1. Integration of Artificial Intelligence (AI) and Automation

Artificial Intelligence (AI) and automation are transforming the medical billing process, making it faster, more accurate, and less prone to errors.

By reducing claim denials and ensuring compliance with coding standards, AI can significantly enhance revenue cycle management. To streamline our client’s entry into AI, Coding & Billing Solutions is proud to announce its partnership with Reasint Artificial Intelligencein adopting this revolutionary technology.

CBS and Reasint have changed the game, providing intelligent production coding tools, automation, documentation analysis, and hyper-transparency and flexibility to streamline medical coding and billing like never before.

Reasint’s breakthrough has come in their new, proprietary, patent-pending machine intelligence system: ARNI. ARNI stands for “Automated Reasoning via Natural Intelligence”. Unlike common AI programs, ARNI isn’t generative; it doesn’t fill in the blanks even if that means providing the wrong answer. Instead, it mimics the thought processes and decision-making skills of an experienced medical coder, ensuring precision and reliability. Healthcare organizations investing in these technologies will see better financial outcomes and improved patient experiences.

2. Expansion of Telehealth Services

Telehealth has become a permanent fixture in the healthcare landscape. As more patients opt for virtual care, billing systems must adapt to accommodate:

• New CPT codes for telemedicine: The 2025 updates include codes for audio-only and video consultations, making it easier to bill for various virtual care modalities.
• Complexity in compliance: Billing for telehealth services often varies by payer and jurisdiction. Providers must navigate these nuances to avoid claim denials.
• Documentation requirements: Accurate and detailed documentation is crucial to support telehealth claims, including time spent, modality used, and patient consent.

With telehealth expected to grow, staying updated on billing requirements is essential to maximize reimbursements.

3. Emphasis on Cybersecurity

As medical billing becomes increasingly digital, protecting sensitive patient data is more critical than ever. Cyberattacks on healthcare systems have surged, making robust cybersecurity measures a top priority. Key strategies include:

• Encryption of sensitive data: Ensuring that data transmitted between providers, payers, and patients is secure.
• Compliance with regulations: Adhering to HIPAA and other data protection laws to avoid penalties.
• Proactive threat monitoring: Using AI-driven security tools to detect and respond to potential breaches in real-time.

Investing in cybersecurity not only protects data but also builds trust with patients and payers.

4. Shift Toward Value-Based Care

The transition from fee-for-service models to value-based care (VBC) is reshaping medical billing. VBC focuses on rewarding providers for patient outcomes rather than the volume of services rendered. Billing professionals must adapt to:

• New quality-based reimbursement codes that reflect patient health outcomes and care efficiency.
• Bundled payment models where a single payment covers all services for a specific condition or procedure.
• Enhanced data analytics to track and report performance metrics tied to reimbursements.

Embracing VBC requires close collaboration between clinicians, coders, and billing teams to align documentation and coding with quality care standards.

5. Adoption of Blockchain Technology

Blockchain is emerging as a game-changer in medical billing by creating transparent and secure transaction records. Its potential benefits include:

• Fraud prevention: Immutable records reduce the risk of fraudulent claims.
• Faster payment processing: Blockchain eliminates intermediaries, enabling quicker settlements between providers and payers.
• Improved interoperability: Secure sharing of billing data among healthcare entities without compromising privacy.

While still in its early stages, blockchain adoption is expected to grow as more organizations recognize its benefits.

6. Focus on Patient-Centric Billing

With patients bearing a larger share of healthcare costs, there is a growing emphasis on improving the billing experience. Patient-centric billing involves:

• Transparent pricing: Providing clear cost estimates upfront to avoid surprises.
• Flexible payment options: Offering installment plans, online payment portals, and digital wallets for convenience.
• Simplified statements: Using plain language and clear layouts to help patients understand their bills.

By addressing patient concerns and making the billing process less stressful, providers can enhance satisfaction and encourage timely payments.

7. Data Analytics for Revenue Cycle Optimization

Data analytics is becoming indispensable to CBS’s clients in optimizing revenue cycles. Advanced analytics tools help:

• Identify denial trends: By analyzing claim rejections, providers can implement corrective measures to reduce future denials.
• Improve cash flow: Predictive analytics forecast revenue trends and highlight areas for improvement.
• Monitor performance: Dashboards provide real-time insights into key metrics such as claim turnaround times and payment rates.

Data-driven decision-making empowers billing teams to be proactive rather than reactive, ensuring financial health and operational efficiency.

As the medical coding and billing industry continues to evolve, embracing these trends is essential for success in 2025 and beyond. From leveraging AI and blockchain to prioritizing cybersecurity and patient satisfaction, healthcare organizations that adapt to these changes will not only improve their financial performance but also enhance the overall care experience for patients. The team at Coding & Billing Solutions is dedicated to helping medical billing professionals navigate the complexities of this dynamic field with confidence. 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.

While the U.S. has implemented federal HIPAA regulations to protect this sensitive information, outsourcing the handling of these records to foreign countries could dangerously undermine patient privacy.

These risks become even more acute when we consider what might happen under the new U.S. Presidential Administration. On a wide variety of trade, data and intellectual property fronts, it is likely that there will be significant restrictions on the transfer of healthcare records out of the U.S. This looming issue makes the case for fully domestic Medical Coding and HIM even more pressing.

The Hidden Vulnerability in Electronic Medical Records

EMRs include a range of personal data beyond basic health details, such as social security numbers, home addresses, workplace information, prescription histories, and even family demographics like children’s schools. Sensitive mental and physical health information, including potentially stigmatizing diagnoses or explicit medical images, also lives within these records. Given the personal and sensitive nature of this data, any compromise could lead to severe consequences for individuals and their families, from identity theft to exposure of private health issues.

The Outsourcing Dilemma: Sacrificing Security for Savings

Over the past decade, healthcare providers increasingly turned to outsourcing companies based in countries like India, Pakistan, and the Philippines to manage HIM functions, primarily due to the cost savings of cheaper labor. Not only do these foreign resources often produce lower quality results than domestic coding firms, but these cost-saving measures introduce a substantial risk: these foreign workforces are not bound by HIPAA or U.S. privacy laws, leaving a critical gap in accountability and enforcement.

In the U.S., HIPAA regulations require strict controls to protect patient data, and the Department of Health and Human Services (HHS) Office for Civil Rights actively enforces these regulations. Violations can result in significant penalties for U.S.-based providers, coders, and contractors. Overseas entities, however, operate outside the reach of HIPAA and U.S. law. Even if a foreign outsourcing firm claims HIPAA compliance, there is no legal recourse if that compliance is not upheld. This reality leaves patients’ EMRs vulnerable to breaches and misuse without the protective recourse available within the U.S.

The Consequences of Data Exposure in Foreign Hands

Medical records have high black-market value, estimated at $100 to $1,000 per record. Cybersecurity experts warn that any patient information processed overseas faces an increased risk of being sold or leaked, with little accountability for the individuals or organizations that misuse it. If foreign workers mishandle or sell this information, U.S. patients have no legal remedy, and enforcement agencies like the HHS cannot prosecute foreign violations. The risk is magnified as foreign countries may lack the stringent data protection standards the U.S. maintains, making it easier for bad actors to access and exploit sensitive information.

Why U.S.-Based HIM Processing is Essential

The most effective solution to safeguarding patients’ privacy is to keep all HIM processing within the U.S. Here are key reasons why:

1. Legal Protections and Accountability: Processing HIM within U.S. borders ensures that federal privacy laws like HIPAA apply. Domestic coders, record-keepers, and other HIM professionals are legally obligated to follow rigorous data protection standards. If a breach occurs, U.S. agencies can investigate, penalize, and ensure corrective action, holding violators accountable in a way that is impossible with foreign firms.
2. Higher Standards and Compliance Assurance: U.S.-based HIM professionals are trained in HIPAA regulations, and their employers must pass routine audits and uphold security certifications. By contrast, foreign companies may not face the same rigorous standards, creating a lower threshold for compliance and increasing the risk of data compromise.
3. National Security Concerns: The security of U.S. citizens’ personal and medical data is not merely a private concern but a matter of national security. With identity theft and fraud posing substantial risks to individuals and financial systems, any weakness in data security can ripple out into wider social and economic instability. U.S.-based processing helps mitigate these risks by keeping sensitive data within the country’s regulatory and legal reach.
4. Probable Upcoming Legislation: We expect that their will be upcoming scrutiny of offshoring medical coding by the Trump administration, which could produce a seismic shift back towards fully domestic medical coding.
5. Supporting Domestic Workforce and Privacy Protections: Moving HIM functions offshore not only endangers patient data but also erodes the U.S. job market for health information professionals. By keeping these jobs domestic, the U.S. strengthens its workforce in this critical sector, benefiting both privacy standards and the economy.

The Path Forward: Patient Privacy Before Cost Savings

While cost-saving incentives may drive healthcare institutions to consider outsourcing HIM functions, the potential consequences for patient privacy and security are simply too high. Patients trust that their healthcare providers will protect their most sensitive information. This trust can only be preserved by ensuring that data handling stays within the framework of U.S. laws, oversight, and accountability.

To truly protect patient privacy, healthcare institutions must prioritize domestic processing of HIM tasks. When patients can trust that their medical records remain protected by robust U.S. privacy laws, they can focus on their health with confidence and peace of mind.

To get ahead of any changes in government policies regarding the offshoring of HIM and medical coding, you may want to talk to the Team at Coding & Billing Solutions. Are superior results and 100% fully domestic approach are something your organization needs to consider.

Do you have an adult family member or friend struggling with drug or alcohol abuse? You’re likely wondering how to help. The following are some questions to ask and some tips on how to help.

Am I Overreacting to a Substance Use Problem?

If you’re noticing issues in your loved one’s work, health, relationships, finances, or social life, you’re not overreacting. Continuing to use substances despite these problems is a clear sign that substance use has become a significant issue. When someone is unwilling to discuss their behavior or consider that there might be a problem, it’s a strong indicator that a problem exists.

What You Can Do:

1. Educate Yourself: Learn about the signs and symptoms of substance use.
2. Observe Behavior: Monitor the person’s actions over days or weeks to gather information. This can be helpful if you decide to talk to other family members, seek professional advice, or address the person directly.
3. Share Concerns: Discuss your observations with other family members and friends to gauge their perspective. If they agree, decide who will talk to the person about seeking help.
4. Seek Professional Advice: Contact a substance use professional, mental health professional, or other trusted experts to describe the situation and get their assessment.
5. Ensure Safety: If there’s any risk of physical or emotional harm, develop a safety plan.

The Benefits of Taking Action Early

The idea that someone must “hit bottom” before they can be helped is a myth. Research shows that early identification of substance use problems is far more effective. Catching the issue early—before significant damage occurs—leads to better outcomes. Early intervention might involve a health screening or a conversation with a professional. Treatment is often less intense and disruptive when the problem is addressed early.

Don’t wait for a crisis to take action. Without intervention, you may face severe consequences like arrests, medical emergencies, job loss, and even death. Moreover, untreated substance use can lead to additional problems for family members, such as health issues, depression, anxiety, and even substance use problems in children.

How to Raise the Subject

You might worry that bringing up the issue will lead to drastic reactions. However, the conversation could be productive. The person might not realize the extent of their problem or its impact on others. Without change, the situation could worsen, leading to the very outcomes you fear.

Tips for a Successful Conversation:

1. Choose the Right Time: Don’t bring up the subject when either of you is under the influence of substances.
2. Plan Ahead: Find a time when you can talk privately and without interruptions. Aim for a dialogue where both of you can express your thoughts.
3. Express Concern: Start by showing that you care for the person and are concerned for their well-being.
4. Be Specific: List the behaviors that worry you and explain how they’ve impacted you and others.
5. Encourage Dialogue: Ask open-ended questions and listen to their perspective without judgment.
6. Follow Up: If the person denies there’s a problem, suggest revisiting the conversation later. Your goal is to express your concerns, not to force an immediate change.

What If They Can’t Cut Back?

If the person has only recently developed a problem, they might be able to cut back on their own. However, many people who try to reduce their use find that they can’t sustain it for long. This realization may help them understand that the problem is more serious than they thought. If the person is willing to consider that there’s a problem, suggest getting an evaluation from a professional.

How to Help a Friend Understand They Need Help

If you’ve tried expressing your concerns repeatedly without seeing any change, focus on delivering a consistent, positive message: “We care about you and want you to get help.” Avoid blaming or arguing, as these can lead to denial and defensiveness.

Consider involving other trusted individuals—such as a friend, doctor, or clergy member—who might be able to reach the person in ways you haven’t been able to.

DOs and DON’Ts

• Don’t try to talk when either of you is under the influence.
• Do protect yourself and others from physical harm.
• Do call the police if there is violence.
• Do set and stick to limits that protect your home, finances, and relationships.

If you’re at your wits’ end, a formal intervention might be necessary.

How to Help a Loved One Get the Care They Need

When people think of treatment for substance use, they often imagine long-term residential facilities or detox. However, treatment options vary widely and are tailored to the individual’s needs. Treatment addresses physical, psychological, emotional, and social aspects of the person’s life.

Treatment Steps:

1. Screening: This involves questions about substance use and its impact. It can be done by various professionals, including doctors and counselors.
2. Brief Intervention: If a problem is identified, the person may receive feedback and be asked to cut back or stop their use. If they’re willing to make changes, a health professional can help set goals and offer support.
3. Ongoing Support: If necessary, the person may be referred for more intensive treatment. Any number of programs can be effective if the person is willing to engage.

To find a treatment program, visit SAMHSA’s Behavioral Health Treatment Services Locator.

What to Do in an Emergency

If your loved one shows any of the following symptoms, call 911 or emergency services immediately:

• Loss of consciousness after taking drugs or alcohol.
• Seizures.
• Suicidal thoughts after drinking or drug use.
• Severe withdrawal symptoms, such as confusion or tremors.

Getting help for someone struggling with substance use is never easy, but taking action is crucial for their well-being and the well-being of those around them.

Use Additional

• code for any associated fever (R50.81)

Type 1 Excludes

• other hemoglobinopathies (D58.-)

Clinical Information

• A blood disorder characterized by the appearance of sickle-shaped red blood cells and anemia.
• A disease characterized by chronic hemolytic anemia, episodic painful crises, and pathologic involvement of many organs. It is the clinical expression of homozygosity for hemoglobin s.
• An inherited disease in which the red blood cells have an abnormal crescent shape, block small blood vessels, and do not last as long as normal red blood cells. Sickle cell anemia is caused by a mutation (change) in one of the genes for hemoglobin (the substance inside red blood cells that binds to oxygen and carries it from the lungs to the tissues). It is most common in people of west and central african descent.
• Disease characterized by chronic hemolytic anemia, episodic painful crises, and pathologic involvement of many organs; the clinical expression of homozygosity for hemoglobin s.
• Sickle cell anemia is a disease in which your body produces abnormally shaped red blood cells. The cells are shaped like a crescent or sickle. They don’t last as long as normal, round red blood cells, which leads to anemia. The sickle cells also get stuck in blood vessels, blocking blood flow. This can cause pain and organ damage. A genetic problem causes sickle cell anemia. People with the disease are born with two sickle cell genes, one from each parent. If you only have one sickle cell gene, it’s called sickle cell trait. About 1 in 12 african americans has sickle cell trait. A blood test can show if you have the trait or anemia. Most states test newborn babies as part of their newborn screening programs.

Codes

D57 Sickle-cell disorders

D57.0 Hb-SS disease with crisis

D57.00 …… unspecified

D57.01 Hb-SS disease with acute chest syndrome

D57.02 Hb-SS disease with splenic sequestration

D57.03 Hb-SS disease with cerebral vascular involvement

D57.09 …… with other specified complication

D57.1 Sickle-cell disease without crisis

D57.2 Sickle-cell/Hb-C disease

D57.20 …… without crisis

D57.21 Sickle-cell/Hb-C disease with crisis

D57.211 Sickle-cell/Hb-C disease with acute chest syndrome

D57.212 Sickle-cell/Hb-C disease with splenic sequestration

D57.213 Sickle-cell/Hb-C disease with cerebral vascular involvement

D57.218 …… with other specified complication

D57.219 …… unspecified

D57.3 Sickle-cell trait

D57.4 Sickle-cell thalassemia

D57.40 …… without crisis

D57.41 Sickle-cell thalassemia, unspecified, with crisis

D57.411 Sickle-cell thalassemia, unspecified, with acute chest syndrome

D57.412 Sickle-cell thalassemia, unspecified, with splenic sequestration

D57.413 Sickle-cell thalassemia, unspecified, with cerebral vascular involvement

D57.418 …… with other specified complication

D57.419 Sickle-cell thalassemia, unspecified, with crisis

D57.42 …… beta zero without crisis

D57.43 Sickle-cell thalassemia beta zero with crisis

D57.431 Sickle-cell thalassemia beta zero with acute chest syndrome

D57.432 Sickle-cell thalassemia beta zero with splenic sequestration

D57.433 Sickle-cell thalassemia beta zero with cerebral vascular involvement

D57.438 …… with other specified complication

D57.439 …… unspecified

D57.44 …… beta plus without crisis

D57.45 Sickle-cell thalassemia beta plus with crisis

D57.451 Sickle-cell thalassemia beta plus with acute chest syndrome

D57.452 Sickle-cell thalassemia beta plus with splenic sequestration

D57.453 Sickle-cell thalassemia beta plus with cerebral vascular involvement

D57.458 …… with other specified complication

D57.459 …… unspecified

D57.8 Other sickle-cell disorders

D57.80 …… without crisis

D57.81 Other sickle-cell disorders with crisis

D57.811 Other sickle-cell disorders with acute chest syndrome

D57.812 Other sickle-cell disorders with splenic sequestration

D57.813 Other sickle-cell disorders with cerebral vascular involvement

D57.818 …… with other specified complication

D57.819 …… unspecified

If your organization is falling behind on coding and billing or just needs some fresh eyes, the Coding & Billing Solutions Team is ready to help. Contact us today!

ICD-10-CM Codes › A00-B99 › B20-B20 › B20- › 2024 ICD-10-CM Diagnosis Code B20

2024 ICD-10-CM Diagnosis Code B20

Human immunodeficiency virus [HIV] disease

• B20 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 B20 became effective on October 1, 2023.
• This is the American ICD-10-CM version of B20 – other international versions of ICD-10 B20 may differ.

Use Additional

• code(s) to identify all manifestations of HIV infection

Code First

• Human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth and the puerperium, if applicable (O98.7-)

Type 1 Excludes

• asymptomatic human immunodeficiency virus [HIV] infection status (Z21)
• exposure to HIV virus (Z20.6)
• inconclusive serologic evidence of HIV (R75)

Includes

• acquired immune deficiency syndrome [AIDS]
• AIDS-related complex [ARC]
• HIV infection, symptomatic

The following code(s) above B20 contain annotation back-references

that may be applicable to B20:

A00-B99 – Certain infectious and parasitic diseases

Approximate Synonyms

• Acquired immune deficiency syndrome (AIDS) in childbirth
• Acquired immune deficiency syndrome (AIDS) postpartum
• Acquired immune deficiency syndrome with pregnancy
• Acquired immune deficiency syndrome-related nephropathy
• AIDS
• AIDS dementia complex
• AIDS in childbirth
• AIDS wasting disease
• AIDS with dementia
• AIDS with neuropathy (nerve disease)
• AIDS with polyneuropathy (multiple nerve disease)
• AIDS, cdc stage a3
• AIDS, cdc stage b3
• AIDS, cdc stage c1
• AIDS, cdc stage c2
• AIDS, cdc stage c3
• Cachexia associated with AIDS
• Cognitive impairment due to human immunodeficiency virus infection
• Dementia associated with AIDS
• HIV cdc category a3 (AIDS)
• HIV cdc category b3 (AIDS)
• HIV cdc category c1 (AIDS)
• HIV cdc category c2 (AIDS)
• HIV cdc category c3 (AIDS)
• HIV in pregnancy
• HIV infection symptomatic
• HIV infection symptomatic b1
• HIV infection symptomatic b2
• HIV lipoatrophy
• HIV related cognitive impairment
• HIV related non hodgkins lymphoma
• HIV1 infection, symptomatic
• Human immunodeficiency virus myelitis
• Lipoatrophy due to HIV infection and treatment
• Myelitis due to HIV
• Nephropathy due to HIV
• Neuropathy due to human immunodeficiency virus
• Non-hodgkin lymphoma associated with human immunodeficiency virus infection
• Polyneuropathy associated with AIDS
• Postpartum AIDS (after childbirth)
• Symptomatic human immunodeficiency virus (HIV) 1 infection
• Symptomatic human immunodeficiency virus (HIV) infection category b1
• Symptomatic human immunodeficiency virus (HIV) infection category b2
• Symptomatic human immunodeficiency virus infection

Clinical Information

• A disease caused by human immunodeficiency virus (HIV). People with acquired immunodeficiency syndrome are at an increased risk for developing certain cancers and for infections that usually occur only in individuals with a weak immune system.
• A prodromal phase of infection with the human immunodeficiency virus (HIV). Laboratory criteria separating AIDS-related complex (arc) from AIDS include elevated or hyperactive b-cell humoral immune responses, compared to depressed or normal antibody reactivity in AIDS; follicular or mixed hyperplasia in arc lymph nodes, leading to lymphocyte degeneration and depletion more typical of AIDS; evolving succession of histopathological lesions such as localization of kaposi’s sarcoma, signaling the transition to the full-blown AIDS.
• A syndrome resulting from the acquired deficiency of cellular immunity caused by the human immunodeficiency virus (HIV). It is characterized by the reduction of the helper t-lymphocytes in the peripheral blood and the lymph nodes. Symptoms include generalized lymphadenopathy, fever, weight loss, and chronic diarrhea. Patients with AIDS are especially susceptible to opportunistic infections (usually pneumocystis carinii pneumonia, cytomegalovirus (cmv) infections, tuberculosis, candida infections, and cryptococcosis), and the development of malignant neoplasms (usually non-hodgkin’s lymphoma and kaposi’s sarcoma). The human immunodeficiency virus is transmitted through sexual contact, sharing of contaminated needles, or transfusion of contaminated blood.
• An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a cd4-positive t-lymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the cdc in 1993.
• An infection caused by the human immunodeficiency virus.
• Any state of infection accompanied by evidence of HIV in the body (positive test for HIV genome, cdna, proteins, antigens, or antibodies); may be medically asymptomatic or symptomatic; use AIDS when appropriate.
• Includes the spectrum of human immunodeficiency virus infections that range from asymptomatic seropositivity, through AIDS-related complex (arc), to acquired immunodeficiency syndrome (AIDS).
• One or more indicator diseases, depending on laboratory evidence of HIV infection (cdc); late phase of HIV infection characterized by marked suppression of immune function resulting in opportunistic infections, neoplasms, and other systemic symptoms (niaid).

ICD-10-CM B20 is grouped within Diagnostic Related Group(s) (MS-DRG v41.0):

• 969 HIV with extensive o.r. Procedures with mcc
• 970 HIV with extensive o.r. Procedures without mcc
• 974 HIV with major related condition with mcc
• 975 HIV with major related condition with cc
• 976 HIV with major related condition without cc/mcc
• 977 HIV with or without other related condition
• 974 HIV with major related condition with mcc
• 975 HIV with major related condition with cc
• 976 HIV with major related condition without cc/mcc

Convert B20 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 B20:

Code Also: I27.21

Code First: B39, C46, F02, F06.7, G05

Type 1 Excludes: I88, B97.3, D61.81, L04, D84.81, D89.89, R62.5, R75, Z21, Z21

Applicable To: Z83.0

Use Additional: O98.7, O98.7, D59.31

Diagnosis Index entries containing back-references to B20:

• Acquired – see also condition

immunodeficiency syndrome B20 (AIDS)

• AIDS B20 (related complex)
• ARC B20 (AIDS-related complex)
• Dementia (degenerative (primary)) (old age) (persisting) (unspecified severity) (without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety) F03.90 in (due to) human immunodeficiency virus (HIV) B20 – see also Dementia, in, diseases specified elsewhere with behavioral disturbance B20 – see also Dementia, in, diseases specified elsewhere.
• Disease, diseased – see also Syndrome

viral, virus B34.9

– see also Disease, by type of virus

human immunodeficiency B20 (HIV)

human immunodeficiency virus B20 (HIV)

slim B20 (HIV)

• Encephalitis (chronic) (hemorrhagic) (idiopathic) (nonepidemic) (spurious) (subacute) G04.90 due to human immunodeficiency virus B20 (HIV)

HIV B20 – see also Human, immunodeficiency virus.

Human

immunodeficiency virus (HIV) disease (infection) B20

dementia B20 – see also Dementia, in, diseases specified elsewhere with behavioral disturbance B20 – see also Dementia, in, diseases specified elsewhere.

Slim disease B20 (in HIV infection)

Syndrome – see also Disease

HIV infection, acute B20

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

HFMA’s Metropolitan Philadelphia Chapter is hosting its 9th Annual Women in Leadership Event at City Winery located at 990 Filbert Street in Philadelphia. The session will provide attendees with the opportunity to spend a full day with exceptional leaders with regional and national ties.

As a female corporate leader, I am excited to be able to attend this exciting event and am looking forward to being able to introduce members of the CBS team to this dynamic group.

The Keynote Speaker will be Lori Herndon, RN, BSN, MBA, who is a recent Former President and CEO of AtlantiCare. Following the keynote presentation, there will be a conversation with a panel of female executives including Dixie James, Dr. Nicole Fox, Kasandrah Garnes, and Karen Smith. Our afternoon starts off with Sarah Ohanesian, a former Chief Marketing Officer turned Productivity Coach, Speaker & Trainer. We close the day with a Networking Happy Hour in the beautiful City Winery.

A common theme of this year’s featured speakers is the importance of giving back to their community through volunteerism, and the Women’s Event Committee has chosen to spotlight My Sister’s Place (MSP), where pregnant women, mothers and their children reside while in treatment for addiction.

It’s not too late to join us at this special event. Just snap on the QR code above, visit the event website, or call me at 610-428-9034 to learn more.

When your organization chooses Coding & Billing Solutions as its out-sourced coding team, you will find a team of coders who have industry-leading expertise in HIM services, including coding, auditing, billing, revenue management and recovery, denial reviews and prevention, and physician coding/billing. CBS proudly provides services 365 days a year with cost-effective solutions for every organization’s needs.

The following are some medical coding and billing tips that will help you to improve claims management and reimbursements.

1. Make Sure You Are Up To Date On The Latest Coding Changes

Medical billing and coding is a constantly evolving field. Regular training and education of the coders can help them stay up to date with the latest changes in the industry, medical codes, and compliance regulations.

Medical codes are the key that connects a patient’s visit to their healthcare provider or hospital into an electronic format that payers use to process claims for reimbursement. If a billed claim has incorrect, outdated, or missing codes, then it will be denied.

With hundreds of thousands of evolving and changing codes to use in billing, medical coders need to have access to the latest information. In the past, coders would rely on manual coding directories to find the right codes, but today, most use digital encoders and digital coding libraries to generate electronic codes.

The most heavily used medical code systems include:

International Classification of Disease 10th edition (ICD-10) Codes:

ICD-10 Codes specify a patient’s diagnosis or condition. ICD-10 is the tenth edition of the International Classification of Diseases, which is a medical coding system chiefly designed by the World Health Organization (WHO).  ICD-10 codes allow medical billers and coders to classify medical conditions into categories of related diseases under which more specific medical conditions are detailed, which in turn relates those specific conditions to broader morbidities. ICD-10 Codes are then used by medical professionals to code and bill for their services.

Current Procedural Terminology (CPT) Codes:

The Current Procedural Terminology (CPT®) codes provide doctors and health care professionals with a standard language for coding medical services and procedures to improve accuracy, streamline reporting, and deliver efficiencies. Where ICD codes describe the patient’s symptoms, CPT codes record their treatment. If there’s a discrepancy between diagnosis and treatment, the claim is likely to be denied by the payer.

Healthcare Common Procedure Coding System (HCPCS) Codes:

The Centers for Medicare and Medicaid Services (CMS) use Healthcare Common Procedure Coding System codes to apply CPT codes to procedures, services, products, and equipment offered to Medicaid and Medicare patients and those covered by private insurance. These codes are constantly being revised and are often recycled, so coders must pay close attention to avoid errors.

National Drug Code (NDC):

NDC codes are used when the patient is taking prescribed or over-the-counter medications and need to be used in billing. The NDC directory dynamic and is updated daily.

Diagnosis-Related Group (DRG) Codes:

Diagnosis-Related Group codes combine ICD and CPT codes to determine the final amount that a hospital can be reimbursed. CMS assigns annually calculated weightings to Diagnosis-Related Group codes based on the severity and duration of a condition of illness, current trends in treatment and other factors.

There are also multiple coding directories for different specialties, such as dental care, mental health treatment and patients with disabilities.

2. Double-Check All Claims Before Submitting

It is essential to double-check the claims codes being used to make sure that they are accurate. As in any complex environment, coding errors can happen, and double-checking can catch those errors before they become costly mistakes. Conducting a thorough, line-by-line review of each claim before it’s submitted means errors can be found and fixed before they result in financial losses.

3. Accurate Patient Information

It is important to make sure that that patient information is correct and current, including demographic information and insurance coverage details.

4. Focus On Quality Documentation

Ensure that medical records are complete, accurate, and legible. Coding accuracy depends on the quality of documentation.

5. Audit The Claims Management Process To Spot Medical Coding Inaccuracies

Finally, it makes sense to undertake regular audits of the medical coding and billing procedures to weed out any recurring issues. Analyze and review claims that are denied or rejected to identify any trends or patterns that could be causing errors in the billing and coding process.

This helps uncover recurring issues with under- and over-coding, use of redundant and retired codes, non-compliance, and poor documentation. Again, maintaining robust, quality data and records will make this process easier.

By implementing these practices, medical billing and coding accuracy can be increased, which will result in timely payment for services rendered, and improved patient care. Partnering with a single, trusted vendor like Coding and Billing Solutions will help your organization achieve this.

Please call us at 610-428-9034 or fill out our Contact Form.

While there is little longitudinal data from across the healthcare industry on the efficacy of offshore medical coding, we at Coding & Billing Solutions have seen the direct results of this trend, which are not always positive.

While the overall picture is complicated, the following are some concerns and deficits that arise from offshore medical coding:

Language Barrier

One of the biggest challenges of using offshore medical coders is the language barrier. Medical coding requires a high level of accuracy and attention to detail, and any misunderstanding or misinterpretation of medical terms or codes can result in incorrect coding, which can have serious consequences for patients, healthcare providers, and insurers. Offshore coders may not be familiar with the nuances of the English language, which can lead to errors in coding.

Time Zone Differences

Another disadvantage of using offshore medical coders is the time zone differences. Healthcare providers may experience delays in receiving coded information due to the time it takes for offshore coders to complete their work. This can result in delays in billing and insurance processing, which can have a negative impact on cash flow.

There is also the related issue of the difficulty in having real-time conversations with overseas coders, which causes further delays and frustration.

Quality Control

Healthcare providers may find it challenging to ensure quality control when working with offshore medical coders. It can be difficult to monitor and review the work of offshore coders, which can lead to errors and inaccuracies in coding. Additionally, offshore coders may not be as invested in the success of the healthcare provider as local coders, which can result in a lack of motivation and attention to detail.

Security Concerns

Offshore medical coders may not be subject to the same data privacy laws and regulations as those in the United States. This can put patient data at risk of being compromised or stolen. Additionally, offshore coders may not be as familiar with U.S. healthcare regulations and compliance requirements, which can lead to violations and fines.

Cultural Differences

Cultural differences can also be a challenge when working with offshore medical coders. In some cultures, it may be considered impolite to ask questions or seek clarification. This can lead to misunderstandings and mistakes in coding.

Denied Claims

Some research shows that offshore medical coders average 10 more denied claims per week than domestic coders. These denied claims then need to be reworked and the coder needs to be retrained on the errors. All of this takes time and reduces the cost benefits of offshore medical coding options.

Overall Productivity

From our observation, offshore coding requires more supervision and auditing due to the poorer coding accuracy and concerns about miscoding. This kind of intervention can eliminate the cost savings from going overseas.

Coding & Billing Solutions, LLC is a 100% domestic medical coding and billing service provider. Our cost structure allows us to be charge in the middle area between fulltime provider staff and overseas coding options. As a result, we are the best cost-benefit option for outsourced medical coding – just ask our client firms!

Contact us to today to discuss how we can become a trusted and cost-effective partner.

Please call us at 610-428-9034 or fill out our Contact Form.

This is the American ICD-10-CM version of C90.00 – other international versions of ICD-10 C90.00 may differ.

These codes are applicable to:

1. Multiple myeloma with failed remission
2. Multiple myeloma NOS

The following code(s) above C90.00 contain annotation back-references that may be applicable to C90.00:

C00-D49 – Neoplasms

C81-C96 – Malignant neoplasms of lymphoid, hematopoietic and related tissue

C90 – Multiple myeloma and malignant plasma cell neoplasms

C90.0 – Multiple myeloma

Approximate Synonyms

• Hypogammaglobulinemia co-occurrent and due to multiple myeloma
• Light chain disease
• Light chain nephropathy
• Light chain nephropathy due to multiple myeloma
• Multiple myeloma
• Multiple myeloma stage i
• Multiple myeloma stage ii
• Multiple myeloma stage iii
• Multiple myeloma w hypogammaglobulinemia
• Smoldering multiple myeloma
• Smoldering myeloma

Clinical Information

• A bone marrow-based plasma cell neoplasm characterized by a serum monoclonal protein and skeletal destruction with osteolytic lesions, pathological fractures, bone pain, hypercalcemia, and anemia. Clinical variants include non-secretory myeloma, smoldering myeloma, indolent myeloma, and plasma cell leukemia. (who, 2001)
• A malignancy of mature plasma cells engaging in monoclonal immunoglobulin production. It is characterized by hyperglobulinemia, excess bence-jones proteins (free monoclonal immunoglobulin light chains) in the urine, skeletal destruction, bone pain, and fractures. Other features include anemia; hypercalcemia; and renal insufficiency.
• A malignant neoplasm of the bone marrow composed of plasma cells.
• A type of cancer that begins in plasma cells (white blood cells that produce antibodies).
• Malignant neoplasm of plasma cells usually arising in the bone marrow and manifested by skeletal destruction, bone pain, and the presence of anomalous immunoglobulins.
• Multiple myeloma is a cancer that begins in plasma cells, a type of white blood cell. These cells are part of your immune system, which helps protect the body from germs and other harmful substances. In time, myeloma cells collect in the bone marrow and in the solid parts of bone.no one knows the exact causes of multiple myeloma, but it is more common in older people and african-americans. Early symptoms may include:
• bone pain, often in the back or ribs
• broken bones
• weakness or fatigue
• weight loss
• repeated infections

myeloma is hard to cure. Treatment may help control symptoms and complications. Options include chemotherapy, stem cell transplantation and radiation.

ICD-10-CM C90.00 is grouped within Diagnostic Related Group(s) (MS-DRG v41.0):

• 820 Lymphoma and leukemia with major o.r. Procedures with mcc
• 821 Lymphoma and leukemia with major o.r. Procedures with cc
• 822 Lymphoma and leukemia with major o.r. Procedures without cc/mcc
• 823 Lymphoma and non-acute leukemia with other procedures with mcc
• 824 Lymphoma and non-acute leukemia with other procedures with cc
• 825 Lymphoma and non-acute leukemia with other procedures without cc/mcc
• 840 Lymphoma and non-acute leukemia with mcc
• 841 Lymphoma and non-acute leukemia with cc
• 842 Lymphoma and non-acute leukemia without cc/mcc

Convert C90.00 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

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

If you would like to learn more about Multiple Myeloma ICD 10 Codes, please call us at 610-442-2346 or fill out our Contact Form.