Coding Articles


Incident-To Billing

Services and supplies properly provided and billed incident-to a physician’s or non-physician practitioner’s services are reimbursed at 100 percent of the Medicare fee schedule amount for Medicare beneficiaries. This provides an opportunity for practices to make the most of their auxiliary staff—but only if they adhere to the Center for Medicare & Medicaid Services’ (CMS) strict incident to requirements. The following quick tips help you cover the basics.

Coding and Billing Maternity Care When Patients Change Insurance

There is a common maternity care coding and billing scenario that CPT® guidelines do not address...

Modifiers 25 and 59

This article, published in the March 2012 CPT Assistant, provides examples of proper and improper reporting when the E/M service is not distinct and is included as a component of the common pre-and post service elements of the service rendered.

Wound Care

For surgical prep of acute wounds, consider using codes 15002-15005

Pump Implants

CPT 2013 updated the definition of pump refill codes 62370 and 95991. Instead of requiring a physician’s skill, the descriptors for the codes state the service must require the skill of "a physician or other qualified health care professional."

When Not to Use Modifier 59

This article courtesy of American Academy of Professional Coders' (AAPC) John Verhovshek. AAPC is one of the nation's largest and most respected providers of education and professional certification to physician-based medical coders.

Pulmonary Function Tests (PFT)

Beginning January 1, 2012, 10 CPT codes used to report pulmonary function tests will be replaced with 4 bundle codes for reporting PFT services.

New vs. Established Patient Scenarios

New vs. Established Patient Scenarios

Separately Billing E/M Visits With Procedures

Billing for E/M visits and procedures on the same day.