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ICD10monitor, a division of MedLearn Media, Inc., is an online news and information service created to help healthcare providers in all settings make informed decisions relative to coding, clinical documentation integrity (CDI), value-based purchasing and other new payment methodologies. ICD10monitor reports on current issues including population health, physician engagement and the patient experience.
ICD10monitor provides a portal of information and a forum for discussion for educational purposes only. The opinions of contributing editors published by ICD10monitor may not necessarily represent those of our sponsors or other organizations affiliated with ICD10monitor. While every effort is made to ensure accuracy and contextual honesty, ICD10monitor will quickly correct and/or retract any information demonstrated to be erroneous. We welcome opposing viewpoints and will publish responses from our readers, which may be edited for economy and clarity. Source
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| Scope | Local |
|---|---|
| Language | English |
| Country | United States of America |
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Recent Articles
Search ArticlesRespiratory Question for the Week of June 22, 2026
What services may be reported with code 94660 related to CPAP or BiPAP? Can it be billed per hour? Code 94660 may be used for the initiation and subsequent management of CPAP or BiPAP. Again, the service is billed per day, not per hour, for CPAP and BiPAP. This question was answered in our annual Respiratory Therapy Reimbursement & Compliance Update webcast. For more hot topics relating to respiratory services, please visit our store or call us at 1.800.252.1578, ext. 2.
Cardiology Question for the Week of June 22, 2026
How did the 2026 coding revisions change reporting requirements for codes 93571 and 93572 when pharmacologic stress is not used? For 2026, CPT® revised the description for 93571 and 93572 to clarify that: “including pharmacologically induced stress, when performed.” This eliminates the need to append modifier –52 when the service is performed without pharmacologic stress (e.g., iFR or DFR). This question was answered in our annual Cardiology Reimbursement & Compliance Update webcast.
General Question for the Week of June 22, 2026
How does Type 1 NSTEMI differ from Type 2 NSTEMI? Type 2 NSTEMI differs significantly from a Type 1 NSTEMI in both its cause and treatment. While a Type 1 NSTEMI results from plaque rupture and thrombus (clot) formation within a coronary artery and is considered an acute coronary syndrome (ACS), a Type 2 NSTEMI occurs because of an imbalance between myocardial oxygen supply and demand.
Laboratory Question for the Week of May 25, 2026
What types of improper laboratory claims are targeted in potential future OIG and Medicare audits? OIG and Medicare audits will focus on the improper use of claim line modifiers for a code pair, genetic testing, and urine drug testing services. Findings from the audits are expected to identify laboratories or other institutions that routinely submit improper claims, including providers that regularly bill Medicare for definitive drug testing at the highest level (G0483).
Respiratory Question for the Week of May 25, 2026
What is the importance of assigning the correct inpatient ventilation procedure code based on the documented duration of respiratory ventilation? The inpatient procedure codes 5A1935Z or 5A1945Z, when assigned, will be assigned to a lower severity MS-DRG. Accurate documentation of time and assignment of the accurate procedure code ensures accurate reimbursement and reduces compliance risk. This question was answered in our annual Respiratory Therapy Reimbursement & Compliance Update webcast.
Respiratory Question for the Week of May 4, 2026
When ventilation management is provided during an observation stay, how will the service be paid? When ventilation management is provided during an observation stay the service will be paid according to the guidelines for outpatient procedures. Under the OPPS, the procedure codes 94002 and 94003 are paid according to APC 5801.
Laboratory Question for the Week of April 27, 2026
If the test our laboratory performs meets the definition of a PLA code do we have to use that code or can the laboratory report an existing Category I code that has a similar description? When a PLA code is available to report a given proprietary laboratory service, that PLA code takes precedence. The service should not be reported with any other CPT® code(s) and other CPT code(s) should not be used to report services that may be reported with that specific PLA code.
General Question for the Week of April 20, 2026
Can you give an example of when to report 59 Distinct Procedural Service? On the same day a patient has a scheduled infusion in the medical oncology department, the patient is also scheduled to have a follow-up CT scan of the abdomen.
Laboratory Question for the Week of April 20, 2026
Is a PLA code a CPT Category I code? When a specific PLA code is not listed, the test must be reported using either a CPT® Category I laboratory code or an Administrative MAAA code, the latter separately listed in Appendix O. Codes are contained in a non-Category I subsection of the Pathology/Laboratory CPT codes. This question was answered in our annual Respiratory Therapy Reimbursement & Compliance Update webcast.
Respiratory Question for the Week of April 6, 2026
Under what conditions can we bill for 94640 and 94664 on the same date of service? To bill both 94640 and 94664 on the same date of service, there must be documentation that supports that the procedures were separate and distinct from one another. The medical record should include a request for each procedure, and therapist documentation should support that the procedures occurred at separate times. This question was answered in our Coding Essentials for RT/Pulmonary Function.