Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC

With spinal fusion procedures moving off the Inpatient Only list, CPT coding for spine surgeries is a skill every outpatient coder should master.

As usual, this year’s OPPS rule had several changes, but perhaps the most impactful to coding professionals is the elimination of the Inpatient Only list. Starting in 2026 and continuing each year until January 1, 2029, the IPO list will be phased out.

Even when using the same CPT codeset, there are differences. Both physician coders and facility coders use CPT, but in some cases, different tasks are involved.

Closely linked to this statement is the idea that every patient’s story is different. I thought of that again as I read through comments on my recent article on when to code history of breast cancer.

When I am teaching diagnosis coding, the area that receives the most comment and outright disagreement with me is that of history of malignancy. As with all diagnosis coding, it is important to understand the nature of what is being coded, including what effect the treatment has, along with the specifics of the ICD-10-CM guidelines in order to code accurately and specifically.

As a coding professional, I often become focused on the reimbursement aspects of new codes. But more exciting to me is that with these codes we will be able to measure, at least indirectly, the impact of prophylactic procedures on the incidence of ovarian cancer.

Any coder will tell you: a coder learns by coding. One of the best ways to master any coding skill, and especially E/M’s unique challenges, is to practice on real records.

There are certainly more practices and hospitals using electronic health records (EHR). But have we avoided medical mistakes? Have we reduced costs? Have we improved care?

What do we, as health information professionals and coders, do when our credibility has been questioned? I have five suggestions.

We just have to find the best way to provide telehealth services while ensuring all compliance concerns are met and that providers are paid appropriately for their services.

Knowing the coverage parameters, reviewing the documentation requirements, coding the services appropriately, informing the patients of the issues and their potential responsibility for payment are all steps in getting the patients the treatment and relief they need and ensuring that the provider is paid appropriately.

One of the frustrating aspects of diagnosis coding for malignancies is that the only information captured in the ICD-10-CM code is the location of the malignancy. This alone does not give information about staging, treatment, or prognosis.

Future roles in health information management and coding will require more agility and more willingness to consider broader and more frequent changes. Our job roles may change. How we perform the very basics of coding may change. My advice to current professionals? Embrace the change.

As coder/billers, it is our responsibility to ensure that the practices that employ PAs and other Non-Physician Practitioners (the preferred term used by CMS) are coding and billing accurately in order to receive appropriate reimbursement for these services. This requires an understanding of the unique requirements that apply.

As coders and billers, helping practices maximize the role of these providers and ensuring they are paid appropriately for NPP services requires an understanding of the unique requirements that apply.

CPT guidance for unlisted codes in the Introduction pages in the front of the manual instructs that we are not to select a CPT code that merely approximates the service. If there is no specific code, then we are to use the appropriate unlisted code.

CMS has sought ways to compensate primary care physicians and others focused on continuing care. CMS estimates that 90% of primary care visits will be billed with G2211 added and that 38% of all E/M services will be eligible for G2211 to be added.

Rather than an indication of nonchalance on the part of the coder or the documenting provider, unlisted codes are critical part of the CPT coding system and their use is appropriate in many situations. I code for a group of six general surgeons and three neurosurgeons. Here are some recent examples of unlisted codes I have assigned:

It can be a struggle to determine what flexibilities allowed during the PHE have continued - there are multiple sources of regulations and many concerns beyond billing. It's hard for one person to pull all the information together. Add to that the scrutiny from the OIG and other regulatory authorities and now we may be afraid to continue doing something that our providers and our patients love!

By Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC Remember three years ago? We were staying home as much as possible, and for those of us working in healthcare, it was all about masks and personal protective equipment and the constant changes from CMS on COVID-19 testing and billing. I remember almost daily updates, especially on billing for telehealth. Now, we have gotten more comfortable with telehealth, and many of our patients have come to love the convenience. We have managed through this with waivers and exceptions to the regulations, but now that the Public Health Emergency has ended,