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As modifier 25 audits pick up, key in on internal review, provider education

06/08/2026

by: Nancy Reading, BS, CPC, CPC-P, CPC-I

The Office of the Inspector General (OIG) announced it is launching a new audit of E/M services billed on the same day as minor procedures effective March 16, 2026. When an E/M service that is significant, separately identifiable, and well documented in the clinical record is performed on the same day as a minor surgical procedure, modifier 25 is used to report the E/M service.

Incorporate quick-glance tool for maternity care coding update

06/08/2026

by: Julia Kyles, CPC

The new codes and guidelines go into effect Jan. 1, 2027, but at least one payer has encouraged providers to use E/M codes to report services for patients who start antenatal care on or around June 1. The quick card here will help staff find the appropriate codes and guidelines for encounters with pregnant patients.

Code swap: Remember that G0136 now covers physical activity, nutrition

06/08/2026

by: Richard Scott

Don’t forget about a key change to a Medicare-covered HCPCS code that providers reported hundreds of thousands of times in its debut year. As of Jan. 1, code G0136 now covers physical activity and nutrition assessments, not social determinants of health (SDOH).

Ensure claims accuracy for wound care coding and documentation

06/08/2026

by: NAHRI Journal

Wound care claims are incredibly complex, and they often involve extensive medical histories, multiple diagnoses and procedures that require detailed documentation to support proper code selection. A minor omission or ambiguity in the documentation could make a big difference when trying to secure reimbursement for these claims, and payers and auditors pay particular attention to them.

With denials already high, practices contend with G0136 revamp

06/08/2026

by: Richard Scott

Family practice and internal medicine providers led the way in reimbursement for HCPCS code G0136 in its first year of eligibility, returning more than $1.6 million in payments. But providers should note a significant revision to the code effective in 2026 or risk major compliance challenges.

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