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Train staff with modifier 25 scenarios as payers stay on high alert

12/22/2025

Use the documentation “cross-out test,” clinical vignettes and expert answers to scenarios to educate staff about when they can and cannot unbundle an E/M visit from a same-day procedure.

Review the answers to 3 modifier 25 scenarios

12/22/2025

by: Julia Kyles, CPC

Payers are still on the lookout for improper use of modifier 25, the modifier that allows the billing provider to unbundle an E/M visit from a procedure performed on the same date of service. Make sure you read the scenarios and decide whether you would report a separate E/M visit with modifier 25, then read the answers.

Share physician tips for remote monitoring combo coding

12/22/2025

by: Julia Kyles, CPC

Whether your practice has been reporting remote monitoring services for years or will try them for the first time in 2026, use these expert tips on what you can and cannot report from an expert to keep your claims compliant and to prevent denials.

Spot triggers, take steps to avoid the next HIPAA breach

12/22/2025

by: Dom Nicastro

Cybersecurity headlines in health care usually spotlight ransomware gangs, phishing schemes or sophisticated supply chain attacks. However, some of the most damaging breaches come from inside organizations themselves.

Overdose coding: What to know when choosing the right diagnosis

12/22/2025

by: Son Hoang

Question: What is the difference between intentional and unintentional overdoses?

Up or down: Based on POS, E/M fees face dueling trajectories in 2026

12/22/2025

by: Richard Scott and Laura Evans, CPC

The place of service (POS) where your providers tend to perform E/M services, including office visits and the care management suite of codes, will significantly influence your reimbursement in 2026. After CMS charted a course that favors non-facility sites of care, the E/M fee picture is coming into focus.

Providers still get hired without valid licenses; don’t skimp on verification

12/15/2025

by: Roy Edroso

Despite technological advances in tracking, medical organizations continue to hire unlicensed and improperly credentialed non-physician practitioners and even physicians. Make extra certain your checklist for new hires — and in some cases existing staff — is thorough and complete.

Focus on longitudinal relationships in G2211 documentation

12/15/2025

by: Julia Kyles, CPC

Questions about add-on code G2211, known as the visit complexity or longitudinal care code, cropped up throughout the CPT & RBRVS 2026 Annual Symposium. The answers to questions about documentation, timing and specific scenarios that support the add-on code can be summarized in one sentiment: Focus on “longitudinal relationships.”

Take note of the next NCCI edits, expect new codes later in 2026

12/15/2025

by: Julia Kyles, CPC

You’ll have to wait a while longer for National Correct Coding Initiative (NCCI) edits for 2026-effective codes. However, the latest quarterly NCCI update will include new medically unlikely edits (MUE) for a variety of HCPCS codes that went into effect in July and October 2025.

Do extra housekeeping as post-shutdown payments clear

12/15/2025

by: Roy Edroso

As Medicare payment ramps back up after the recent government shutdown, Ahzam Afzal, CEO and co-founder of Puzzle Healthcare in Detroit, points out some things to watch for as the claims and payments come through.

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