Billing for post-procedure care can become complicated when a patient remains in the hospital longer than expected after a planned outpatient surgery. One common question coders face is whether they can bill a discharge-day management code (99238 or 99239) the day after an elective outpatient procedure without first billing an initial observation care code. The answer is usually no, but there are important exceptions that depend on payer policies and the patient’s status duri

Primary care serves as the foundation of effective healthcare, yet many systems struggle to meet the growing demands of patient populations. Advanced primary care management offers a practical approach to improving patient outcomes by enhancing coordination, communication, and proactive care. This post explores key strategies healthcare professionals can use to strengthen primary care delivery and ultimately support better health results. Healthcare provider reviewing patient

Medicare therapy services have undergone significant changes in 2026. The longstanding therapy cap has been repealed, but new rules now require careful attention to billing practices. Specifically, claims for therapy services exceeding $3,000 must include a KX modifier to indicate medical necessity. This update affects how healthcare professionals submit claims and manage therapy services for Medicare beneficiaries. This article explains the 2026 Medicare changes, the role of

Superior HealthPlan is implementing a new policy on Leveling of Care for office based Evaluation and Management Over-coding (CC.PP.066) Nurse adjusting IV drip to ensure proper care level What Superior Leveling of Care Means Superior will implement an automated pre-payment claims review process to assess and standardize the correct level of evaluation and management (E&M) service effective February 1, 2026. The coding algorithm will analyze each diagnosis code billed on the c

The Blue Cross Blue Shield (BCBS) network is rolling out a significant update that affects how professional providers bill for psychiatry and psychotherapy services. Starting December 22, 2025, a new Clinical Payment and Coding Policy, CPCP051 Psychiatry/Psychotherapy Services-Professional Provider , will take effect. This policy aims to clarify billing and coding procedures for behavioral health services, ensuring smoother claims processing and reimbursement. This update is