In this article, we’ll explore the 5 most pervasive challenges in medical billing, introduce actionable solutions provided by skilled human coding and billing teams like those at Coding & Billing Solutions, and discuss how expertise in traditional approaches can significantly impact financial performance.

For a foundational understanding of medical billing and its distinction from medical coding, visit our related article: The Critical Role of Medical Billing in Healthcare Revenue Cycle Management.

Key Medical Billing Challenges and Solutions

While medical billing is an essential process, it comes with complexities that can hinder financial success. Here’s a closer look at the common challenges and how healthcare providers can overcome them with human expertise:

Challenge #1: Administrative Burden

Medical billing involves numerous tasks, such as managing denials, tracking claims, and communicating with payers. These responsibilities often demand attention to detail, time, and coordination, which can overwhelm existing staff. The problem is compounded by staffing shortages, as 78% of physicians report challenges in hiring and retaining qualified staff.

Solution: Skilled Billing Teams
Medical billing professionals excel in handling complex administrative tasks, providing:

• Hands-on management of claims: Experienced staff can proactively follow up on claims to reduce the likelihood of denials.
• Personalized problem-solving: Medical billers can negotiate with payers, address disputes, and find tailored solutions to resolve billing issues.
• Knowledge of best practices: Experienced staff can identify inefficiencies in current processes and implement improvements.

By investing in well-trained billing teams, practices can reduce administrative burdens and maintain higher levels of accuracy.

 Challenge #2: Compliance with Billing Guidelines and Regulations

Keeping up with evolving regulations is a major hurdle. Each payer has unique requirements, and new billing models like value-based care add layers of complexity. Non-compliance can lead to denials, penalties, or delays in reimbursement.

Solution: Expert Coding and Billing Professionals
Experienced coders and billers play a crucial role in ensuring compliance by:

• Staying updated on regulations: Trained professionals regularly review payer guidelines and industry changes to ensure accurate claims submission.
• Ensuring accuracy in coding: Coders with deep expertise verify that claims meet payer requirements and use the correct codes for diagnoses and procedures.
• Handling complex cases: Human teams can review and manage difficult claims that automated systems might flag incorrectly or fail to resolve.

Their expertise helps practices avoid costly errors while ensuring adherence to payer guidelines and federal regulations.

 Challenge #3: Data Management and Quality Control

Accurate billing relies on clean, organized data from diverse sources, including clinical documentation, patient demographics, and insurance details. Poor data quality or inaccessible information can delay claims and lead to denials.

Solution: Manual Data Review and Validation
Traditional billing teams excel in managing and validating data by:

• Conducting thorough reviews: Human teams manually verify data accuracy and completeness before claims submission.
• Cross-checking patient information: Skilled staff can confirm that all necessary details—such as insurance eligibility—are current and accurate.
• Identifying and addressing errors: By carefully reviewing documentation, billing teams can correct errors that might result in denied claims.

This hands-on approach ensures that the billing process runs smoothly, minimizing the risk of denials due to data discrepancies.

Challenge #4: Rising Costs and Declining Reimbursements

The healthcare industry faces increasing financial pressures due to rising costs and declining reimbursement rates. Practices must maximize revenue collection to remain viable.

Solution: Revenue Recovery Specialists
Experienced billing teams can address financial challenges by:

• Performing detailed accounts receivable analysis: Specialists identify unpaid claims and prioritize follow-up efforts to recover outstanding balances.
• Reducing rework rates: Skilled professionals focus on “first-pass” claim success, minimizing the need for resubmissions.
• Conducting regular audits: Billing teams can review claims and payments to ensure every service provided is reimbursed accurately.

Human expertise adds a layer of accountability that helps practices recover more revenue while reducing unnecessary costs.

Challenge #5: Patient Payment Collections

With patients taking on more financial responsibility through high-deductible health plans, practices often struggle to collect payments efficiently.

Solution: Patient-Focused Billing Teams
Billing professionals improve patient collections by:

• Providing personalized assistance: Staff can work directly with patients to explain bills, answer questions, and set up payment plans tailored to their financial situation.
• Enhancing transparency: Experienced teams ensure patients receive clear, itemized billing statements that are easy to understand.
• Proactively managing follow-ups: Dedicated staff can remind patients about upcoming due dates and follow up on overdue payments with professionalism and care.

This personalized approach builds trust with patients, improving collections and fostering satisfaction.

Ready to Empower Your Billing Team?

Medical billing is more than just a financial process—it’s the lifeline of your practice. Partnering with skilled medical billing professionals like the Team at Coding & Billing Solutions will streamline operations, reduce denials, and ensure your practice receives the revenue it’s owed.

Contact a Coding & Billing Solutions expert today to learn how our team of experienced professionals can support your practice with accurate, compliant, and patient-focused billing services.

Nontoxic single thyroid nodule

• E04.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2025 edition of ICD-10-CM E04.1 became effective on October 1, 2024.
• This is the American ICD-10-CM version of E04.1 – other international versions of ICD-10 E04.1 may differ.

Applicable To:

• Colloid nodule (cystic) (thyroid)
• Nontoxic uninodular goiter
• Thyroid (cystic) nodule NOS

The following code(s) above E04.1 contain annotation back-references that may be applicable to E04.1:

• E00-E89
• Endocrine, nutritional and metabolic diseases
• E04
• Other nontoxic goiter

Approximate Synonyms:

• Cyst of thyroid
• Dominant nodule of thyroid
• Dominant thyroid nodule
• Functioning thyroid nodule
• Non-toxic uninodular goiter
• Thyroid cyst
• Thyroid goiter, nontoxic, uninodular
• Thyroid nodule
• Thyroid nodule, functioning

ICD-10-CM E04.1 is grouped within Diagnostic Related Group(s) (MS-DRG v42.0):

• 011 Tracheostomy for face, mouth and neck diagnoses or laryngectomy with mcc
• 012 Tracheostomy for face, mouth and neck diagnoses or laryngectomy with cc
• 013 Tracheostomy for face, mouth and neck diagnoses or laryngectomy without cc/mcc
• 643 Endocrine disorders with mcc
• 644 Endocrine disorders with cc
• 645 Endocrine disorders without cc/mcc

Convert E04.1 to ICD-9-CM

Thyroid Nodule ICD 10 Code History:

• 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
• 2017 (effective 10/1/2016): No change
• 2018 (effective 10/1/2017): No change
• 2019 (effective 10/1/2018): No change
• 2020 (effective 10/1/2019): No change
• 2021 (effective 10/1/2020): No change
• 2022 (effective 10/1/2021): No change
• 2023 (effective 10/1/2022): No change
• 2024 (effective 10/1/2023): No change
• 2025 (effective 10/1/2024): No change

Diagnosis Index entries containing back-references to E04.1:

• Colloid nodule E04.1 (of thyroid) (cystic)
• Cyst (colloid) (mucous) (simple) (retention)

thyroid E04.1 (gland)

• Goiter (plunging) (substernal) E04.9

nontoxic E04.9

uninodular E04.1

uninodular (nontoxic) E04.1

• Nodule(s)

thyroid (cold) (gland) (nontoxic) E04.1

colloid E04.1 (cystic)

• Struma – see also Goiter

nodosa (simplex) E04.9

uninodular E04.1

• Thyroid (gland) (body) – see also condition

nodule E04.1 (cystic) (nontoxic) (single)

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

If you need more information about Thyroid Nodule ICD 10 code updates or just want to learn more about medical coding and HIM solutions from Coding & Billing Solutions, contact us today.

New CPT codes for telemedicine 2025:  there are updates for CPT codes for telemedicine that include codes for audio-only and video consultations, making it easier to bill for various virtual care modalities.

Besides new and updated CPT codes, there is increased complexity in compliance. Billing for telehealth services often varies by payer and jurisdiction. Providers must navigate these nuances to avoid claim denials.

Accurate and detailed documentation is crucial to support telehealth claims, including time spent, modality used, and patient consent. In 2025, medical coding guidelines for telehealth are expected to continue evolving alongside regulatory changes and technological advancements. Here are some general guidelines and trends your healthcare organization can anticipate based on current practices:

1. CPT Codes: Familiarize yourself with the latest Current Procedural Terminology (CPT) codes specifically designated for telehealth services. Codes for virtual visits, remote patient monitoring, and other telehealth-related services may be updated.
2. Modifiers: Use the appropriate modifiers, such as 95 for telehealth services provided via real-time audio and video technology. Ensure you stay updated on any new modifiers introduced.
3. Documentation Requirements: Thorough documentation is essential. Providers must document the modality of the visit (e.g., audio, video), patient consent, and the specific services rendered during the telehealth encounter.
4. Patient Location: Be aware of the rules regarding the patient’s location during the telehealth visit. Some payers require the patient to be in specific locations (such as at home, in a healthcare setting, etc.) to qualify for reimbursement.
5. Coverage Variations: Different insurers may have varying coverage for telehealth services. Ensure you are familiar with the specific policies of Medicare, Medicaid, and private payers.
6. New Codes for Remote Monitoring: As remote patient monitoring continues to grow, we can anticipate updates in coding guidelines that may introduce new codes for remote services, including patient engagement tools and chronic care management.
7. Interstate Licensure: Make sure that you are aware of the implications of interstate licensure for telehealth services, especially if coding involves care provided across state lines. This may impact reimbursement eligibility.
8. Compliance with HIPAA: Ensure that all telehealth practices comply with HIPAA regulations for patient privacy and data security. This is crucial for maintaining trust and ensuring proper coding.
9. Continuing Education: Stay updated through webinars, coding workshops, and guidelines from organizations like the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).
10. Feedback Loop: Engage in regular reviews of coding practices and feedback from claims submissions to adapt to ongoing changes and improve accuracy.

In the Evaluation and Management (E/M) section, there are 17 new telemedicine codes (98000-98016), effective Jan. 1, 2025

CPT 2025 will include new codes for audio-only telemedicine visits for new patients (98008-98011) and established patients (98012-98015). These expanded codes will replace the existing telephone-only codes 99441-99443, which CPT 2025 will delete.

New telemedicine code debuting in 2025, 98016 (Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion). It will replace the existing HCPCS code G2012.

The following are some CPT codes for telehealth services in 2025:

• 9X091: A new code for a brief virtual check-in encounter
• 98975: Updated to include digital therapeutic intervention
• 98976-98978: Revised to include device supply for data access or data transmissions

Other telehealth-related changes in 2025 include:

• CMS will suspend frequency limitations for subsequent inpatient visits, subsequent nursing facility visits, and critical care consultation services
• CMS will keep looser direct supervision requirements for audio-visual telehealth services in certain circumstances
• Providers who perform telehealth services from home can continue to report services under their office address
• Statutory restrictions on location, site of service, and practitioner type will go back into effect

Commercial health insurance carriers are not subject to the same telemedicine restrictions as Medicare. They may set their own telemedicine reimbursement rates.

CPT New patients:

• 98000 – Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded
• 98001 – …which requires a medically appropriate history and/or examination and low medical decision-making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded
• 98002 – …which requires a medically appropriate history and/or examination and moderate medical decision-making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded
• 98003 – which requires a medically appropriate history and/or examination and high medical decision-making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded

CPT Established patients:

• 98004 – Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
• 98005 – … which requires a medically appropriate history and/or examination and low medical decision-making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded
• 98006 – …which requires a medically appropriate history and/or examination and moderate medical decision-making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded
• 98007 – … which requires a medically appropriate history and/or examination and high medical decision-making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

Before the PHE, the following frequency limitations were in place:

• Limit of one telehealth visit every three days for subsequent inpatient visits;
• Limit of one telehealth visit every 14 days for subsequent nursing facility visits; and
• Limit on critical care consultations to one telehealth visit per day.

CMS proposed to continue to delay through December 31, 2025, before reinstating limitations on the number of times certain services in high-acuity settings may be performed via telehealth. During this time, CMS will continue to evaluate whether the removal of these frequency limitations should be made permanent.

The extension of CMS’s current suspension of frequency limitations applies to the following codes:

• Subsequent inpatient visit CPT codes 99231, 99232, 99233;
• Subsequent nursing facility visit CPT codes 99307, 99308, 99309, 99310; and
• Critical Care Consultation Services HCPCS codes G0508, G0509.

Telehealth Services under the PFS

For CY 2025, CMS proposed to add several services to the Medicare Telehealth Services List on a provisional basis, including demonstration prior to initiation of home International Normalized Ratio (INR) monitoring and caregiver training services. They were proposing to continue the suspension of frequency limitations for subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations for CY 2025. https://www.cms.gov/medicare/coverage/telehealth/list-services

CMS proposed that beginning January 1, 2025, an interactive telecommunications system may include two-way, real-time audio-only communication technology for any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system, but the patient is not capable of, or does not consent to, the use of video technology.

CMS proposed that, through CY 2025, we will continue to permit the distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home.

CMS proposed, for a certain subset of services that are required to be furnished under the direct supervision of a physician or other supervising practitioner, to permanently adopt a definition of direct supervision that allows the physician or supervising practitioner to provide such supervision through real-time audio and visual interactive telecommunications. CMS specifically proposed that the physician or supervising practitioner may provide such virtual direct supervision for services furnished incident to a physician’s service when they are provided by auxiliary personnel employed by the physician and working under his or her direct supervision and for which the underlying HCPCS code has been assigned a PC/TC indicator of office or other outpatient visit for the evaluation and management of an established patient who may not require the presence of a physician or other qualified health care professional. For all other services furnished under the direct supervision of the supervising physician or other practitioner, we are proposing to continue to define “immediate availability” to include real-time audio and visual interactive telecommunications technology only through December 31, 2025.

CMS proposed to continue our current policy to allow teaching physicians to have a virtual presence for purposes of billing for services furnished involving residents in all teaching settings, but only in clinical instances when the service is furnished virtually (for example, a three-way telehealth visit, with the patient, resident, and teaching physician all parties in separate locations) through December 31, 2025. This virtual presence will continue to meet the requirement that the teaching physician be present for the key portion of the service. We are also requesting information to help us consider whether and how best to expand the array of services included under the primary care exception in future rulemaking.

CMS transformed the working definition of “direct supervision” over the course of the public health emergency. The definition was updated in regard to supervision for the following:

• Diagnostic tests
• Physician’s services
• And certain hospital outpatient services

The 2025 Medicare Physician Fee Schedule (MPFS) includes several changes, including: 

• Conversion factor

The conversion factor for 2025 is proposed to be $32.36, a 2.8% decrease from 2024. This is due to the expiration of the 2.93% increase for 2024, as well as a small budget neutrality adjustment.

• G2211 complexity add-on code

This code can be paid when the base code is reported on the same day as a preventive service, such as a vaccine administration or annual wellness visit. For CY 2025, CMS proposed to allow payment of the O/O E/M visit complexity add-on code G2211 when the O/O E/M base code is reported by the same practitioner on the same day as an annual wellness visit (AWV), vaccine administration, or any Medicare Part B preventive service furnished in the office or outpatient setting.

• Telehealth flexibilities

Several telehealth flexibilities implemented during the COVID-19 pandemic will be maintained or extended.

• Digital mental health treatment

Three new G codes will be established for reporting digital mental health treatment.

• MIPS performance thresholds

MIPS performance thresholds will be revised.

• Infectious disease physician services

A new add-on code, HCPCS code GIDXX, was created to describe the intensity and complexity of hospital inpatient or observation care for infectious diseases.

• Preventive vaccines in RHCs and FQHCs

RHCs and FQHCs will be allowed to bill for Part B preventive vaccines and their administration at the time of service.

• Direct supervision

Direct supervision will be permitted through real-time audio and visual interactive telecommunications until December 31, 2025.

New Additions to the List of Telehealth Services:

CMS proposed adding certain codes to the Proposed List of Telehealth Services on a provisional basis. The List includes the services that are payable under the Medicare Physician Fee Schedule when furnished via telehealth. No codes are proposed to be added on a permanent basis, but the proposed provisional additions include:

• HCPS Code G0248 (Home International Normalized Ratio Monitoring)
• HCPS Code G0011 (PrEP for HIV)
• HCPS Code G0013 (PrEP for HIV)
• HCPS Codes GCTD1 – 3 (Caregiver Training In Direct Care Strategies and Techniques)
• HCPS Codes GCTB1 – 2 (Individual Behavior Management/Modification Caregiver Training)
• CPT Codes 97550-97552 (Caregiver Training in Strategies To Facilitate Patient Functional Performance in the Home or Community)
• CPT Codes 96202 – 96203 (Group Behavior Management/Modification Caregiver Training)

No Recognition of New AMA Telemedicine Evaluation and Management (E/M) Services Codes

The American Medical Association (“AMA”) recently revised the CPT Codebook and valued seventeen new codes (9X075 – 9X091) to describe telemedicine Evaluation and Management (“E/M”) services. CMS proposes to decline recognizing and paying for the new codes because they mirror existing office/outpatient E/M codes. For those new codes, CMS also proposes assigning a procedure status indicator of “I” to indicate that there is a more specific code that should be used for Medicare purposes.

If you have any questions about this or other coding issues, please contact the experts at Coding & Billing Solutions.

Malignant neoplasm of ovary

• C56 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
• The 2024 edition of ICD-10-CM C56 became effective on October 1, 2023.
• This is the American ICD-10-CM version of C56 – other international versions of ICD-10 C56 may differ.

Use Additional code to identify any functional activity

The following code(s) above C56 contain annotation back-references

that may be applicable to C56:

• C00-D49 – Neoplasms
• C51-C58 – Malignant neoplasms of female genital organs

Clinical Information

• A primary or metastatic malignant neoplasm involving the ovary. Most primary malignant ovarian neoplasms are either carcinomas (serous, mucinous, or endometrioid adenocarcinomas) or malignant germ cell tumors. Metastatic malignant neoplasms to the ovary include carcinomas, lymphomas, and melanomas.
• A primary or metastatic malignant tumor involving the ovary. Most primary malignant ovarian neoplasms are either carcinomas (serous, mucinous, or endometrioid adenocarcinomas) or malignant germ cell tumors. Metastatic malignant neoplasms to the ovary include carcinomas, lymphomas, and melanomas.
• Cancer that forms in tissues of the ovary (one of a pair of female reproductive glands in which the ova, or eggs, are formed). Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells).
• The ovaries are part of the female reproductive system. They produce a woman’s eggs and female hormones. Each ovary is about the size and shape of an almond.cancer of the ovary is not common, but it causes more deaths than other female reproductive cancers. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early. Women with ovarian cancer may have no symptoms or just mild symptoms until the disease is in an advanced stage. Then it is hard to treat. Symptoms may include
• a heavy feeling in the pelvis
• pain in the lower abdomen
• bleeding from the vagina
• weight gain or loss
• abnormal periods
• unexplained back pain that gets worse
• gas, nausea, vomiting, or loss of appetite
• to diagnose ovarian cancer, doctors do one or more tests. They include a physical exam, a pelvic exam, lab tests, ultrasound, or a biopsy. Treatment is usually surgery followed by chemotherapy. nih: national cancer institute

Code History

2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)

2017 (effective 10/1/2016): No change

2018 (effective 10/1/2017): No change

2019 (effective 10/1/2018): No change

2020 (effective 10/1/2019): No change

2021 (effective 10/1/2020): No change

2022 (effective 10/1/2021): No change

2023 (effective 10/1/2022): No change

2024 (effective 10/1/2023): No change

Code annotations containing back-references to C56:

Code First: R18.0

Type 1 Excludes: C75

Diagnosis Index entries containing back-references to C56:

• Adenofibroma

endometrioid D27.9

malignant C56-

• Brenner

tumor (benign) D27.9

malignant C56

• Carcinoma (malignant) – see also Neoplasm, by site, malignant

granulosa cell C56-

• Dermoid (cyst) – see also Neoplasm, benign, by site

with malignant transformation C56-

• Teratoma (solid) – see also Neoplasm, uncertain behavior, by site

ovary

embryonal, immature or malignant C56-

• Thecoma D27-

malignant C56-

• Tumor – see also Neoplasm, unspecified behavior, by site

Brenner D27.9

malignant C56-

dermoid – see Neoplasm, benign, by site

with malignant transformation C56-

granulosa cell D39.1-

malignant C56-

granulosa cell-theca cell D39.1-

malignant C56-

papillary – see also Papilloma

mucinous of low malignant potential C56-

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

2024 ICD-10-CM Diagnosis Code D69.3

• D69.3 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2024 edition of ICD-10-CM D69.3 became effective on October 1, 2023.
• This is the American ICD-10-CM version of D69.3 – other international versions of ICD-10 D69.3 may differ.

Applicable To

• Hemorrhagic (thrombocytopenic) purpura
• Idiopathic thrombocytopenic purpura
• Tidal platelet dysgenesis

The following code(s) above D69.3 contain annotation back-references

that may be applicable to D69.3:

• D50-D89 – Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
• D69 Purpura and other hemorrhagic conditions

Approximate Synonyms

• Acute idiopathic thrombocytopenic purpura
• Chronic idiopathic thrombocytopenic purpura
• Idiopathic thrombocytopenia purpura (itp)
• Idiopathic thrombocytopenic purpura
• Idiopathic thrombocytopenic purpura, chronic
• Purpura, idiopathic thrombocytopenia, acute

Clinical Information

• A condition in which platelets (blood cells that cause blood clots to form) are destroyed by the immune system. The low platelet count causes easy bruising and bleeding, which may be seen as purple areas in the skin, mucous membranes, and outer linings of organs.
• An autoimmune disorder in which the number of circulating platelets is reduced due to their antibody-mediated destruction. Itp is a diagnosis of exclusion and is heterogeneous in origin.
• Bleeding or bruising tendency due to low platelet level
• Thrombocytopenia occurring in the absence of toxic exposure or a disease associated with decreased platelets. It is mediated by immune mechanisms, in most cases immunoglobulin g autoantibodies which attach to platelets and subsequently undergo destruction by macrophages. The disease is seen in acute (affecting children) and chronic (adult) forms.

ICD-10-CM D69.3 is grouped within Diagnostic Related Group(s) (MS-DRG v41.0):

• 813 Coagulation disorders

Convert D69.3 to ICD-9-CM

Code History

2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)

2017 (effective 10/1/2016): No change

2018 (effective 10/1/2017): No change

2019 (effective 10/1/2018): No change

2020 (effective 10/1/2019): No change

2021 (effective 10/1/2020): No change

2022 (effective 10/1/2021): No change

2023 (effective 10/1/2022): No change

2024 (effective 10/1/2023): No change

Code annotations containing back-references to D69.3:

• Type 1 Excludes: D69.0

Diagnosis Index entries containing back-references to D69.3:

• Dysgenesis

tidal platelet D69.3

• Frank’s essential thrombocytopenia D69.3
• Hemorrhage, hemorrhagic (concealed) R58

purpura D69.3 (primary)

• Purpura D69.2

hemorrhagic, hemorrhagica D69.3

idiopathic (thrombocytopenic) D69.3

thrombocytopenic D69.49

hemorrhagic D69.3

idiopathic D69.3

immune D69.3

immune thrombocytopenic D69.3

• Thrombocytopenia, thrombocytopenic D69.6

primary NEC D69.49

idiopathic D69.3

essential D69.3

idiopathic D69.3

• Werlhof’s disease D69.3

2023 ICD-10-CM Diagnosis Code I48.91

Unspecified atrial fibrillation

• I48.91 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2023 edition of ICD-10-CM I48.91 became effective on October 1, 2022.
• This is the American ICD-10-CM version of I48.91 – other international versions of ICD-10 I48.91 may differ.

The following code(s) above I48.91 contain annotation back-references

that may be applicable to I48.91:

• I00-I99 -Diseases of the circulatory system

Approximate Synonyms

• Atrial fibrillation
• Atrial fibrillation with rapid ventricular response

ICD-10-CM I48.91 is grouped within Diagnostic Related Group(s) (MS-DRG v40.0):

• 308 Cardiac arrhythmia and conduction disorders with mcc
• 309 Cardiac arrhythmia and conduction disorders with cc
• 310 Cardiac arrhythmia and conduction disorders without cc/mcc
• 791 Prematurity with major problems
• 793 Full term neonate with major problems

Convert I48.91 to ICD-9-CM

Code History

2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)

2017 (effective 10/1/2016): No change

2018 (effective 10/1/2017): No change

2019 (effective 10/1/2018): No change

2020 (effective 10/1/2019): No change

2021 (effective 10/1/2020): No change

2022 (effective 10/1/2021): No change

2023 (effective 10/1/2022): No change

Diagnosis Index entries containing back-references to I48.91:

• Fibrillation

atrial or auricular (established) I48.91

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Coding & Billing Solutions has deep expertise in addiction treatment coding and compliance and has clients like New Life Medical Addiction Services, which has turned over all of its medical coding and billing to the CBS Team. “Sheri and her coding team have become an indispensable part of the extended New Life Team. Not only have they streamlined our medical coding, they have provided us with valuable insights and coding tips that have allowed us to claim more revenue from the services we provide while also facilitating a better patient experience and outcome” said Dr. Joseph Savon, Chief Medical Officer and Co-Founder of New Life.

The CBS Team is constantly reviewing the latest standards for medical coding for substance abuse treatment. In this post we will review 3 of the most used CPT codes for addiction treatment and how they should be implemented in your treatment center’s coding and billing operation.

Modifiers for Addiction Treatment Billing CPT Codes

In CPT codes for addiction treatment, most of the base code is the same, but it is the alpha modifiers that facilitate proper detailed coding.

The following are some of the most common CPT code modifiers for addiction treatment billing:

HA: For programs dealing with children under 18

HB: For programs dealing with adults younger than geriatric age.

HD: Used for programs designed for pregnant and parenting women.

HF: Substance use programs

HV: Used for addiction services that are funded by the state.

TG: Designates programs that deliver a complex and/or high level of care.

The Following Is An Overview Of The CPT Codes For Addiction Treatment

Addiction Treatment Billing CPT Code – H0001HF

H0001HF is a CPT code that refers to drug and alcohol assessments for SUD (Substance Use Disorder) treatment.

The CPT code for this is “H0001” and the modifier for this is “HF.” H0001 refers to time that counselors, doctors, and other clinicians spend performing alcohol and drug assessments with clients in the course of treatment for SUDs. The HF modifier is the indication that the billable hours are taking place in the context of a substance use program.

This code is used when conducting assessments with clients to determine the presence and severity of SUD in the course of creating and updating their treatment plans at an addiction treatment facility.

Addiction Treatment Billing CPT Code – H0004HF

H0004HF is a CPT code that refers to individual therapy/one-on-one counseling in an addiction treatment environment.

The CPT code for this is “H0004” and the modifier for this is “HF.” H0004 describes time spent doing individual counseling with a client and the inclusion of the modifier, HF, indicates that these billable hours have occurrent within the context of a substance use program. Please note that this code can only be used for sessions with an individual patient and not for sessions involving the patient’s friends or family,

Each instance of this code corresponds to 15 minutes of service. Accordingly, if sessions are one hour long, this code needs to be submitted four times to account for the four 15-minute blocks of individual therapy that occurred on that day.

Addiction Treatment Billing CPT Code – 96164HF

96164HF is a CPT code for group counseling done in a face-to-face setting in an addiction treatment program.

The CPT code is “96164” and the modifier is “HF.” The CPT code, 96164, represents face-to-face (in-person) group counseling and the HF modifier is used to communicate that the service took place in a substance use program. This code is used to describe the first 30 minutes of any behavioral health group session.

When billing for any of these CPT codes, it’s often recommended to provide a taxonomy code that describes the facility by provider type and/or specialization. The taxonomy code that is most often used for this is 261QR0405X which describes a provider that specializes in addressing substance use disorders.

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Are you a substance abuse or addiction treatment facility and you would like to discuss how Coding & Billing Solutions can help you with medical coding and compliance, contact us today!

Psoriasis, unspecified

L40.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

The 2023 edition of ICD-10-CM L40.9 became effective on October 1, 2022.

This is the American ICD-10-CM version of L40.9 – other international versions of ICD-10 L40.9 may differ.

The following code(s) above L40.9 contain annotation back-references

that may be applicable to L40.9:

L00-L99 – Diseases of the skin and subcutaneous tissue

Approximate Synonyms

Psoriasis

Clinical Information

• A chronic disease of the skin marked by red patches covered with white scales.
• A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. Psoriatic lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region; the pathology involves an accelerated epidermopoiesis. Psoriasis is associated with increased risk for melanoma, squamous cell carcinoma, and basal cell carcinoma.
• A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis.
• Common polygenetically determined, chronic, squamous dermatosis characterized by rounded erythematous, dry, scaling patches.
• Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. You usually get them on your elbows, knees, scalp, back, face, palms and feet, but they can show up on other parts of your body. A problem with your immune system causes psoriasis. In a process called cell turnover, skin cells that grow deep in your skin rise to the surface. Normally, this takes a month. In psoriasis, it happens in just days because your cells rise too fast. Psoriasis can last a long time, even a lifetime. Symptoms come and go. Things that make them worse include
  • infections
  • stress
  • dry skin
  • certain medicines
• psoriasis usually occurs in adults. It sometimes runs in families. Treatments include creams, medications and light therapy. nih: national institute of arthritis and musculoskeletal and skin diseases

ICD-10-CM L40.9 is grouped within Diagnostic Related Group(s) (MS-DRG v40.0):

• 595 Major skin disorders with mcc
• 596 Major skin disorders without mcc

Convert L40.9 to ICD-9-CM

Code History

• 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
• 2017 (effective 10/1/2016): No change
• 2018 (effective 10/1/2017): No change
• 2019 (effective 10/1/2018): No change
• 2020 (effective 10/1/2019): No change
• 2021 (effective 10/1/2020): No change
• 2022 (effective 10/1/2021): No change
• 2023 (effective 10/1/2022): No change

Diagnosis Index entries containing back-references to L40.9:

Psoriasis L40.9

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Group B Strep ICD 10 Sepsis due to streptococcus, group B

• A40.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2024 edition of ICD-10-CM A40.1 became effective on October 1, 2023.
• This is the American ICD-10-CM version of A40.1 – other international versions of ICD-10 A40.1 may differ.

The following code(s) above A40.1 contain annotation back-references

that may be applicable to A40.1:

• A00-B99 – Certain infectious and parasitic diseases
• A40 – Streptococcal sepsis

Approximate Synonyms

• Sepsis due to streptococcus agalactiae
• Sepsis with septicemia
• Septic shock with acute organ dysfunction
• Septic shock with acute organ dysfunction due to group b streptococcus
• Severe sepsis with acute organ dysfunction
• Severe sepsis with acute organ dysfunction due to group b streptococcus

ICD-10-CM A40.1 is grouped within Diagnostic Related Group(s) (MS-DRG v41.0):

• 870 Septicemia or severe sepsis with mv >96 hours
• 871 Septicemia or severe sepsis without mv >96 hours with mcc
• 872 Septicemia or severe sepsis without mv >96 hours without mcc

Convert A40.1 to ICD-9-CM

Code History

• 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
• 2017 (effective 10/1/2016): No change
• 2018 (effective 10/1/2017): No change
• 2019 (effective 10/1/2018): No change
• 2020 (effective 10/1/2019): No change
• 2021 (effective 10/1/2020): No change
• 2022 (effective 10/1/2021): No change
• 2023 (effective 10/1/2022): No change
• 2024 (effective 10/1/2023): No change

Diagnosis Index entries containing back-references to A40.1:

Sepsis (generalized) (unspecified organism) A41.9

Streptococcus, streptococcal A40.9

group

B A40.1

agalactiae A40.1

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

To learn more about Group B Strep ICD 10, contact us today.

Juvenile arthritis, unspecified

M08.9 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.

The 2024 edition of ICD-10-CM M08.9 became effective on October 1, 2023.

This is the American ICD-10-CM version of M08.9 – other international versions of ICD-10 M08.9 may differ.

Type 1 Excludes

• Juvenile rheumatoid arthritis, unspecified (M08.0-)

The following code(s) above M08.9 contain annotation back-references

that may be applicable to M08.9:

• M00-M99 – Diseases of the musculoskeletal system and connective tissue
• M08 – Juvenile arthritis

Clinical Information

Rheumatoid arthritis of children occurring in three major subtypes defined by the symptoms present during the first six months following onset: systemic onset (still’s disease, juvenile onset), polyarticular onset, and pauciarticular onset; adult onset cases of still’s disease (still’s disease, adult onset) are also known; only one subtype of juvenile rheumatoid arthritis (polyarticular onset, rheumatoid factor positive) clinically resembles adult rheumatoid arthritis and is considered its childhood equivalent.

Code History

• 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
• 2017 (effective 10/1/2016): No change
• 2018 (effective 10/1/2017): No change
• 2019 (effective 10/1/2018): No change
• 2020 (effective 10/1/2019): No change
• 2021 (effective 10/1/2020): No change
• 2022 (effective 10/1/2021): No change
• 2023 (effective 10/1/2022): No change
• 2024 (effective 10/1/2023): No change