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07/21/2025
You are likely encountering updates about artificial intelligence, or AI, everywhere, including in the medical industry. But when a practice wants to know whether it’s ready to adopt AI, look for certain green lights that indicate your practice is ready for AI adoption. But also beware of the red lights.
07/21/2025
The FY2026 ICD-10-CM guidelines are out and include updated language around coding for patients with human immunodeficiency virus (HIV) infections, hypertension/heart disease and antineoplastic chemotherapy.
07/21/2025
Use of the modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) has been in steep decline in the past 10 years, falling from more than 531,000 claims in 2015 to 87,826 claims in 2020 and 51,177 in 2022. But in 2023, the most recent year for which Medicare data is available, there was a slight reversal.
07/14/2025
After earlier reforms that sought to reduce the impact of prior authorization on providers and patients, CMS has created a demonstration model that will add prior authorization for regular Medicare for a select group of regional providers.
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).
07/14/2025
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.
07/14/2025
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?
07/14/2025
Question: How would you count the following tests toward medical decision-making (MDM) in the following two scenarios?
  1. 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.
  2. 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...
07/14/2025
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.
06/30/2025
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.

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