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As modifier 25 audits pick up, key in on internal review, provider education

06/08/2026

by: Nancy Reading, BS, CPC, CPC-P, CPC-I

The Office of the Inspector General (OIG) announced it is launching a new audit of E/M services billed on the same day as minor procedures effective March 16, 2026. When an E/M service that is significant, separately identifiable, and well documented in the clinical record is performed on the same day as a minor surgical procedure, modifier 25 is used to report the E/M service.

Incorporate quick-glance tool for maternity care coding update

06/08/2026

by: Julia Kyles, CPC

The new codes and guidelines go into effect Jan. 1, 2027, but at least one payer has encouraged providers to use E/M codes to report services for patients who start antenatal care on or around June 1. The quick card here will help staff find the appropriate codes and guidelines for encounters with pregnant patients.

Code swap: Remember that G0136 now covers physical activity, nutrition

06/08/2026

by: Richard Scott

Don’t forget about a key change to a Medicare-covered HCPCS code that providers reported hundreds of thousands of times in its debut year. As of Jan. 1, code G0136 now covers physical activity and nutrition assessments, not social determinants of health (SDOH).

Ensure claims accuracy for wound care coding and documentation

06/08/2026

by: NAHRI Journal

Wound care claims are incredibly complex, and they often involve extensive medical histories, multiple diagnoses and procedures that require detailed documentation to support proper code selection. A minor omission or ambiguity in the documentation could make a big difference when trying to secure reimbursement for these claims, and payers and auditors pay particular attention to them.

With denials already high, practices contend with G0136 revamp

06/08/2026

by: Richard Scott

Family practice and internal medicine providers led the way in reimbursement for HCPCS code G0136 in its first year of eligibility, returning more than $1.6 million in payments. But providers should note a significant revision to the code effective in 2026 or risk major compliance challenges.

Add other separately billable E/M modifiers to your compliance training

05/25/2026

by: Julia Kyles, CPC

Modifiers 24 and 57 don’t get as much attention as modifier 25, the modifier for an unrelated separately billable E/M service performed on the same day as another service. But to capture revenue for medically necessary E/M visits and avoid overpayments, your staff must understand when they should and should not use these modifiers.

G2211: CMS emphasizes trust, instructs MACs to create home/residence edit

05/25/2026

by: Julia Kyles, CPC

Remind your team that the relationship between the patient and the provider is the focus of add-on code G2211. The code is commonly known as the complexity of care code, but the “patient trust code” might be a better name. CMS revisited the concept of trust in the policy section of CMS 100-04, Change Request 14447.

$50 a month for GLP-1s will be open to some Medicare patients July 1

05/25/2026

by: Roy Edroso

CMS announced on May 6 that, starting in July, some patients with Medicare prescription drug coverage will be eligible for select GLP-1 treatments for which they would pay $50 a month, a significant savings.

Bolster your biopsy coding: Know types, definitions, multiple procedures

05/25/2026

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

It is critical to understand when a procedure should be coded as a biopsy. The right code depends on the purpose of the procedure. Use a biopsy CPT code (11102-11107) when the goal of the procedure is to obtain only a sample of tissue for diagnosis through a histopathologic exam.

Ask the right questions to avoid misusing modifier 59

05/25/2026

by: HCPro staff

Modifier 59, used to describe a distinct procedural service, has been associated with considerable abuse and high levels of manual audit activity, leading to reviews, appeals and even civil fraud and abuse cases. Ask yourself some key questions to ensure your modifier 59-appended claims pass muster.

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