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HIPAA reproductive care PHI overturned, but law still mostly protects it

07/14/2025

Most of a Biden era reproductive health HIPAA policy has been stopped by a federal court decision. Be clear, though, about your remaining duties to safeguard this kind of protected health information (PHI).

Check Aetna policy if you see unexpected ultrasound, injection denials

07/14/2025

by: Julia Kyles, CPC

When Aetna is the patient’s insurer take a close look at the ultrasound policy before the practice reports 76942 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpretation with treatment for acute or chronic pain), or services that include ultrasound.

Written protocol for inappropriate behavior, however mild, can help

07/14/2025

by: Roy Edroso

Question: We have a patient who sometimes brings gifts such as flowers or candy to his provider. The provider has shared with us that she finds this awkward and has asked him to stop, but the patient persists. We have a harassment policy, but it seems like overkill to bring it to bear here. What should we do?

The doc’s practice did the imaging test. Can we still count it toward MDM?

07/14/2025

by: Laura Evans, CPC

Question: How would you count the following tests toward medical decision-making (MDM) in the following two scenarios?

The physician orders an MRI at today’s visit for the patient’s right ankle. His practice performs the MRI three days later and bills the professional and technical component.
The physician orders a CT scan at today’s visit for the patient’s right ankle and the CT is performed on the same date by the physician’s practice, which then bills the professional and technical component for the scan...

PCPs embraced new prolonged service, chronic pain in 2023

07/14/2025

by: Julia Kyles, CPC

Higher-than-average reporting and relatively low denial rates indicate smooth adoption of several new HCPCS G codes that were introduced in 2023. In addition, a few specialties took the lead in using the new codes, according to the latest Medicare Part B claims data.

Check the FY2026 ICD-10-CM tabular addenda for changes to existing codes

06/30/2025

by: Julia Kyles, CPC

You can take your team through the notes for the 487 new diagnosis codes when you receive your 2026 DecisionHealth ICD-10-CM manual. But remember to check the tabular addenda for codes that you regularly report so you don’t miss additional information that can augment coding through more guidance or alert you to potential pitfalls.

Master medically unlikely edits to keep denials down

06/30/2025

by: Julia Kyles, CPC

CMS developed medically unlikely edits (MUE) as a way to limit the number of times a particular service is allowed to be billed by a single provider to a single patient on a given date of service. Medicare began using these unit-of-service edits in 2007 in an effort to reduce payment errors for Medicare Part B claims.

Medical decision-making: Know how to keep it on the level

06/30/2025

by: Terry Tropin, MSHAI, RHIA, CCS-P

Selecting a level of medical decision-making (MDM) is confusing and complicated. This article defines key terms and describes a simplified system for selecting a level.

Aside from XS, denial rates on X modifiers diverge widely

06/30/2025

by: Richard Scott

Practices turned to two of the X-series modifiers in place of modifier 59 (Distinct procedural service) more than 7 million times in 2023 and saw mixed results with denial rates on the top-billed codes.

Follow HIPAA rules when you receive employment-related requests

06/23/2025

by: Julia Kyles, CPC

Keep HIPAA compliance front-of-mind when a patient asks you to send their records to an employer. In particular, your practice should understand when you do and do not need a patient’s authorization to disclose protected health information (PHI) in response to an employment-related request.

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