliance program design to prevent unbundling audit findings.

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Medical Coding Audit Preparation Guide: How to Survive a RAC, OIG, or Internal Audit
Compliance Aug 18, 2026

Medical Coding Audit Preparation Guide: How to Survive a RAC, OIG, or Internal Audit

RAC, TPE, CERT, UPIC, and payer audit types and response strategies, high-risk coding areas auditors target including E&M upcoding and Modifier 59 misuse, responding to ADRs with complete defensible documentation, Medicare 5-level appeals process and extrapolation challenges, and building a proactive internal coding audit program with OIG Work Plan monitoring.

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Charge Capture Guide: Preventing Revenue Leakage From Missed and Undercoded Services
Revenue Cycle Aug 19, 2026

Charge Capture Guide: Preventing Revenue Leakage From Missed and Undercoded Services

Charge capture workflow from service delivery through claim generation, common missed charge scenarios including add-on codes, consults, and inpatient daily visits, charge capture technology from EHR modules to AI-assisted charge generation, reconciliation processes for outpatient, OR, and inpatient settings, and measuring charge capture rate vs. revenue-per-encounter benchmarks.

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Workers' Compensation Billing Guide: How to Bill Work Injury Claims, Fee Schedules, and State Rules
Revenue Cycle Aug 21, 2026

Workers' Compensation Billing Guide: How to Bill Work Injury Claims, Fee Schedules, and State Rules

WC billing vs. commercial insurance — separate payer, no patient cost-sharing, state-specific fee schedules, state WC fee schedule structure and rates, utilization review authorization with evidence-based treatment guidelines, claim submission to adjusters with WC-specific form requirements, and WC dispute resolution through state appeals boards and independent medical review.

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Hospital Billing Guide: UB-04, Revenue Codes, DRGs, and Facility vs. Professional Billing
Revenue Cycle Aug 22, 2026

Hospital Billing Guide: UB-04, Revenue Codes, DRGs, and Facility vs. Professional Billing

UB-04 claim form elements including Type of Bill, condition codes, and occurrence codes, revenue code categories for hospital departments and services, inpatient IPPS DRG payment calculation with CC/MCC impact, outpatient OPPS APC reimbursement and packaging rules, chargemaster vs. actual reimbursement gap, and facility vs. professional billing for hospital-employed and independent physicians.

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Dental Billing Guide: CDT Codes, Medical Necessity Cross-Billing, and Insurance Coordination
Medical Coding Aug 23, 2026

Dental Billing Guide: CDT Codes, Medical Necessity Cross-Billing, and Insurance Coordination

CDT code structure by category (diagnostic D0, preventive D1, restorative D2, endodontics D3, periodontics D4, oral surgery D7, orthodontics D8), ADA claim form requirements and dental clearinghouse ecosystem, dental insurance benefit tiers with annual maximums vs. medical insurance, medical-dental cross-billing for medically necessary procedures using CPT codes on CMS-1500, and orthodontic billing conventions.

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Patient Access and Registration Guide: Front-End Revenue Cycle Best Practices
Revenue Cycle Aug 24, 2026

Patient Access and Registration Guide: Front-End Revenue Cycle Best Practices

Scheduling and pre-registration information capture to prevent downstream denials, insurance eligibility verification timing and 270/271 transaction workflow, prior authorization management including PA matrix maintenance and tracking, patient registration demographic accuracy requirements for clean claims, point-of-service collection strategies and copay collection compliance, and how 60-70% of claim denials originate from front-end errors.

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Medical Billing Software Guide: EHR vs. PMS, Standalone Billing Software, and RCM Platform Selection
Technology Aug 25, 2026

Medical Billing Software Guide: EHR vs. PMS, Standalone Billing Software, and RCM Platform Selection

EHR vs. PMS functional distinctions and overlap at charge capture, integrated suite vs. best-of-breed standalone approach trade-offs, key features to evaluate including eligibility verification, claim scrubbing, ERA auto-posting, denial management, and analytics, leading vendors by practice size segment, and hidden total cost of ownership factors including implementation, transaction fees, and productivity loss during transition.

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Value-Based Care Billing Guide: ACOs, Bundled Payments, MIPS, and Alternative Payment Models
Revenue Cycle Aug 26, 2026

Value-Based Care Billing Guide: ACOs, Bundled Payments, MIPS, and Alternative Payment Models

ACO Medicare Shared Savings Program mechanics including risk-adjusted benchmarking and attribution, BPCI-A bundled payment episode cost management and target price risk adjustment, MIPS four-category performance scoring and payment adjustment range, Advanced APM qualifying threshold and 5% APM incentive payment, and HCC coding accuracy as the foundation for ACO and APM risk-adjusted performance.

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Payer Contracting and Negotiation Guide: How to Negotiate Better Insurance Contracts for Your Practice
Revenue Cycle Aug 27, 2026

Payer Contracting and Negotiation Guide: How to Negotiate Better Insurance Contracts for Your Practice

Payer contract analysis comparing revenue and rate by payer as a percentage of Medicare RBRVS, fee schedule benchmarking against MGMA data and peer rates, negotiation leverage strategies using market position and quality metrics, contract language red flags including MFN clauses and unilateral amendment rights, and payer relationship management with annual performance reviews.

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Skilled Nursing Facility (SNF) Billing Guide: Medicare PDPM, RUG-IV, and SNF Revenue Cycle
Post-Acute Care Aug 28, 2026

Skilled Nursing Facility (SNF) Billing Guide: Medicare PDPM, RUG-IV, and SNF Revenue Cycle

Medicare Part A SNF coverage criteria including the three-day qualifying hospital inpatient stay requirement and observation status pitfalls, PDPM five-component case-mix classification replacing RUG-IV therapy-minutes model, MDS assessment timing and ICD-10 coding accuracy for PDPM revenue, SNF consolidated billing requirements for outside providers, and SNF Advance Beneficiary Notice (NOMNC) obligations before coverage termination.

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Home Health Billing Guide: PDGM, OASIS, Medicare Coverage, and Home Health Revenue Cycle
Post-Acute Care Aug 29, 2026

Home Health Billing Guide: PDGM, OASIS, Medicare Coverage, and Home Health Revenue Cycle

Medicare home health coverage criteria including homebound status definition and face-to-face encounter requirement, PDGM five-component payment classification including admission source, timing, clinical grouping, functional impairment level, and comorbidity adjustment, OASIS clinical assessment timing and item accuracy for PDGM classification, LUPA threshold monitoring and management, and home health UB-04 claim submission requirements.

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Hospice Billing Guide: Medicare Hospice Benefit, Levels of Care, and Hospice Revenue Cycle
Post-Acute Care Aug 30, 2026

Hospice Billing Guide: Medicare Hospice Benefit, Levels of Care, and Hospice Revenue Cycle

Medicare hospice eligibility criteria including six-month prognosis certification and hospice election statement, four levels of hospice care billing including Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care per diem rates, physician certification and face-to-face recertification requirements, aggregate hospice cap and inpatient cap calculations, and monthly UB-04 claim submission requirements.

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Radiology Billing Guide: Technical Component, Professional Component, Modifiers, and Radiology RCM
Medical Coding Aug 31, 2026

Radiology Billing Guide: Technical Component, Professional Component, Modifiers, and Radiology RCM

Technical component (TC) vs. professional component (PC) billing using Modifier TC and Modifier 26, global radiology billing for freestanding imaging centers, contrast agent CPT coding for without contrast vs. with contrast vs. without and with contrast study variants, prior authorization and Appropriate Use Criteria (AUC) requirements for advanced imaging, and interventional radiology procedure and catheter placement code selection.

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Anesthesia Billing Guide: Base Units, Time Units, Qualifying Circumstances, and Anesthesia RCM
Medical Coding Sep 1, 2026

Anesthesia Billing Guide: Base Units, Time Units, Qualifying Circumstances, and Anesthesia RCM

Anesthesia unit-based billing formula of base units plus time units plus qualifying circumstance units multiplied by conversion factor, anesthesia CPT code selection by procedure and anatomical region, qualifying circumstances add-on codes 99100-99140 for age and emergency conditions, anesthesia modifiers AA and QK for personally performed vs. medically directed cases, CRNA billing with QX and QZ modifiers, and the seven TEFRA medical direction conditions.

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Physical Therapy Billing Guide: Timed vs. Untimed Codes, KX Modifier, and PT Revenue Cycle
Medical Coding Sep 2, 2026

Physical Therapy Billing Guide: Timed vs. Untimed Codes, KX Modifier, and PT Revenue Cycle

Timed PT CPT codes including 97110 therapeutic exercise, 97112 neuromuscular reeducation, and 97140 manual therapy billed in 15-minute units using the 8-minute rule, PT evaluation complexity levels 97161-97163 for low to high complexity, Medicare therapy threshold and KX modifier attestation for services above the annual financial limit, PTA billing with CQ modifier and 15% payment reduction, and PT supervision and incident-to billing requirements.

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Auto Insurance and Personal Injury Medical Billing Guide: No-Fault, PIP, MedPay, and Lien-Based Billing
Revenue Cycle Sep 3, 2026

Auto Insurance and Personal Injury Medical Billing Guide: No-Fault, PIP, MedPay, and Lien-Based Billing

No-fault PIP billing with state-specific fee schedules and 30-day timely filing requirements, MedPay coordination with health insurance for accident-related treatment, letter of protection (LOP) lien-based billing for personal injury patients with pending liability settlements, health insurance subrogation and Medicare secondary payer rules for auto accident cases, and systematic auto accident billing workflow from registration through settlement collection.

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Oncology Billing Guide: Chemotherapy Administration Codes, Infusion Hierarchy, Drug Coding, and Oncology RCM
Medical Coding Sep 4, 2026

Oncology Billing Guide: Chemotherapy Administration Codes, Infusion Hierarchy, Drug Coding, and Oncology RCM

CPT infusion administration hierarchy with chemotherapy codes 96413-96417 as primary over therapeutic and hydration infusions, HCPCS J-code chemotherapy drug unit calculation and buy-and-bill reimbursement at ASP plus 6% for Medicare, 340B drug pricing and Modifier JW waste documentation, prior authorization for oncology regimens with NCCN guideline support, and Modifier 25 documentation requirements for E&M billed with infusion on the same day.

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Behavioral Health Billing Guide: Mental Health CPT Codes, Parity Laws, Telehealth, and BH Revenue Cycle
Medical Coding Sep 5, 2026

Behavioral Health Billing Guide: Mental Health CPT Codes, Parity Laws, Telehealth, and BH Revenue Cycle

Psychotherapy time-based CPT codes 90832-90837 for standalone sessions vs. E&M plus psychotherapy add-on codes 90833-90838, psychiatric diagnostic evaluation codes 90791-90792, Mental Health Parity and Addiction Equity Act (MHPAEA) non-quantitative treatment limitation compliance, behavioral health telehealth billing with POS 10 and Modifier 95, substance use disorder SBIRT and MAT billing codes, and LCSW vs. psychiatrist billing differences including 75% Medicare reimbursement rate for LCSWs.

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Orthopedic Billing Guide: Fracture Care, Global Surgery Period, Joint Replacement Bundled Payments, and Orthopedic RCM
Medical Coding Sep 6, 2026

Orthopedic Billing Guide: Fracture Care, Global Surgery Period, Joint Replacement Bundled Payments, and Orthopedic RCM

90-day global surgery period content including included vs. separately billable post-operative services with Modifiers 24 and 78, fracture care closed vs. open reduction CPT code selection by anatomical site, knee and shoulder arthroscopy code selection with multiple procedure Modifier 51, spinal surgery layered coding for decompression plus arthrodesis plus instrumentation by level, implant and device billing, and BPCI-A joint replacement bundled payment episode cost management.

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Pediatric Billing Guide: Well-Child Visits, Vaccines, EPSDT, CHIP, and Pediatric Revenue Cycle
Medical Coding Sep 7, 2026

Pediatric Billing Guide: Well-Child Visits, Vaccines, EPSDT, CHIP, and Pediatric Revenue Cycle

Pediatric billing involves well-child visit preventive care codes age-banded from infant through adolescent, vaccine administration CPT codes 90460 and 90471 with HCPCS product codes and VFC program billing, EPSDT mandatory Medicaid coverage for children under 21 including developmental screening codes 96110 and 96127, CHIP billing and eligibility verification, and same-day well-child plus sick visit billing with Modifier 25.

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Cardiology Billing Guide: Echocardiography, Cardiac Catheterization, Nuclear Cardiology, and Cardiology RCM
Medical Coding Sep 8, 2026

Cardiology Billing Guide: Echocardiography, Cardiac Catheterization, Nuclear Cardiology, and Cardiology RCM

Cardiology billing covers echocardiography TC/PC component billing with complete vs. limited TTE codes 93306-93308, nuclear myocardial perfusion imaging SPECT codes 78451-78452 with radiopharmaceutical HCPCS codes, cardiac catheterization CPT codes 93454-93461 with PCI codes 92928 and 92943, electrophysiology ablation codes 93653-93656 and device management, and remote cardiac monitoring billing with extended monitoring codes 93241-93248.

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Dermatology Billing Guide: Skin Lesion Excision, Mohs Surgery, Cosmetic vs. Medical Coding, and Dermatology RCM
Medical Coding Sep 9, 2026

Dermatology Billing Guide: Skin Lesion Excision, Mohs Surgery, Cosmetic vs. Medical Coding, and Dermatology RCM

Dermatology billing requires skin lesion excision coding by benign vs. malignant status and excision diameter by anatomical site (11400-11646), Mohs micrographic surgery staged excision coding with 17311-17315 including tissue block add-ons, cosmetic vs. medically necessary service segregation with ABN documentation, benign and premalignant lesion destruction add-on codes 17000-17004, and phototherapy per-session billing with prior authorization for psoriasis and atopic dermatitis.

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Emergency Medicine Billing Guide: ED E&M Levels, Critical Care, EMTALA, and Emergency Department RCM
Medical Coding Sep 10, 2026

Emergency Medicine Billing Guide: ED E&M Levels, Critical Care, EMTALA, and Emergency Department RCM

Emergency medicine billing uses ED-specific E&M codes 99281-99285 based solely on Medical Decision Making with no new vs. established distinction, critical care time billing with 99291 for first 30-74 minutes and 99292 add-on for each additional 30 minutes, EMTALA obligations and compliant patient financial screening processes, No Surprises Act out-of-network emergency physician billing requirements and IDR process, and ED procedure coding for laceration repair, airway management, and moderate sedation.

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Laboratory Billing Guide: Medicare Clinical Lab Fee Schedule, PAMA, CLIA, and Clinical Laboratory RCM
Medical Coding Sep 11, 2026

Laboratory Billing Guide: Medicare Clinical Lab Fee Schedule, PAMA, CLIA, and Clinical Laboratory RCM

Laboratory billing operates under the Medicare Clinical Laboratory Fee Schedule with PAMA private payer rate reporting requirements, CLIA certification requirements by test complexity level from waiver certificate through certificate of compliance, ABN and advance beneficiary notice requirements for non-covered tests with GA and GZ modifier usage, molecular diagnostics billing with Tier 1 and Tier 2 molecular pathology CPT codes and Proprietary Laboratory Analyses PLA codes, and LCD and NCD coverage determination compliance workflows for laboratory billing.

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DME Billing Guide: DMEPOS HCPCS Codes, Medicare Coverage, Competitive Bidding, and DME Revenue Cycle
Medical Coding Sep 12, 2026

DME Billing Guide: DMEPOS HCPCS Codes, Medicare Coverage, Competitive Bidding, and DME Revenue Cycle

DMEPOS billing uses HCPCS Level II E, K, A, and L codes with rental vs. purchase modifiers RR and NU, Medicare durable medical equipment coverage criteria including the four-part coverage test and face-to-face examination requirements, Competitive Bidding Program contract supplier requirements and payment impacts, Certificate of Medical Necessity CMN completion by treating physician, oxygen therapy rental billing with 36-month cap, and CPAP coverage criteria with 90-day compliance evaluation requirement.

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Ambulatory Surgery Center Billing Guide: ASC Payment System, Covered Procedures, and ASC Revenue Cycle
Revenue Cycle Sep 13, 2026

Ambulatory Surgery Center Billing Guide: ASC Payment System, Covered Procedures, and ASC Revenue Cycle

Ambulatory surgery center billing covers Medicare ASC payment system at 65.6% of OPPS APC rates with packaged services and device-intensive procedure offsets, covered vs. excluded procedures on the ASC covered procedures list, UB-04 facility claim billing with Type of Bill 831X and revenue code 0360, implant and device-intensive procedure pass-through and carve-out billing, commercial payer ASC contracting with percentage of Medicare and implant carve-out provisions, and ASC Conditions for Coverage compliance requirements.

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Urgent Care Billing Guide: Walk-In Visit Codes, POS 20, Facility vs. Professional Billing, and Urgent Care RCM
Revenue Cycle Sep 14, 2026

Urgent Care Billing Guide: Walk-In Visit Codes, POS 20, Facility vs. Professional Billing, and Urgent Care RCM

Urgent care billing uses office/outpatient E&M codes 99202-99215 with Place of Service 20 for urgent care facility, new vs. established patient determination for walk-in practices with predominantly new patient population, same-day E&M and procedure billing with Modifier 25 for laceration repair and splinting, real-time insurance eligibility verification for walk-in patients with unknown coverage, X-ray global vs. TC/PC component billing, workers compensation billing requirements, and freestanding vs. hospital provider-based urgent care facility and professional billing models.

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Nephrology and Dialysis Billing Guide: ESRD Monthly Capitation, Dialysis CPT Codes, CKD Management, and Nephrology RCM
Medical Coding Sep 15, 2026

Nephrology and Dialysis Billing Guide: ESRD Monthly Capitation, Dialysis CPT Codes, CKD Management, and Nephrology RCM

Nephrology billing covers ESRD Medicare eligibility regardless of age with 30-month MSP coordination period for employer group health insurance, dialysis facility ESRD PPS bundle payment system including bundled drugs and laboratory monitoring, nephrologist ESRD Monthly Capitation Payment MCP codes 90960-90966 based on face-to-face visit frequency, separately billable services beyond MCP including hospital visits and non-ESRD office visits, CKD stages 1-5 management with E&M coding and chronic care management billing, and kidney transplant professional billing with post-transplant immunosuppressive drug coverage.

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FQHC Billing Guide: Federally Qualified Health Center Prospective Payment, Sliding Fee Scales, and FQHC RCM
Revenue Cycle Sep 16, 2026

FQHC Billing Guide: Federally Qualified Health Center Prospective Payment, Sliding Fee Scales, and FQHC RCM

FQHC billing uses per-encounter Prospective Payment System rates with G0466-G0470 encounter codes replacing individual CPT codes for Medicare, Medicaid managed care wraparound payment reconciliation for the difference between MCO payment and Medicaid PPS rate, sliding fee discount schedule requirements for patients at or below 200% of federal poverty level, 340B Drug Pricing Program eligibility and Modifier JG billing for drugs acquired at 340B prices, and FQHC vs. FQHC look-alike designation differences affecting Section 330 grant funding and FTCA coverage.

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Obstetrics and Gynecology Billing Guide: Global OB Package, Gynecology Procedures, and OB/GYN RCM
Revenue Cycle Sep 26, 2026

Obstetrics and Gynecology Billing Guide: Global OB Package, Gynecology Procedures, and OB/GYN RCM

OB/GYN billing covers the global obstetric care package CPT codes 59400 59510 59610 bundling antepartum delivery and postpartum care, component OB billing with antepartum-only codes 59425-59426 and delivery-only codes 59409 59514 when the complete package is not provided, high-risk obstetrics antepartum fetal surveillance NST 59025 biophysical profile 76818 and obstetric ultrasound billing, gynecology procedure codes for colposcopy 57452-57461 hysteroscopy 58555-58563 and hysterectomy, and Medicaid OB reimbursement and locum tenens OB billing.

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Rheumatology Billing Guide: Joint Injections, Biologic Infusions, Arthrocentesis, and Rheumatology RCM
Medical Coding Sep 25, 2026

Rheumatology Billing Guide: Joint Injections, Biologic Infusions, Arthrocentesis, and Rheumatology RCM

Rheumatology billing covers arthrocentesis and joint injection CPT codes by major intermediate and small joint size with ultrasound guidance codes 20611 20606 and 20604, viscosupplementation hyaluronic acid HCPCS drug billing, IV biologic infusion billing for infliximab J1745 abatacept J0129 rituximab J9312 and tocilizumab J3262 with biosimilar Q-codes, RA biologic prior authorization documentation with DAS28 disease activity scoring and DMARD step therapy, and rheumatology buy-and-bill drug margin management.

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Allergy and Immunology Billing Guide: Allergy Testing, Immunotherapy, IVIG, and Allergy RCM
Medical Coding Sep 24, 2026

Allergy and Immunology Billing Guide: Allergy Testing, Immunotherapy, IVIG, and Allergy RCM

Allergy and immunology billing covers percutaneous allergy testing CPT 95004 and intradermal testing 95024 billed per allergen test, allergen immunotherapy split billing between preparation 95165 per dose and injection administration 95115-95117, IVIG infusion billing with drug-specific HCPCS codes for primary immunodeficiency, biologic injection billing for asthma agents including omalizumab J2357 mepolizumab J2182 and dupilumab J0173 with prior authorization step therapy requirements, and allergy practice revenue cycle management.

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Ophthalmology Billing Guide: Eye Exam Codes, Intravitreal Injections, Cataract Surgery, and Ophthalmology RCM
Medical Coding Sep 23, 2026

Ophthalmology Billing Guide: Eye Exam Codes, Intravitreal Injections, Cataract Surgery, and Ophthalmology RCM

Ophthalmology billing uses specialty-specific eye exam codes 92002-92014 instead of standard E&M codes, intravitreal injection CPT 67028 with anti-VEGF drug HCPCS codes for aflibercept J0178 ranibizumab J2778 and faricimab J0180, cataract surgery 66984 with 90-day global period and premium IOL upgrade non-covered patient billing compliance, glaucoma and retinal procedure codes including panretinal photocoagulation 67228, and vision vs. medical insurance routing for ophthalmology practices.

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Neurology Billing Guide: EEG, EMG/NCS, Botox for Headache, Epilepsy Monitoring, and Neurology RCM
Medical Coding Sep 22, 2026

Neurology Billing Guide: EEG, EMG/NCS, Botox for Headache, Epilepsy Monitoring, and Neurology RCM

Neurology billing covers EEG CPT code selection by study duration and video monitoring status with epilepsy monitoring unit billing, EMG and nerve conduction study coding 95907-95913 with individual nerve documentation requirements, onabotulinumtoxinA Botox CPT 64615 for chronic migraine with prior authorization step therapy requirements, evoked potential and transcranial Doppler billing, lumbar puncture and nerve block procedure codes, and neurology revenue cycle management including inpatient stroke and DBS programming billing.

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Pulmonology Billing Guide: Pulmonary Function Tests, Bronchoscopy, Sleep Medicine, and Pulmonology RCM
Medical Coding Sep 21, 2026

Pulmonology Billing Guide: Pulmonary Function Tests, Bronchoscopy, Sleep Medicine, and Pulmonology RCM

Pulmonology billing covers pulmonary function test CPT codes by test type including spirometry 94010 and 94060 with bronchodilator DLCO add-on 94729 and plethysmography 94726, bronchoscopy procedure coding with EBUS 31652-31654 and transbronchial biopsy add-on codes, sleep medicine billing distinguishing attended polysomnography 95810-95811 from home sleep apnea testing 95800-95806 with Medicare NCD coverage criteria, thoracentesis with ultrasound guidance 32555, and critical care and ventilator management billing.

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Infusion Center Billing Guide: Drug Administration Codes, Infusion Hierarchy, Drug HCPCS Billing, and Infusion RCM
Revenue Cycle Sep 20, 2026

Infusion Center Billing Guide: Drug Administration Codes, Infusion Hierarchy, Drug HCPCS Billing, and Infusion RCM

Infusion center billing requires mastery of drug administration hierarchy rules with one initial code per encounter and sequential add-on codes 96367 and concurrent add-on 96368, therapeutic infusion CPT codes 96365-96368 vs. chemotherapy administration codes 96413-96417, drug HCPCS J-code billing with NDC numbers and Modifier JW for drug wastage and Modifier JG for 340B-acquired drugs, buy-and-bill financial risk management, and prior authorization management for specialty biologics.

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Wound Care Billing Guide: Wound Debridement Codes, Skin Substitutes, Hyperbaric Oxygen, and Wound Care RCM
Medical Coding Sep 19, 2026

Wound Care Billing Guide: Wound Debridement Codes, Skin Substitutes, Hyperbaric Oxygen, and Wound Care RCM

Wound care billing covers debridement CPT code selection by tissue depth with selective debridement 97597-97598 and surgical debridement 11042-11047 by subcutaneous tissue muscle fascia and bone depth, cellular and tissue-based product skin substitute HCPCS billing in HOPD vs. physician office settings, hyperbaric oxygen therapy Medicare LCD coverage criteria for Wagner Grade III diabetic foot wounds, negative pressure wound therapy 97605-97608 billing, and wound care center revenue cycle management.

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Gastroenterology Billing Guide: Colonoscopy Coding, Upper Endoscopy, Capsule Endoscopy, and GI Billing RCM
Medical Coding Sep 18, 2026

Gastroenterology Billing Guide: Colonoscopy Coding, Upper Endoscopy, Capsule Endoscopy, and GI Billing RCM

Gastroenterology billing covers colonoscopy CPT code selection by diagnostic vs. screening designation and extent reached with polyp removal technique codes 45378-45392, upper endoscopy EGD billing with biopsy and therapeutic intervention codes 43235-43255, capsule endoscopy coverage criteria and billing for 91110-91113, screening-to-therapeutic colonoscopy conversion with Modifier PT for zero-cost-sharing preservation, and ERCP add-on code billing for sphincterotomy stone extraction and stent placement.

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Medicare Advantage Billing Guide: MA Plan Requirements, Prior Authorization, Star Ratings, and Medicare Advantage RCM
Revenue Cycle Sep 17, 2026

Medicare Advantage Billing Guide: MA Plan Requirements, Prior Authorization, Star Ratings, and Medicare Advantage RCM

Medicare Advantage billing differs fundamentally from traditional Medicare: MA plans have their own fee schedules, prior authorization requirements for services traditional Medicare never requires PA for, HCC risk adjustment coding requirements affecting MA plan capitation payments, Star Ratings quality measures affecting provider incentive payments, and MA-specific denial patterns and appeals through the five-level Medicare appeals process.

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Palliative Care Billing Guide: Advance Care Planning, Hospice vs. Palliative Care Billing, and Palliative Care RCM
Revenue Cycle Oct 6, 2026

Palliative Care Billing Guide: Advance Care Planning, Hospice vs. Palliative Care Billing, and Palliative Care RCM

Palliative care billing covers advance care planning CPT codes 99497-99498 with same-day AWV billing rules, palliative care E&M coding for complex symptom management using High MDM or total time, the distinction between palliative care E&M billing and Medicare hospice benefit Part A billing, concurrent care Modifier GV for attending physician Part B services to hospice patients for conditions unrelated to the terminal illness, and hospital-based and outpatient palliative care program revenue cycle management.

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Radiation Oncology Billing Guide: Treatment Planning, IMRT, SBRT, Brachytherapy, and Radiation Oncology RCM
Medical Coding Oct 5, 2026

Radiation Oncology Billing Guide: Treatment Planning, IMRT, SBRT, Brachytherapy, and Radiation Oncology RCM

Radiation oncology billing covers treatment planning CPT codes 77261-77295 by complexity level, IMRT planning 77301 and delivery codes 77385 simple vs. 77386 complex for VMAT, SBRT per-fraction delivery 77373 and per-course management 77435, stereotactic radiosurgery 61796-61797, brachytherapy HDR codes 77770-77772 and LDR seed source HCPCS A9527, treatment management 77427 per 5 fractions with weekly physician documentation, and technical vs. professional component billing for freestanding and hospital-based radiation oncology.

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Home Health Billing Guide: OASIS, RAPs, PDGM, Medicare Conditions of Participation, and Home Health RCM
Revenue Cycle Oct 4, 2026

Home Health Billing Guide: OASIS, RAPs, PDGM, Medicare Conditions of Participation, and Home Health RCM

Home health billing under Medicare PDGM covers Patient-Driven Groupings Model 30-day payment period grouping by clinical group admission source and functional impairment level, OASIS-E assessment accuracy and primary diagnosis selection for correct PDGM group assignment, homebound status documentation requirements for Medicare coverage, RAP submission within 5-day timely filing window, face-to-face encounter physician certification compliance, LUPA threshold management, and home health agency revenue cycle management.

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Hematology and Oncology Billing Guide: Chemotherapy Administration, Oncology E&M, Drug Billing, and Heme-Onc RCM
Medical Coding Oct 3, 2026

Hematology and Oncology Billing Guide: Chemotherapy Administration, Oncology E&M, Drug Billing, and Heme-Onc RCM

Hematology oncology billing covers chemotherapy administration CPT hierarchy 96413-96417 with sequential add-on 96417 and concurrent 96416, cancer drug HCPCS J-code billing with NDC numbers and Modifier JW for single-dose vial wastage and Modifier JG for 340B-acquired drugs, biosimilar Q-code management, oncology E&M with Modifier 25 for same-day infusion visits, supportive care drug billing including G-CSF J2505 and ESA J0885, and prior authorization management for chemotherapy regimens and targeted therapies.

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Behavioral Health Billing Guide: Psychiatric Evaluation, Psychotherapy Codes, Collaborative Care Model, and BH RCM
Medical Coding Oct 2, 2026

Behavioral Health Billing Guide: Psychiatric Evaluation, Psychotherapy Codes, Collaborative Care Model, and BH RCM

Behavioral health billing covers psychiatric diagnostic evaluation 90791-90792, individual psychotherapy timed codes 90832-90837, combined E&M and psychotherapy add-on codes 90833/90836/90838 for prescribing psychiatrists, collaborative care model 99492-99494 for integrated primary care behavioral health programs, mental health parity compliance and parity-based denial appeals, and behavioral health revenue cycle management for psychiatry and psychology practices.

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Physical Therapy Billing Guide: Timed vs. Service-Based Codes, 8-Minute Rule, Functional Limitation Reporting, and PT RCM
Medical Coding Oct 1, 2026

Physical Therapy Billing Guide: Timed vs. Service-Based Codes, 8-Minute Rule, Functional Limitation Reporting, and PT RCM

Physical therapy billing covers timed CPT codes 97110-97542 billed in 15-minute units vs. service-based untimed codes 97010-97036, the Medicare 8-minute rule for calculating billable units from total treatment minutes, KX modifier application when Medicare therapy cap threshold is reached with medical necessity documentation, PT evaluation complexity codes 97161-97163, plan of care certification requirements, and physical therapy revenue cycle management for outpatient PT practices.

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Orthopedic Billing Guide: Joint Replacement, Arthroscopy, Fracture Care, Sports Medicine, and Orthopedic RCM
Medical Coding Sep 30, 2026

Orthopedic Billing Guide: Joint Replacement, Arthroscopy, Fracture Care, Sports Medicine, and Orthopedic RCM

Orthopedic billing covers total joint replacement 90-day global period management for THA 27130 TKA 27447 and TSA 23472, arthroscopy CPT codes 29800-29999 with NCCI bundling rules and add-on code requirements, fracture care coding by open vs. closed treatment and with vs. without manipulation, sports medicine PRP injection 0232T with payer coverage verification, and orthopedic revenue cycle management for surgical practices and ASCs.

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Endocrinology Billing Guide: Diabetes Management, Thyroid Procedures, Bone Density, and Endocrinology RCM
Medical Coding Sep 29, 2026

Endocrinology Billing Guide: Diabetes Management, Thyroid Procedures, Bone Density, and Endocrinology RCM

Endocrinology billing covers diabetes management E&M coding with chronic care management 99490 and principal care management 99424 for complex diabetes patients, CGM professional interpretation billing 95250-95251 with formal written report requirements, insulin pump management coding with 99091 data review, thyroid ultrasound 76536 and ultrasound-guided FNA biopsy 10005-10006, DEXA bone density scanning 77080 with Medicare coverage criteria, and injectable osteoporosis medication HCPCS billing for denosumab J0897 romosozumab J0584 and zoledronic acid J3489.

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Urology Billing Guide: Cystoscopy, Lithotripsy, BPH Procedures, Prostate Coding, and Urology RCM
Medical Coding Sep 28, 2026

Urology Billing Guide: Cystoscopy, Lithotripsy, BPH Procedures, Prostate Coding, and Urology RCM

Urology billing covers cystoscopy CPT codes 52000-52240 with the multiple endoscopy rule for same-session procedures, ureteroscopy and lithotripsy billing including ESWL 50590 and ureteroscopy 52353-52356, BPH treatment procedure coding for TURP 52601 UroLift 52441-52442 and Rezum 53850 with payer coverage requirements, prostate biopsy coding distinguishing TRUS 55700 from MRI-fusion 55706 with prior mpMRI PI-RADS criteria, and urodynamics split-billing for technical and professional components.

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Pain Management Billing Guide: Epidural Injections, Nerve Blocks, Spinal Cord Stimulation, and Pain Management RCM
Medical Coding Sep 27, 2026

Pain Management Billing Guide: Epidural Injections, Nerve Blocks, Spinal Cord Stimulation, and Pain Management RCM

Pain management billing covers epidural steroid injection coding by approach and level with interlaminar codes 62321-62323 and transforaminal codes 64479-64484, medial branch block and radiofrequency ablation billing with Medicare LCD documentation requirements for positive diagnostic block response, spinal cord stimulator trial and permanent implant billing with device HCPCS codes, urine drug testing presumptive G0480 and definitive G0481-G0483 billing with medical necessity documentation, and pain management compliance program requirements for interventional pain practices.

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Geriatrics and Palliative Care Billing Guide: Comprehensive Geriatric Assessment, Hospice, Advance Care Planning, and Geriatrics RCM
Revenue Cycle Dec 19, 2026

Geriatrics and Palliative Care Billing Guide: Comprehensive Geriatric Assessment, Hospice, Advance Care Planning, and Geriatrics RCM

Geriatrics billing covers Annual Wellness Visit G0438-G0439, cognitive assessment G0505 separate visit requirements, advance care planning 99497-99498 time documentation with same-day E&M rules, transitional care management 99495-99496 discharge workflows, chronic care management 99490-99491, hospice attending physician GV and GW modifier billing, and geriatrics Medicare-specific code capture.

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Sports Medicine Billing Guide: Musculoskeletal Injections, PRP, Concussion Management, Preparticipation Exams, and Sports Medicine RCM
Medical Coding Dec 18, 2026

Sports Medicine Billing Guide: Musculoskeletal Injections, PRP, Concussion Management, Preparticipation Exams, and Sports Medicine RCM

Sports medicine billing covers joint injection codes 20600-20611 with and without ultrasound guidance, hyaluronic acid J-code billing for knee OA, trigger point injections 20552-20553, PRP 0232T patient billing and ABN compliance, concussion management coding with neurocognitive testing 96116-96138, Modifier 25 for same-day E&M and injection, and sports medicine denial prevention.

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Dermatology Billing Guide: Shave Biopsy, Excision, Destruction, Mohs Surgery, and Dermatology RCM
Medical Coding Dec 16, 2026

Dermatology Billing Guide: Shave Biopsy, Excision, Destruction, Mohs Surgery, and Dermatology RCM

Dermatology billing covers shave removal codes 11300-11313 by size and location, skin lesion excision 11400-11646 with excised diameter calculation including margins, destruction codes 17000-17286 for actinic keratoses and multiple-lesion add-on coding, Mohs micrographic surgery 17311-17315 stage and block billing, wound repair closure coding, Modifier 25 compliance, and dermatology denial prevention.

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Gastroenterology Billing Guide: Colonoscopy, EGD, ERCP, Capsule Endoscopy, and GI RCM
Medical Coding Dec 15, 2026

Gastroenterology Billing Guide: Colonoscopy, EGD, ERCP, Capsule Endoscopy, and GI RCM

Gastroenterology billing covers colonoscopy CPT codes 45378-45398 including polyp removal by snare and hot biopsy forceps, screening vs. diagnostic colonoscopy ACA preventive benefit distinction, EGD codes 43235-43270 with biopsy and ablation add-ons, ERCP codes 43260-43278, capsule endoscopy 91110-91113 medical necessity, GI motility studies, and gastroenterology denial prevention.

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Behavioral Health Billing Guide: Psychotherapy Codes, Psychiatric E&M, Collaborative Care Management, and Behavioral Health RCM
Medical Coding Dec 14, 2026

Behavioral Health Billing Guide: Psychotherapy Codes, Psychiatric E&M, Collaborative Care Management, and Behavioral Health RCM

Behavioral health billing covers psychotherapy CPT codes 90832-90838 timed code thresholds and add-on structure, psychiatric diagnostic evaluation 90791 vs. 90792 prescriber distinction, psychiatric E&M medication management, psychotherapy add-on codes 90833-90838 for combined visits, collaborative care management 99492-99494 monthly time documentation, mental health parity MHPAEA violation identification, and behavioral health denial prevention.

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Plastic Surgery Billing Guide: Reconstructive vs. Cosmetic, Skin Grafts, Breast Reconstruction, and Plastic Surgery RCM
Medical Coding Dec 13, 2026

Plastic Surgery Billing Guide: Reconstructive vs. Cosmetic, Skin Grafts, Breast Reconstruction, and Plastic Surgery RCM

Plastic surgery billing covers the reconstructive vs. cosmetic coverage distinction and documentation requirements, skin graft CPT codes 15100-15278 with area-based measurement, local and free flap closure codes 14000-15758, breast reconstruction coding 19340-19396 under the WHCRA mandate, prior authorization medical necessity criteria for blepharoplasty and breast reduction, and plastic surgery denial prevention.

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Neurosurgery Billing Guide: Spine Surgery Coding, Craniotomy, Shunt Procedures, Neuromonitoring, and Neurosurgery RCM
Medical Coding Dec 12, 2026

Neurosurgery Billing Guide: Spine Surgery Coding, Craniotomy, Shunt Procedures, Neuromonitoring, and Neurosurgery RCM

Neurosurgery billing covers spine surgery CPT codes for ACDF 22551-22552 and lumbar fusion 22558-22630 with multi-level add-on coding, spinal instrumentation 22840-22848 and interbody device 22853-22854, craniotomy codes 61304-61576 for tumor resection and vascular procedures, CSF shunt 62220-62258, intraoperative neuromonitoring billing compliance, and neurosurgery prior authorization.

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Physical Therapy Billing Guide: Therapeutic Exercise, Manual Therapy, Timed Codes, KX Modifier, and PT RCM
Medical Coding Dec 7, 2026

Physical Therapy Billing Guide: Therapeutic Exercise, Manual Therapy, Timed Codes, KX Modifier, and PT RCM

Physical therapy billing covers timed therapeutic procedure codes 97110-97542 and the 8-minute rule for unit calculation, constant attendance vs. supervised modality codes, Medicare therapy threshold and KX modifier requirements, PT evaluation codes 97161-97163 complexity selection, plan of care certification management, and physical therapy denial prevention strategies.

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Oncology Billing Guide: Chemotherapy Administration, Drug J-Codes, OCM, Radiation Oncology, and Oncology RCM
Medical Coding Dec 6, 2026

Oncology Billing Guide: Chemotherapy Administration, Drug J-Codes, OCM, Radiation Oncology, and Oncology RCM

Oncology billing covers chemotherapy administration codes 96401-96549 including sequential and concurrent infusion hierarchy, antineoplastic drug J-codes and unit calculation, NDC documentation, buy-and-bill ASP+6% economics, immunotherapy checkpoint inhibitor J-codes, radiation oncology treatment management 77427, IMRT 77385-77386, SBRT 77373, and oncology prior authorization management.

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Radiology Billing Guide: TC/PC Split Billing, Modality Codes, Interventional Radiology, and Radiology RCM
Medical Coding Dec 5, 2026

Radiology Billing Guide: TC/PC Split Billing, Modality Codes, Interventional Radiology, and Radiology RCM

Radiology billing covers technical component and professional component split billing with Modifier TC and Modifier 26, diagnostic imaging CPT codes for X-ray CT MRI and ultrasound, interventional radiology catheterization and drainage procedure coding, nuclear medicine and PET NCD coverage criteria, radiology benefit manager prior authorization workflows, and radiology denial management.

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Vascular Surgery Billing Guide: Carotid Endarterectomy, Endovascular Procedures, AV Access, and Vascular Surgery RCM
Medical Coding Dec 4, 2026

Vascular Surgery Billing Guide: Carotid Endarterectomy, Endovascular Procedures, AV Access, and Vascular Surgery RCM

Vascular surgery billing covers carotid endarterectomy 35301 and carotid stenting 37215-37216, endovascular aortic repair EVAR 34800-34805, zone-based peripheral endovascular codes 37220-37235 with imaging S&I bundling rules, AV fistula creation 36818-36821 and dialysis access maintenance 36901-36906, and vascular surgery global period management.

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Hospitalist Billing Guide: Hospital Admission Codes, Subsequent Care, Discharge, Co-Management, and Hospitalist RCM
Revenue Cycle Dec 3, 2026

Hospitalist Billing Guide: Hospital Admission Codes, Subsequent Care, Discharge, Co-Management, and Hospitalist RCM

Hospitalist billing covers initial hospital care codes 99221-99223, subsequent hospital care 99231-99233 level selection, hospital discharge 99238-99239 time documentation, observation care billing, SNF care 99304-99316, critical care criteria vs. subsequent care, Two-Midnight Rule documentation, and hospitalist co-management billing for surgical patients.

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Urology Billing Guide: Cystoscopy, Prostate Procedures, Lithotripsy, Urodynamics, and Urology RCM
Medical Coding Dec 2, 2026

Urology Billing Guide: Cystoscopy, Prostate Procedures, Lithotripsy, Urodynamics, and Urology RCM

Urology billing covers cystoscopy codes 52000-52356 including ureteroscopic procedures, prostate procedure coding for TURP 52601 and robotic prostatectomy 55866, lithotripsy ESWL 50590 and PCNL 50080-50081, urodynamics 51725-51797 with TC/PC billing, global period management for major urology procedures, and prior authorization management for robotic-assisted procedures.

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Rheumatology Billing Guide: Joint Injections, Biologic Infusions, Immunology Testing, and Rheumatology RCM
Medical Coding Dec 1, 2026

Rheumatology Billing Guide: Joint Injections, Biologic Infusions, Immunology Testing, and Rheumatology RCM

Rheumatology billing covers joint and soft tissue injection codes 20600-20611 with and without ultrasound guidance, biologic DMARD infusion J-codes and Q-codes for biosimilars, infusion administration codes 96413-96415 and 96365-96366, prior authorization step therapy documentation, NDC requirement for biologics, and in-office infusion suite buy-and-bill revenue cycle management.

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Endocrinology Billing Guide: Diabetes Management, Thyroid Procedures, CGM, Insulin Pump, and Endocrinology RCM
Medical Coding Nov 30, 2026

Endocrinology Billing Guide: Diabetes Management, Thyroid Procedures, CGM, Insulin Pump, and Endocrinology RCM

Endocrinology billing covers diabetes management E&M complexity documentation with ICD-10 diabetes codes E11.x, continuous glucose monitoring interpretation codes 95249-95251, insulin pump CSII Medicare coverage criteria E0784, thyroid ultrasound 76536 and FNA biopsy 10005-10006, DEXA scan 77080 TC/PC billing, and endocrinology revenue cycle management.

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Neurology Billing Guide: EEG, EMG/NCS, Botulinum Toxin, Lumbar Puncture, and Neurology RCM
Medical Coding Nov 19, 2026

Neurology Billing Guide: EEG, EMG/NCS, Botulinum Toxin, Lumbar Puncture, and Neurology RCM

Neurology billing covers EEG codes 95812-95830, EMG and nerve conduction studies 95860-95913, botulinum toxin injection codes 64612-64647 with J-codes J0585-J0588 and NDC documentation, lumbar puncture 62270, evoked potential studies, and neurostimulator management. This guide covers neurology CPT coding, medical necessity documentation, and common neurology billing denials.

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Revenue Integrity Program Guide: Charge Capture, CDM, Compliance, and Revenue Integrity RCM
Revenue Cycle Oct 26, 2026

Revenue Integrity Program Guide: Charge Capture, CDM, Compliance, and Revenue Integrity RCM

Revenue integrity programs cover charge capture optimization through service-documentation reconciliation audits, chargemaster CDM maintenance with annual CPT updates and price transparency compliance, clinical documentation improvement CDI for inpatient DRG CC/MCC capture and outpatient specificity, OIG Work Plan-aligned internal audit methodology with statistical sampling and error rate benchmarking, voluntary self-disclosure protocol guidance, and revenue integrity program structure for hospitals and physician practices.

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Population Health and Value-Based Care Billing Guide: CCM, TCM, AWV, and VBC RCM
Revenue Cycle Oct 25, 2026

Population Health and Value-Based Care Billing Guide: CCM, TCM, AWV, and VBC RCM

Population health billing covers chronic care management codes 99490-99491 and 99439-99437 with consent and time documentation requirements, transitional care management 99495-99496 post-discharge 2-business-day contact and face-to-face visit requirements, annual wellness visit G0438-G0439 vs. traditional physical exam distinctions, behavioral health integration 99492-99494, principal care management 99424-99427, remote physiologic monitoring 99453-99458, MIPS quality reporting, Medicare Advantage HCC coding, and value-based care revenue cycle management.

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Neonatology and Pediatrics Billing Guide: Newborn Care, NICU Codes, Well-Child Visits, and Pediatric RCM
Medical Coding Oct 24, 2026

Neonatology and Pediatrics Billing Guide: Newborn Care, NICU Codes, Well-Child Visits, and Pediatric RCM

Neonatology and pediatrics billing covers newborn hospital care codes 99460-99463, NICU neonatal critical care 99468-99469 and continuing intensive care 99477-99480 stratified by birth weight with common birth weight coding error explanation, well-child preventive medicine codes 99381-99395 by patient age, same-day well-child and sick visit billing with Modifier 25, immunization administration 90460-90474 with vaccine product codes and VFC program compliance, and pediatric revenue cycle management.

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Nursing Home and Long-Term Care Billing Guide: SNF E&M Codes, MDS, and LTC RCM
Revenue Cycle Oct 23, 2026

Nursing Home and Long-Term Care Billing Guide: SNF E&M Codes, MDS, and LTC RCM

Nursing home and long-term care billing covers nursing facility E&M codes 99304-99318 for initial, subsequent, annual, and discharge care, Medicare Part A SNF PPS and PDPM payment model with MDS 3.0 assessment scheduling, consolidated billing rules preventing outside providers from separately billing during Part A stays, NP and PA billing at 85% NPP rates in LTC settings, physician certification and recertification requirements, and long-term care revenue cycle management.

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Inpatient Psychiatric Billing Guide: Hospital E&M, Psychotherapy Add-Ons, and Behavioral Health RCM
Revenue Cycle Oct 22, 2026

Inpatient Psychiatric Billing Guide: Hospital E&M, Psychotherapy Add-Ons, and Behavioral Health RCM

Inpatient psychiatric billing covers hospital E&M codes 99221-99233 combined with psychotherapy add-on codes 90833-90836-90838 with documentation requirements for separately delineated E&M and psychotherapy components, psychiatric diagnostic evaluation 90791-90792, interactive complexity add-on 90785, psychological testing 96130-96146, Mental Health Parity and Addiction Equity Act compliance, carved-out behavioral health payer billing, and behavioral health revenue cycle management.

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Urgent Care Billing Guide: E&M Level Selection, Facility vs. Office Coding, and Urgent Care RCM
Revenue Cycle Oct 21, 2026

Urgent Care Billing Guide: E&M Level Selection, Facility vs. Office Coding, and Urgent Care RCM

Urgent care billing covers E&M level selection 99202-99215 using medical decision making complexity criteria, place of service POS 11 office vs. POS 20 urgent care facility and its reimbursement impact, procedure coding for laceration repair 12001-13160 with Modifier 25, fracture care, point-of-care testing 87880-85025, urgent care credentialing and provider enrollment, workers compensation billing under state WC fee schedules, No Surprises Act Good Faith Estimate compliance, and urgent care revenue cycle management.

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Neurology Billing Guide: EEG Codes, EMG/NCS, Botox for Migraine, and Neurology RCM
Medical Coding Oct 20, 2026

Neurology Billing Guide: EEG Codes, EMG/NCS, Botox for Migraine, and Neurology RCM

Neurology billing covers EEG codes 95812-95827 with routine vs. prolonged monitoring documentation and TC/PC split billing, nerve conduction study NCS codes 95907-95913 with study counting rules and documentation compliance, EMG needle electrode codes 95860-95872 by body region and muscle count, Botox for chronic migraine 64615 with J0585 drug billing and prior authorization requirements, evoked potentials 95925-95937, and neurology revenue cycle management.

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Obstetrics and Gynecology Billing Guide: Global OB Package, GYN Procedures, and OB/GYN RCM
Medical Coding Oct 19, 2026

Obstetrics and Gynecology Billing Guide: Global OB Package, GYN Procedures, and OB/GYN RCM

OB/GYN billing covers global obstetric package codes 59400 vaginal delivery and 59510 cesarean with bundled antepartum, delivery, and postpartum care, antepartum-only codes 59425-59426 and delivery-only codes 59409-59514 for split care among multiple providers, high-risk obstetric services including NST 59025, biophysical profile 76818, amniocentesis 59000, GYN surgical codes for hysterectomy 58150-58571 by approach and uterine weight, laparoscopic GYN 58660-58671, hysteroscopy 58555-58563, and OB/GYN revenue cycle management.

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Pulmonology Billing Guide: Spirometry, Bronchoscopy, Sleep Studies, and Pulmonology RCM
Medical Coding Oct 18, 2026

Pulmonology Billing Guide: Spirometry, Bronchoscopy, Sleep Studies, and Pulmonology RCM

Pulmonology billing covers pulmonary function testing codes 94010-94070 with medical necessity documentation requirements, bronchoscopy codes 31622-31654 including diagnostic flexible bronchoscopy, transbronchial biopsy, and EBUS-guided lymph node sampling 31652-31653, polysomnography 95808-95811 and home sleep testing G0398-G0400 Medicare coverage rules, CPAP titration 95811 and CPAP management billing, mechanical ventilation codes 94002-94004, and pulmonology revenue cycle management.

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Ophthalmology Billing Guide: Eye Exam Codes, Cataract Surgery, Retinal Procedures, and Ophthalmology RCM
Medical Coding Oct 17, 2026

Ophthalmology Billing Guide: Eye Exam Codes, Cataract Surgery, Retinal Procedures, and Ophthalmology RCM

Ophthalmology billing covers eye examination codes 92002-92014 vs. EM codes 99202-99215, cataract surgery 66982-66984 with premium IOL and FLACS non-covered service billing, intravitreal anti-VEGF injection 67028 with J-code and NDC billing (J0178 aflibercept, J2778 ranibizumab, J0179 faricimab), Modifier JW drug waste, retinal procedure codes 67101-67228, glaucoma surgical codes 66170-66180, laser procedures 65855-66761, visual field testing 92081-92083, and ophthalmology revenue cycle management.

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Gastroenterology Billing Guide: Colonoscopy, EGD, ERCP, Capsule Endoscopy, and GI RCM
Medical Coding Oct 16, 2026

Gastroenterology Billing Guide: Colonoscopy, EGD, ERCP, Capsule Endoscopy, and GI RCM

Gastroenterology billing covers colonoscopy CPT codes 45378-45398 with polypectomy technique documentation and add-on code sequencing, EGD codes 43235-43259, ERCP 43260-43278, the multiple endoscopy rule for same-session multi-procedure payment calculation, Medicare screening colonoscopy G0105 high-risk and G0121 average-risk billing with Modifier PT for screening-converted-to-therapeutic, capsule endoscopy 91110-91111, moderate sedation during endoscopy, and GI revenue cycle management.

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ENT and Otolaryngology Billing Guide: Sinus Surgery, Tonsillectomy, Hearing, and ENT RCM
Medical Coding Oct 15, 2026

ENT and Otolaryngology Billing Guide: Sinus Surgery, Tonsillectomy, Hearing, and ENT RCM

ENT and otolaryngology billing covers FESS codes 31231-31297 with multi-sinus bilateral sequencing and NCCI bundling rules, tonsillectomy and adenoidectomy 42820-42836 age-based code selection, tympanoplasty 69631-69633 and mastoidectomy 69641-69645, laryngoscopy codes 31505-31579, audiologic testing 92551-92588, cochlear implant programming 92601-92604, allergy testing 95004-95028 and immunotherapy 95115-95165 billing rules, and ENT revenue cycle management.

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Cardiology Billing Guide: Cardiac Catheterization, Electrophysiology, Echocardiography, and Cardiology RCM
Medical Coding Oct 14, 2026

Cardiology Billing Guide: Cardiac Catheterization, Electrophysiology, Echocardiography, and Cardiology RCM

Cardiology billing covers cardiac catheterization CPT codes 93454-93461 with coronary angiography and imaging add-ons, PCI codes 92920-92944 with multi-vessel add-on codes and NCCI bundling rules, EP study codes 93619-93620 and ablation codes 93653-93657 including AF ablation 93656 with pulmonary vein isolation and 93657 add-on for additional lesion sets, pacemaker and ICD implantation codes 33206-33249, echocardiography TC/PC billing 93306-93317, stress testing 93015-93018, and cardiology revenue cycle management.

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Nephrology and Dialysis Billing Guide: ESRD Monthly Capitation, Dialysis Procedure Codes, CKD Management, and Nephrology RCM
Medical Coding Oct 13, 2026

Nephrology and Dialysis Billing Guide: ESRD Monthly Capitation, Dialysis Procedure Codes, CKD Management, and Nephrology RCM

Nephrology and dialysis billing covers ESRD monthly capitation payment codes 90951-90970 by patient age and face-to-face visit frequency, hemodialysis procedure codes 90935-90937 for acute inpatient settings, peritoneal dialysis 90945-90947, home dialysis training 90989-90993 and monthly management 90963-90966, AKI inpatient E&M billing, partial-month MCP calculation during hospitalizations, CKD outpatient management, and nephrology revenue cycle management.

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Anesthesia Billing Guide: Time Units, Base Units, Qualifying Circumstances, and Anesthesia RCM
Medical Coding Oct 12, 2026

Anesthesia Billing Guide: Time Units, Base Units, Qualifying Circumstances, and Anesthesia RCM

Anesthesia billing uses a unique unit-based payment formula: base units by procedure complexity from the ASA RVG, time units at 1 per 15 minutes of documented anesthesia time, qualifying circumstance add-on codes 99100-99140 for extreme age and emergency conditions, physical status modifiers P1-P6, CRNA supervision and medical direction modifiers QK QX QY QZ AA, monitored anesthesia care MAC billing with QS G8 G9 modifiers, conversion factor benchmarking and payer contract negotiation, and anesthesia group revenue cycle management.

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Emergency Medicine Billing Guide: ED E&M Codes, Critical Care, Observation, and Emergency Medicine RCM
Revenue Cycle Oct 11, 2026

Emergency Medicine Billing Guide: ED E&M Codes, Critical Care, Observation, and Emergency Medicine RCM

Emergency medicine billing covers ED E&M codes 99281-99285 MDM-based level selection and 2023 CPT revisions, critical care time-based billing 99291-99292 in the ED setting, facility vs. professional fee dual billing in the emergency department, split-shared visit rules for ED physician and NPP encounters, ED procedure coding for laceration repair, fracture care, intubation, central line, and point-of-care ultrasound, EMTALA compliance, No Surprises Act compliance for out-of-network ED groups, and emergency medicine revenue cycle management.

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Dermatology Billing Guide: Skin Biopsy Codes, Destruction Codes, Mohs Surgery, and Dermatology RCM
Medical Coding Oct 10, 2026

Dermatology Billing Guide: Skin Biopsy Codes, Destruction Codes, Mohs Surgery, and Dermatology RCM

Dermatology billing covers skin biopsy technique-based CPT codes 11102-11107 by tangential, punch, and incisional technique with add-on codes for multiple lesions, excision of benign 11400-11471 and malignant 11600-11646 lesions with total excised diameter including margins, actinic keratosis destruction 17000-17004, benign lesion destruction 17110-17111, malignant lesion destruction 17260-17286, Mohs micrographic surgery stage billing 17311-17315 with repair code selection, and dermatology revenue cycle management.

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Speech-Language Pathology Billing Guide: SLP Evaluation Codes, Swallowing Studies, Dysphagia Therapy, and SLP RCM
Medical Coding Oct 9, 2026

Speech-Language Pathology Billing Guide: SLP Evaluation Codes, Swallowing Studies, Dysphagia Therapy, and SLP RCM

Speech-language pathology billing covers SLP evaluation codes 92521-92524 by disorder type, clinical swallowing evaluation 92610, modified barium swallow study 92611 professional and technical component billing, FEES 92612-92613, dysphagia treatment 92526 documentation to prevent maintenance therapy denials, speech-language treatment 92507-92508, cognitive rehabilitation 97127-97128, AAC evaluation and device billing 92597-92609, Medicare therapy cap KX modifier compliance, and SLP revenue cycle management.

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Occupational Therapy Billing Guide: OT Evaluation Codes, Therapeutic Procedures, and OT RCM
Medical Coding Oct 8, 2026

Occupational Therapy Billing Guide: OT Evaluation Codes, Therapeutic Procedures, and OT RCM

Occupational therapy billing covers OT evaluation CPT codes 97165-97167 by complexity level and re-evaluation 97168, timed therapeutic procedure codes 97110 therapeutic exercise and 97112 neuromuscular re-education billed in 15-minute units with the 8-minute rule, therapeutic activities 97530 vs. therapeutic exercise 97110 distinction, ADL and IADL training 97535 documentation to prevent custodial care denials, Medicare therapy cap threshold and KX modifier compliance, and occupational therapy revenue cycle management for outpatient OT practices, HOPD OT departments, and SNF therapy programs.

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Hospitalist and Inpatient Billing Guide: Hospital E&M Codes, Critical Care, Observation, and Hospitalist RCM
Revenue Cycle Oct 7, 2026

Hospitalist and Inpatient Billing Guide: Hospital E&M Codes, Critical Care, Observation, and Hospitalist RCM

Hospitalist and inpatient billing covers initial hospital care E&M codes 99221-99223 MDM-based level selection, subsequent hospital care 99231-99233, critical care time-based billing 99291-99292 with documentation requirements for critical illness and physician time, observation status billing 99218-99220 vs. inpatient admission criteria under the 2-midnight rule, same-day admission and discharge coding 99234-99236, discharge day management codes 99238-99239, transitional care management 99495-99496, and hospitalist program revenue cycle management including census reconciliation and charge capture workflows.

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