Analyze key provisions in the 2026 Inpatient Prospective Payment System (IPPS) proposed rule to understand potential updates to Medicare inpatient coding and billing.
Recent data shows that all improper payments for bacterial culture lab tests can be traced back to insufficient documentation. Review CMS' provider compliance tip to prevent denials.
Practices upped their use of modifier 59 (Distinct procedural service) in recent years, adding nearly 1 million 59-appended claims to the most frequently reported same-day procedural codes.
On November 1, 2024, CMS released its final rule describing calendar year 2025 policies and rates for Medicare’s Outpatient Prospective Payment System and the final rule was published in the Federal Register. This article is a comprehensive overview of all the major highlights, allowing coders to stay informed about key updates and navigate the changes throughout the year.
In January 2024, CMS released guidance for the implementation of the office and outpatient evaluation and management visit complexity HCPCS add-on code G2211. Courtney Crozier provides a breakdown of the code, including documentation requirements and appropriate and inappropriate billing scenarios.
