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Master modalities, lesion sites when coding fine needle aspiration biopsies

02/23/2026

The CPT manual includes many types of biopsies: fine needle aspiration (FNA), core needle and skin (tangential, punch and incisional). Some of the guidelines tend to be confusing, particularly those for FNA and core needle biopsies performed at the same surgical session. Cut through the confusion with a clear-eyed look at coding best practices.

Connect the dots between coding and team-based care

02/23/2026

by: Julia Kyles, CPC

Help your clinicians and coders connect on team-based care management and value-based care (VBC) by explaining the role coding plays in treating patients and patient attribution. During the final Q&A session of the CPT & RBRVS 2026 Annual Symposium, a variety of health care professionals who had given presentations on teams-based and value-based care fielded questions from symposium attendees.

OIG releases MA compliance program guidance; watch coding standards

02/23/2026

by: HCPro staff

After releasing its General Compliance Program Guidance in 2023, the Office of Inspector General (OIG) is continuing to deliver supplemental guides geared toward specific subsectors of the health care industry. Released on Feb. 3, the Medicare Advantage (MA) Industry Segment-Specific Compliance Program Guidance (ICPG) details several key risk areas relevant to the MA program and provides recommendations to various parties to mitigate these risks.

Denial rates mostly up on top 59-appended codes

02/23/2026

by: Richard Scott

Of the top 15 codes that practices reported with modifier 59 (Distinct procedural service), only a handful saw positive movement in denial rates between 2023 and 2024, and lesion-destruction codes once again fronted the list.

Telehealth waivers secure through 2027, watch controlled Rx deadlines

02/16/2026

by: Julia Kyles, CPC

Medicare patients can continue to receive telehealth services from home for the next two years, thanks to the latest extension of popular waivers that were introduced during the COVID-19 public health emergency.

ACO REACH to become LEAD, with more features, high-needs patient care

02/16/2026

by: Roy Edroso

Having converted from CMS’ Direct Contracting model in 2023, ACO REACH is converting again by 2027 to a model called Long-term Enhanced ACO Design, or LEAD. Details are still emerging but CMS promises, and experts expect, that the new model will expand REACH’s appeal to smaller practices, particularly those with high-needs populations.

Open Payments update is a reminder to keep records, dispute mistakes

02/16/2026

by: Julia Kyles, CPC

The January Open Payments update shows an uptick in the number of disputed records. That’s a reminder that covered recipients, including physicians and non-physician practitioners (NPP), should check the information that group purchasing organizations, pharmaceutical companies and medical device companies report to CMS before the agency publishes it.

Know when add-on behavioral codes apply to the APCM code set

02/16/2026

by: HCPro staff

Question: How has the 2026 Medicare physician fee schedule final rule, effective Jan. 1, 2026, affected coding of advanced primary care management (APCM)?

Contractor medical director: Cloned time may ‘raise red flags during audits’

02/16/2026

by: Julia Kyles, CPC

Documenting the same time for every patient encounter can raise red flags during audits and increases risk for practitioners. Those warnings were issued during the CPT & RBRVS 2026 Annual Symposium’s question and answer session for Medicare contractor medical directors (CMD).

To stop embezzlers, guard your figures, and let them know you’re watching

02/16/2026

by: Roy Edroso

More big embezzlement charges against medical practice managers serve as a reminder that it’s too easy for a practice to lose money when basic safeguards aren’t in place.

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