Bundling in CPT coding means combining multiple services into one code for billing, while unbundling is separating them out to bill each individually.Bundling is often required to follow payer rules and avoid overbilling, while unbundling (when appropriate) ensures every provided service gets recognized. Correct usage protects against claim denials, audits, and compliance risks. What Is … Read more
Understanding these distinctions ensures accurate billing, compliance, and maximum reimbursements. 1. CPT Category I Codes: The Foundation of Medical Billing Purpose: Used for established medical, surgical, and diagnostic services.Examples: Why They Matter:✔ Required for insurance claims.✔ Directly tied to reimbursements.✔ Updated annually by the American Medical Association (AMA). Common Challenges: 2. CPT Category II Codes: Tracking Quality … Read more
Navigating health insurance claims can be complex, especially when patients have multiple insurance policies. Understanding the difference between primary and secondary insurance is crucial for accurate billing, timely reimbursements, and minimizing claim denials. This article explores the distinctions between primary and secondary insurance, their importance in healthcare billing, key processes involved, and the benefits of outsourcing medical … Read more
Denial Code 18 signifies that the insurance payer has rejected the claim because it appears to be a duplicate submission. This occurs when a provider submits the same claim multiple times, whether intentionally or unintentionally, before the original claim has been fully processed. Common Causes of Denial Code 18 Several factors contribute to Denial Code … Read more
Modifier 81 is used in medical billing to indicate that a Minimum assistant surgeon was involved in a lesser complexity surgery, as compared to more complex procedures that might require the use of Modifier 80 (which refers to an assistant surgeon in more complicated surgeries). When an assistant surgeon participates in a procedure that is … Read more
Modifier 80 is used in medical billing to indicate that an assistant surgeon was required during a surgical procedure. When a patient undergoes a surgery that requires the assistance of a second surgeon, Modifier 80 is added to the primary surgeon’s CPT code to notify payers (such as Medicare, Medicaid, or private insurance) that the … Read more
Introduction Modifier CS is a code used to indicate that a service or procedure was related to COVID-19 testing or treatment. It was introduced by the Centers for Medicare and Medicaid Services (CMS) as part of the response to the COVID-19 pandemic. This modifier ensures that certain healthcare services associated with the testing and treatment … Read more
Introduction When billing for services, selecting the correct Place of Service (POS) code is critical to ensure clean claims and proper reimbursement. One frequently used—but sometimes misunderstood—POS code is 20, which represents an Urgent Care Facility. Let’s break down what POS 20 is, when it should be used, and how it affects billing and reimbursement. … Read more
Definition Place of Service Code 11 is used on professional claims (CMS-1500 form) to indicate that the service was provided in a physician’s office, or a clinician-owned or leased space used to treat patients on an outpatient basis. CMS definition: “Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, … Read more
