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Fewer claims with modifier 25 won’t automatically reduce denials

07/06/2026

Don’t assume your denial rate for claims with modifier 25 (Significant, separately identifiable evaluation and management [E/M] service by the same physician or other qualified health care professional on the same day of a procedure or other service) went down if you reported fewer claims with the modifier.

The art of coding: Think like an auditor to defend modifier 25

06/29/2026

by: Julia Kyles, CPC

Train yourself and members of your coding and clinical teams to think like an auditor before you report modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

FY2027 ICD-10-CM guidelines clarify genetic disorders, DES reporting

06/29/2026

by: Laura Evans, CPC

The revised FY 2027 ICD-10-CM Official Guidelines, issued June 16, add genetic disorders to existing guidelines in Chapter 17 and give new guidance for reporting Z codes for exposure to diethylstilbestrol (DES).

Heads up: New No Surprises rule may block some IDR claims

06/29/2026

by: Roy Edroso

A new final rule pertaining to the No Surprises Act (NSA) makes filing independent dispute resolution (IDR) requests easier for providers in some ways. But certain tweaks also make it easier for payers to thwart provider claims, so practices should take extra care to bullet-proof their claims ahead of time.

MedPAC wants higher PFS payments; don’t get your hopes up

06/29/2026

by: Roy Edroso

The June report from the Medicare Payment Advisory Commission (MedPAC) suggests more generous reimbursement to Part B providers under the physician fee schedule (PFS). But they didn’t offer a clear path forward, and it’s unlikely to have a near-term effect.

Clear the blockage: How to assign CPT codes for cerumen removal

06/29/2026

by: HCPro staff

Two of the key things to understand about coding for the removal of cerumen, commonly referred to as earwax, is that the code assignment is based on whether the cerumen is impacted and which type of procedure is used.

Claims up for instrumentation-based ear wax removal procedures

06/29/2026

by: Richard Scott

Clearing blocked cerumen, or ear wax, is far more frequently performed using instrumentation than water irrigation, and providers report millions of the cerumen-removal services per year.

Train staff on coding instruction changes in the ICD-10-CM update

06/22/2026

by: Julia Kyles, CPC

While you and your team prepare for the new ICD-10-CM codes that will go into effect Oct. 1, make sure you’re also ready for changes to coding instructions for existing codes. For example, you’ll find new clarifying terms and changes to Excludes notes. These revisions can speed coding and reduce denials but they’re easy to overlook.

CMS recruits practices and payers to help guide PA policy

06/22/2026

by: Roy Edroso

CMS has been pushing hard to get stakeholders, including providers, up to speed on prior authorization automation before a key deadline hits on Jan. 1. Payers have been at the forefront of this, but with its “Early Adopters” program, the agency is also enlisting health IT companies and provider groups to help move the ball forward. The agency seeks more such groups to step up.

Consider new tech solutions, including wearables, for practice security

06/22/2026

by: Roy Edroso

The plague of violence at medical practices against staff and patients shows no sign of abating. Make sure your due-diligence security protocols are in place and look at some recent innovations if you feel the need to strengthen your perimeter.

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