Understanding CPT 99417 for prolonged E/M services

2026 CPT code changes are coming and most practices will find out when their claims start getting denied. January 1st isn't just New Year anymore. It's also CPT update day. And this time, the changes are bigger than usual: What's new in CPT 2026: 📍AI-assisted diagnosis codes (finally billable) 📍Telehealth codes 98000-98016 (replacing old phone visit codes) 📍Remote monitoring thresholds changed (stricter requirements) 📍Old audio-only codes deleted (video or nothing) What this means for you: ✔️ Submit claims with old codes = Automatic denial ✔️ Use new codes without proper documentation = Audit risk ✔️ Wait until January to learn = Lost revenue in Q1 Smart practices are preparing now: 📍Updating EHR systems before December ends. 📍Training staff on new documentation requirements. 📍Checking which payers accept which new codes. The ones waiting until January? They'll spend Q1 fixing denied claims instead of collecting revenue. Here's the reality: ✔️ Code changes don't wait for you to be ready. ✔️ Claims get denied whether you knew about updates or not. ✔️ Revenue stops when coding stops working. This isn't about being perfect. ❌ It's about being prepared before the deadline hits. ☑️ Ready to prepare your practice for CPT 2026 before January chaos begins? Book a call: https://lnkd.in/g2ts4rdh #cpt2026 #medicalcoding #healthcare #rcm #billingcompliance #revenuecycle

👇 🧩 Q5 or Q6 — can you spot the difference that decides your reimbursement? 🤔 In medical billing, Q5 and Q6 modifiers come into play when a substitute or locum tenens physician steps in — but the real question is, who’s covering whom? 👇 💠 Modifier Q5 – Service furnished by a substitute physician who belongs to the same group as the regular physician. 🧾 Example: When a provider in the same group covers another provider’s patients temporarily — coverage period should not exceed 60 continuous days. 💠 Modifier Q6 – Service furnished by a locum tenens (temporary) physician who is not part of the same group. 🧳 Example: When a practice hires an outside physician to cover for vacations, illness, or leave — allowed for up to 60 continuous days. ✅ Key Takeaway: Choosing the correct modifier ensures accurate reimbursement and CMS compliance. 📘 Pro Tip: Always document the coverage period, reason for absence, and date range clearly in the patient record. 💬 If you know about these modifiers, write down your thoughts in the comments! 👇 #MedicalBilling #Modifiers #Q5 #Q6 #HealthcareCompliance #RCM #MedicalCoding #RevenueCycleManagement

In healthcare billing, knowing the difference between CPT and ICD-10 is key for clean claims and faster approvals ✅ 💡 CPT Codes = What was done (procedure/service) 💡 ICD-10 Codes = Why it was done (diagnosis/reason) Here’s a quick guide 🩺👇 📘 ICD-10 Guidelines Code to the highest level of specificity Use combination codes when applicable Add 7th character for injuries (A – Initial, D – Follow-up, S – Sequela) Avoid unspecified codes unless truly unknown Link signs & symptoms only when no final diagnosis 📙 CPT Guidelines Pick the most specific procedure code Use correct modifiers (25, 26, TC, 59, 51…) Always link the appropriate ICD-10 for medical necessity Follow payer rules (DHA, HAAD, MOHAP) Check for bundled or add-on codes Ensure correct place of service (POS 11 – office, 21 – inpatient, etc.) ✨ Pro Tip: Accurate coding = fewer denials, faster payments, and happier patients 💰 #MedicalCoding #UAEHealthcare #RCM #CPT #ICD10 #InsuranceCoordinator #HealthInformationManagement #ClaimSubmission

✨🔹 Medical Coding Tip of the Day 🔹 In medical coding and billing, accuracy begins with understanding your codes! ✅ CPT Codes (Current Procedural Terminology) → Used for procedures and services performed by healthcare professionals. → Maintained by the AMA (American Medical Association). → 5-digit numeric format (e.g., 99213). ✅ HCPCS Codes (Healthcare Common Procedure Coding System) → Used for supplies, durable medical equipment, and services not covered under CPT. → Maintained by CMS (Centers for Medicare & Medicaid Services). → Alphanumeric format (e.g., A0427). Mastering both ensures: 💡 Smoother claim processing 💡 Fewer denials 💡 Faster reimbursements #MedicalCoding #MedicalBilling #RCM #CPTCodes #HCPCSCodes #ClaimsProcessing #HealthcareBilling #DenialManagement #RevenueCycleManagement #HealthcareFinance

💡 Bundling in Medical Billing Bundling occurs when payers combine multiple related procedures into one payment — meaning some services aren’t paid separately. ⚠️ Common Denial Codes 📍 CO-97: Included in payment for another procedure 📍 CO-151: Too many services submitted 📍 CO-236: Not paid separately 📍 PI-97: Payment included in another service 🔍 How to Resolve Bundling Denials ✅ 1. Review EOB: Identify bundled CPT codes and reasons. ✅ 2. Check NCCI Edits: Use CMS’s edit tool to confirm billable code pairs. ✅ 3. Apply Correct Modifiers:  • 59 – Distinct Procedural Service  • X(E,P,S,U) – More specific 59 versions ✅ 4. Add Documentation: Attach operative notes or proof of medical necessity. ✅ 5. File an Appeal: If justified, submit detailed records for reconsideration. 💬 Pro Tip: Each payer has unique bundling rules — always verify with payer-specific policies! #MedicalBilling #RevenueCycleManagement #DenialManagement #Bundling #NCCIedits #HealthcareBilling #RCM #TruCare

Accurate coding is the foundation of reimbursement. Without it, providers risk denials, delays, and lost revenue. Our blog outlines best practices in medical coding that help FQHCs capture every dollar they’re owed while maintaining compliance and supporting sustainable operations. Read our full coding guide here: https://bit.ly/4nZ9A4K #MedicalCoding #FQHC #RevenueCycleManagement

ICD-10 is a world of 70,000+ diagnosis codes — but precision is everything. Code smarter. Bill cleaner. Get paid faster. with Allzone Prevent Reimbursement Delays with Accurate ICD-10 Coding Accurate ICD-10 coding is the key to faster reimbursements and smoother claim processing. Even minor coding errors can trigger claim denials, payment delays, or costly resubmissions. By ensuring each diagnosis is coded precisely and supported by proper documentation, healthcare providers can demonstrate medical necessity, reduce payer rejections, and maintain compliance. Read More: https://lnkd.in/gEZcdpqP #Allzonems #allzonemanagementservices #medicalcoding #MedicalCodingServices #medicalcodingcompany #medicalcoder #medicalbilling #ICD10 #ICD10coding #outsource #healthcare #healthcarepractice #MedicalPractice #hospital #medicalpracticemanagement #outsourcingcompany #offshorecompany #mondaymotivation

Day 42/365 - #MedicalCodingInsights In medical billing, accuracy starts with knowing your codes! CPT codes cover procedures and services, while HCPCS codes include supplies, equipment, and services not found in CPT. Mastering both ensures smoother claims, fewer denials, and faster reimbursements #MedicalBilling #RCM #HealthcareFinance #CPTCodes #HCPCSCodes #DenialManagement #RevenueCycleManagement #MedicalCoding #HealthcareBilling #ClaimsProcessing

💡 Why CPT #90868 Matters So Much in #TMS Therapy Billing If you’ve handled TMS therapy claims, you know how CPT #90868 can make or break clean reimbursement. It’s the only valid CPT code for reporting each #TMS treatment session — covering both the therapy delivery and provider supervision. Here’s why it’s so important 👇 ✅ Recognized by all major payers — #Medicare, #UHC, #BCBS, and more ✅ Captures clinical oversight and treatment management ✅ No replacement or alternate code exists — this one defines #TMS care Pro tip 💬 → Always document session details (date, duration, provider involvement) to avoid denials and keep your claims audit-ready. TMS therapy is growing fast — and mastering 90868 helps keep billing compliant, clean, and revenue-strong. #MedicalBilling #RCM #TMSBilling #CPT90868 #HealthcareFinance #Compliance #provider #behavioralhealth #revenue

📢 Update in Medical Billing & Coding 📢 Starting October 1, 2025, Cigna’s new policy R49 (Evaluation & Management Coding Accuracy) will go into effect. 🔍 What’s changing? Cigna will have the right to downcode E/M claims if documentation doesn’t support the billed level of service. ⚡ Why this matters: Possible revenue loss for providers. Increased pressure on accurate documentation. More claim scrutiny from payers. 💡 For medical billers, coders, and providers: Now is the time to tighten documentation, align with CPT guidelines, and prepare your teams for claim reviews after October. This move has already raised concerns from medical associations, calling it burdensome and unfair. But one thing is clear: coding accuracy will be under the spotlight. 👉 What do you think — is this about compliance, or just another payer control measure? #MedicalBilling #Healthcare #RevenueCycle #Cigna #MedicalCoding