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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
How to Bill APCM in 2026: G0556 to G0558 and the New Behavioral Health Add-Ons
Advanced Primary Care Management pays a monthly amount per Medicare patient with no time tracking. For 2026, CMS added three add-on codes for behavioral health integration and collaborative care. Here is how the codes fit together, what must be documented, and what cannot be billed alongside them.
When to Use Modifier 25 and How to Document the Separate E/M Visit
Modifier 25 is the most audited two digits in office billing. We explain when to use modifier 25, what "significant and separately identifiable" means in a real note, how the preventive-plus-problem visit works, and why practices either leave it off and lose the visit or add it by reflex.
New Patient vs Established Patient: Three-Year Rule and the Denials It Causes
Most staff know one part of the new patient rule and not the other two. We walk through the three-year clock, the same group and same specialty tests, Medicare's NP and PA rule, the B16 denial it causes, and the quieter loss: established visits that should have been billed as new.
HCC Coding for Primary Care Practices: What Risk Adjustment Means on Claims
Medicare Advantage plans are paid based on the diagnoses your claims carry, and they know which of your patients have conditions not yet coded this year. Here is how hierarchical condition categories work, what CMS-HCC version 28 changed, the documentation rule and a capture workflow.
Modifier 59 vs XE, XS, XP and XU: When to Use Each and How NCCI Reads Them
Modifier 59 is the most audited modifier in outpatient coding, and the X modifiers CMS introduced in 2015 were meant to replace most uses of it. Here is what each one means, how NCCI edit indicators decide whether any of them will work, examples by specialty and the documentation behind the claim.
CPT 2026 Is Live: Codes to Load, Retire and Re-Map Before the First Claim Run
The 2026 CPT code set brought 288 new codes, 84 deletions and 46 revisions on January 1. Remote monitoring, AI-assisted services, hearing devices and leg revascularization changed the most. Here is how to work through the update without a wave of CO-4 and CO-181 denials.
CPT 99214 Documentation Requirements: What the Note Needs Under MDM Rules
Since 2021, an established patient office visit is leveled by medical decision making or total time, not by history and exam bullets. Here is what a 99214 note has to show in each of the three MDM elements, with worked examples, the common downcoding traps and what auditors flag.
FY2026 ICD-10-CM Update: 487 New Codes and Where Coders Will Get Them Wrong
The FY2026 ICD-10-CM code set took effect on October 1, 2025 with 487 new codes, 38 revisions and 28 deletions. Here is what changed, the chapters that matter for office practices, and the workflow mistakes that turn a code update into a denial spike.
CPT 2026 Code Set Released: 418 Changes and What to Do Before January 1
The AMA released the CPT 2026 code set on September 11, 2025: 288 new codes, 84 deletions and 46 revisions, effective January 1, 2026. Here is what is in it, how it interacts with the fee schedule final rule expected in November, and the charge master and contract work to start now.
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