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Monitor recent updates CMS added to E/M billing and coding guide

10/27/2025

CMS revised an MLN Booklet on E/M services to clarify billing and coding requirements for critical care scenarios, hospital outpatient clinic visits, telehealth services and more.

Ensure appropriate coding, documentation for skin substitute claims

10/27/2025

by: HCPro staff

Skin substitutes continue to play a critical role in the treatment of chronic wounds, and there are more products available today than ever before. Organizations have long called for Medicare administrative contractors (MAC) to develop local coverage determinations (LCD) for skin substitute products and their application. Although MACs have slowly started to spell out their coverage criteria for skin substitute grafts used to treat certain conditions, progress has been slow.

Care management codes rise from COVID depths; so do some denials

10/27/2025

by: Roy Edroso

You might imagine that the suite of Medicare chronic care management (CCM) and transitional care management (TCM) codes would take a hit in the COVID pandemic and then bounce back. And they did. But a look at the denial numbers between 2020 and 2024 shows a more complicated picture.

Discover 280-plus new codes in CPT update, including RPM services

10/20/2025

by: Laura Evans, CPC, Julia Kyles, CPC, and Richard Scott

You’ll find a fresh batch of CPT codes that you can begin reporting on Jan. 1, 2026, with 288 new codes coming online, including two new E/M codes covering remote physiologic monitoring (RPM). The code update, announced with the release of the 2026 CPT Manual, also includes 46 revised code descriptors and 84 deleted codes.

AMA fears physicians are improperly reporting online A/M services

10/20/2025

by: Julia Kyles, CPC

With Medicare’s popular telehealth waivers in limbo and telephone E/M visits off-limits for Medicare patients, practices might increase their use of other non-face-to-face services, such as the online E/M and assessment and management (A/M) codes.

Practice sues hospitals, claiming they freeze out providers

10/20/2025

by: Roy Edroso

A lawsuit in New Jersey suggests that hospital management that fails to allow local doctors a fair chance to treat their patients may be in restraint of trade, among other violations.

Drug drops: Amazon’s One Medical offices to feature pharmacy kiosks

10/20/2025

by: Roy Edroso

Amazon has announced that, in selected cities, its One Medical offices will soon have Amazon Pharmacy kiosks to dispense its providers’ prescriptions. It marks an intriguing new model for provider-pharmacy cooperation, though the situation may be difficult for other companies or even Amazon to replicate elsewhere.

Defined roles, not length of note, support split/shared billing

10/20/2025

by: Julia Kyles, CPC

You know that Medicare’s split/shared rule allows practices to bill E/M visits in the facility setting under the physician’s name and identification number when a qualified health care professional (QHP) performs part of the encounter and the physician performs the substantive portion of the work for the encounter. However, the documentation must clearly show how the providers divided their work.

Critical care: Split/shared claims rose, unrelated encounters stayed flat

10/20/2025

by: Julia Kyles, CPC

Three years of data for critical care services (99291-99292) showed a steady increase for split/shared critical care services. Over the same period critical care services during a procedure’s global period stayed flat.

Shutdown slows claims, blocks telehealth; plan now, alert patients

10/13/2025

by: Roy Edroso

Like previous federal government shutdowns, the one that ensued when Congress failed to produce a continuing resolution (CR) on the budget by Oct. 1 has implications for providers. You should reduce the chances of harm by planning to address them now.

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