We’ll help you make sure your coding and billing keep up with the latest changes and requirements

“Frequently performed” does not necessarily translate to “easy coding.” This is the case with coding and billing for mammography and other breast imaging procedures, as well as bone density scans — among the most common services in hospitals and imaging centers. Every year brings advances in technologies and procedures, along with new state and federal mandates and changes to codes and coding guidelines. Is your department staying on top of all these changes?

Through years of change, coders and billing departments have depended on the steady guidance provided by our Breast & Bone Density Procedure Coding Guide. In one resource, you get comprehensive help, from clear explanations of CPT® codes and their practical application to clarification of common questions. If the full, appropriate payment is important to your facility, you need this tried-and-true guide!

Features and Benefits

New for 2022:

• Explanations and practical application of new and revised codes, including the new trabecular bone score (TBS) measurements, and imaging guidance (ultrasonic, CT and MR)
• Updated billing tips and expanded guidance through common problem areas, such as breast MRI-including the abbreviated protocol (fast) MRI, fine needle aspiration (FNA) biopsy, ultrasound elastography and breast ultrasound
• Updated NCD detail for percutaneous image-guided breast biopsy, mammography and bone mineral density studies
• The latest information on proposed federal dense breast notification laws
• Guidance related to the COVID-19 public health emergency (PHE)
• New appendices on the use of artificial intelligence (AI) in breast cancer detection and raising awareness of the alarming surge in breast cancer in younger women
• New payment information, including reductions for the new year and where the impact will fall

Our experts address common questions, concerns, and problem areas:

• How to report a screening vs. diagnostic mammogram
• The use of "complete" CPT codes for breast interventions
• Clarification of when you may code for a diagnostic and screening mammogram during the same patient encounter
• Avoiding inappropriate billing for evaluation and management services
• Help with ICD-10 coding for various procedures, including bone density scans
• Addressing National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUEs)
• Documentation required to support code assignments

Clear, step-by-step guidance through the tasks you perform every day:

• Coding for a full range of diagnostic and interventional procedures, including breast interventions, mammography, digital breast tomosynthesis, bone density scans (DEXA/DXA) — including the new trabecular bone score (TBS) measurements, and imaging guidance (ultrasonic, CT and MR)
• Discussion of alternate imaging types such as ultrasound elastography, contrast-enhanced ultrasound and bone density ultrasound
• Covers and translates code assignments by both hospital (technical) and physician (professional) entities

A proven quick-reference approach for busy professionals:

• Codes are organized by types of procedures and technologies, and then by CPT/HCPCS code sequence
• Each section includes:
  • Listings of CPT/HCPCS codes, revenue codes and modifiers, along with the corresponding procedures
  • Medicare payment table containing RVUs and hospital OPPS rates
  • Description of procedures by CPT/HCPCS codes
  • Billing tips
• Case examples and Q&As to help clarify and reinforce key points

Much more than a coding resource…a guide to the full, compliant payment

Is your documentation missing critical start and stop times for infusions? Are there medical necessity issues with your hydration therapy services? Which coding and billing missteps for drug administration are auditors targeting? These are just a few of the many scenarios that threaten infusion and injection service compliance and revenues nationwide, year after year.

When you’re equipped with the right resource, these high-risk situations are also highly avoidable. As its name implies, our Coding Essentials for Infusion & Injection Therapy Services provides clear-cut guidance through coding for a full range of infusion and injection services in all settings. But it also tackles the recurring issues and challenges that put your payments and compliance at risk, from missing crucial elements in documentation, to confusion surrounding current payer trends.

Our book delivers everything you need, starting with clear authoritative guidance from the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS), supplemented by plain-English explanations, quick tips, answers to FAQs, case examples and other tools. Our ultimate goal is to help you capture — and keep — the full, compliant payment for these high-volume services.

Features and Benefits

Updated and expanded content, including:

• COVID-19 update highlighting documentation requirements, plus coding and billing for therapeutic infusions and injections.
• Coverage of all changes pertaining to infusion and injection therapy services, including updated Outpatient Prospective Payment System (OPPS) rates, status indicators and APCs
• Guidance to ensure proper implementation and coordination between departments when mid-year changes are released
• Tactics for preventing high-risk practices and auditor takebacks
• Detailed instruction through coding hierarchies
• Expanded guidance with payer issues and challenges related to drug administration and other infusion services

Our experts address common questions, concerns, and problem areas:

• Documentation related to time, route, site and flushes for timed codes
• "White bagging" and "brown bagging" drug supplies, including documentation and modifier requirements
• The impact of smart pumps and other technologies on documentation
• Comprehensive APC (C-APC), for observation care
• Coding and billing in alignment with the Medicare move to site-neutral payments

Clear, step-by-step guidance through the tasks you perform every day:

• Coding and documentation for infusion and injection services in all care settings
• Covers a broad range of infusion/injection services, including hydration therapy, drug administration, injections and chemotherapy services, as well as blood collection, transfusions and other procedures; also includes a section on coding for drugs and biologicals

A proven quick-reference approach for busy professionals:

• Coding index that quickly identifies pages in the book for specific drug administration codes
• Easy-to-understand overviews of coding systems, including ICD-10, modifiers, evaluation and management (E&M) services, medical necessity, local/national coverage determinations, audit targets and other critical topics
• Sections on specific services include:
  • Descriptions of services with their corresponding current codes (CPT®, HCPCS, revenue center) and descriptions
  • Explanations of intended code use
  • Documentation requirements
  • Tables displaying time increments for reporting services, where applicable
  • Examples of drugs involved
  • Billing tips
• Case studies, answers to FAQs reflecting common and complex challenges faced by professionals across the country, and case examples, to reinforce best practices and provide a concrete breakdown of problem areas
• Chapter with payment tables for physicians and hospitals

Maximize revenue while avoiding risky practices with this unique resource as your guide

Facilities strive to maximize revenue, but, with respiratory therapy services, it’s also about avoiding risky practices — because auditors, regulators and payers are watching closely! This unique resource will guide you through charge capture and coding while helping you avoid noncompliant practices for a full range of respiratory therapy, pulmonary function testing and sleep study services.

Count on our trusted RT experts to guide you step by step through the intricacies of coding, charging, billing and documentation for this very challenging area of healthcare. Along the way, you’ll discover a wealth of dos and don’ts, equipping you to protect your compliance and revenue. We address many potential pitfalls, including insufficient documentation, unbundled coding, modifier misuse, and the inappropriate coding of services.

Features and Benefits

Updated and expanded content, including:

• Explanation of new, deleted, and revised CPT®/HCPCS codes – including two new codes and the elimination of the longstanding G-codes for outpatient pulmonary rehab
• Guidance with all RT-specific HCPCS code changes and National Correct Coding Initiative (NCCI) updates
• Comprehensive information including clarification of supervision requirements for pulmonary rehab, an audit topic that poses serious consequences for noncompliance
• Updated billing tips and expanded guidance for common problem areas such as inhalation treatments (94640) and ventilation management, including coding guidelines and clarification of confusing NCCI rules
• Expanded information and guidance specific to inhaled nitric oxide and remote monitoring services—including new codes for remote therapeutic monitoring (RTM)
• FAQ section addressing some of the most commonly asked questions and challenges observed by our experts across the country
• Special guidance with services that should not be reported, such as evaluation and management (E&M) and recreational therapy, as well as testing provided per protocol —this is a growing area of noncompliance for RT departments that focus on counting productivity
• New appendices on the COVID-19 public health emergency (PHE) and the latest OIG audits regarding coverage requirements for outpatient cardiac and pulmonary rehabilitation services

Our experts address common questions, concerns, and problem areas:

• High-risk practices inherent with polysomnography and other sleep studies, such as insufficient prior authorization and incorrect coding for home sleep study tests
• Billing issues with breathing treatments — a prime RAC target — and billing sequence or date of service
• Unbundling of codes and groups of CPT/HCPCS codes that are inappropriately reported together
• Incorrectly billing for routine monitoring, oxygen, and services not specifically ordered by a physician
• Medicare medical necessity coverage policies and frequency limitations
• Lack of documentation to support medical necessity

Clear, step-by-step guidance through the tasks you perform every day:

• Coding, documentation, and billing for a full range of respiratory therapy services and pulmonary function testing, plus polysomnography and other sleep studies, EEGs, home sleep testing, and penile studies
• Covers code assignments by both hospital (technical) and physician (professional) entities

A proven quick-reference approach for busy professionals:

• Easy to navigate; each section contains:
  • Descriptions and intended uses of services provided
  • Listings of the corresponding CPT/HCPCS and revenue codes, along with explanations of intended code usage
  • Modifier usage, where appropriate
  • Documentation and medical necessity requirements
  • Billing tips
  • Clinical examples
• Complete and current payment information, including:
  • Hospital Outpatient Prospective Payment System (OPPS) rates
  • Procedures with APCs, status indicators and at-a-glance tables showing CPT/HCPCS codes included in APCs, plus prior year and current payment rates
  • National and local coverage determinations (LCDs/NCDs)
  • Advance beneficiary notices (ABNs)
  • NCCI, including procedure-to-procedure (PTP) and Medically Unlikely Edits (MUEs)

The fastest, easiest access to the right IR codes, every time

Interventional radiology coding has changed dramatically over the years. But one thing that hasn’t changed is the popularity of our trusted Interventional Radiology Coder book. In fact, it remains our number-one selling resource. Why? Quite simply, its unique “menus” provide the fastest, easiest access to the correct CPT/HCPCS codes for hundreds of common and not-so-common IR procedures — critically important in an era where IR coding accuracy rates continue to hover around 70%.

Of course, we update each year’s edition of Interventional Radiology Coder with the latest codes and coding guidelines. You also get clear-cut guidance through those tricky gray areas, including bundled, hybrid-bundled and component coding. Tools such as quick coding tips, FAQs in each chapter and anatomical illustrations provide additional clarity and further accelerate your code selection and validation process.

Features and Benefits

Updated and expanded content, including:

• New, deleted and revised codes for reporting IR procedures
• Guidance with parenthetical note revisions
• Updated billing tips and expanded guidance with common problem areas
• FAQ sections at the end of each chapter, delivering additional insights into difficult areas

Our experts address common questions, concerns, and problem areas:

• Confusion and questions about coding for:
  • Biliary procedures — imaging, drainage catheters, stent placement/exchange, biopsy
  • Genitourinary procedures — imaging, stent placement/exchange, biopsy
  • Dialysis circuit — AV graft/fistula
  • Endovascular aortic aneurysm repair
  • Cryoablation treatment for pulmonary tumors
  • Diagnostic bone marrow procedures
• Coding for pain management and venous sclerosing/ablation procedures — significant sources of revenue for many IR providers
• Proper application of bundled, hybrid-bundled and component codes

Clear, step-by-step guidance through the tasks you perform every day:

• Coding for hundreds of vascular and nonvascular IR procedures, encompassing both diagnostic exams and therapeutic interventions, including: diagnostic angiography, intracranial angiography, angioplasty, stenting, atherectomy, embolization, EVAR, FEVAR, TEVAR, dialysis graft/fistula, and lower extremity revascularization
• Covers code assignments by both hospital (technical) and physician (professional) entities

A proven quick-reference approach for busy professionals:

• Content is organized by body system (e.g., head and neck)
• Each section includes:
  • Menus that walk you from the procedure descriptions, listed alphabetically, to the current radiological and surgical codes
  • Payment tables (RVUs and APCs) by CPT/HCPCS code
  • Coding tips for each coding example listed
  • Anatomical illustrations showing common procedures and the corresponding CPT codes that fast track understanding

Count on us to guide you through your biggest coding challenges in a complex area of medicine

Based on experiences with hospitals and physician practices nationwide, our nuclear medicine and PET experts have identified many areas of confusion, uncertainty and noncompliance. Fortunately, our 2022 Nuclear Medicine & PET Coder book provides clarity and spells out the steps you must take to achieve compliant coding and documentation. As always, you get clear, detailed explanations of procedures and how they should be reported and documented. You also get clarification of gray areas, plus case examples, concrete tips, and much more. In short, this trusted resource delivers workable solutions and actionable answers to your real-world coding, documentation and billing issues.

Features and Benefits

Updated and expanded content, including:

• Explanations and practical application of new, deleted, and revised CPT® codes for nuclear medicine services including SPECT, SPECT/CT and planar imaging, and cardiac PET procedures, with crosswalks and guidance for use
• Update on the Appropriate Use Criteria (AUC) program
• Updated payment tables, radiopharmaceutical information, and other essential details throughout the book
• Guidance and references regarding PET and PET-CT national coverage changes for 2021 and 2022
• HCPCS Level II radiopharmaceutical updates

Our experts address common questions, concerns, and problem areas:

• When to use the new SPECT, SPECT/CT and planar imaging codes
• What the bundled cardiac PET and PET/CT codes do, and do not, include
• Documentation requirements for coding a thyroid “whole-body” exam vs. a “limited” exam
• Preventing the under-reporting of radiopharmaceutical units
• Recurring issues with coding, such as code unbundling and omitting CPT codes for certain procedures

Clear, step-by-step guidance through the tasks you perform every day:

• Coding and documentation for a full range of nuclear medicine and PET procedures, including SPECT, PET, PET/CT, planar imaging, integrated imaging, and therapeutic treatments
• Covers code assignments by both hospital (technical) and physician (professional) entities

A proven quick-reference approach for busy professionals:

• Codes are grouped by body system (e.g., endocrine, gastrointestinal, cardiovascular and more) and then by code sequence
• Each section includes:
  • Table of drugs and radiopharmaceuticals typically used for nuclear medicine procedures, along with the pertinent HCPCS and revenue codes
  • Definition of each procedure with its corresponding CPT® code
  • Coding and billing tips for each code
  • Payment tables based on the current Medicare physician fee schedule (MPFS) and the hospital outpatient prospective payment system (OPPS)

  CPT® is a registered trademark of the American Medical Association.

In-depth help with cardiac cath & peripheral coding, physician documentation and much more

The blending of new peripheral procedures into cardiac cath labs has created new challenges for coders. Do you struggle to pinpoint the keywords and phrases in already highly complex documentation — which, to compound the challenge, can vary from physician to physician? Is there confusion about which codes to use based on the procedure performed? If you answered “yes” to either of these questions, you’ll love how our Peripheral & Cardiology Coder book supports your coding accuracy and, ultimately, your revenue stream.

Count on the experts behind this popular, practical resource to explain, step by step, how procedures are performed, the subtle differences between similar procedures and how to zero in on keywords and phrases in the physician documentation to arrive at the correct code. With enhanced knowledge, skills and confidence, you will quickly and correctly arrive at the right code choices that support your ability to consistently capture the full, legal payment.

Features and Benefits

Our experts address recent changes, plus common questions, concerns, and problem areas:

• Coverage of the latest code changes for reporting peripheral and cardiology procedures
• Confusion over the coding and documentation of peripheral procedures involving lower and upper extremities, abdominal (aortography and renal) and carotid; includes detailed narrative to address proper code selection and which services may be billed separately
• Critical differences between documenting cardiac cath and peripheral procedures
• Special help with the rules for coding and documenting peripheral imaging and interventions — an area being embraced by more and more cath labs
• Answers to many frequently asked questions, such as "can we use add-on codes for cardiac cath and coronary interventions?" and "how do we bill for a diagnostic coronary angiogram in addition to an intervention?"

Clear, step-by-step guidance through the tasks you perform every day:

• Coding for diagnostic and interventional cardiac catheterization and peripheral procedures (lower extremity, upper extremity, lower extremity veins, abdominal, renal, head/neck), as well as diagnostic cardiology and noninvasive vascular procedures
• Covers code assignments by both hospital (technical) and physician (professional) entities
• Meeting documentation requirements to support medical necessity and code assignments

A proven quick-reference approach for busy professionals:

• Codes are grouped for fast navigation: by body system (e.g., head and neck) and then by CPT® code sequence
• Each section includes general coding guidelines; tables with CPT/HCPCS codes, modifier information, RVUs and hospital OPPS payment rates; definition of each procedure with its corresponding CPT code; and billing tips
• Case studies, with insightful commentary throughout the book, as well as full dictated reports, featuring highlighted key phrases, at the end of each chapter, to reinforce the rationale behind code assignments
• Anatomical illustrations for visual representations of common and complex procedures

Think of it as your one-stop resource for safeguarding crucial CT and MR revenues

Your facility generates substantial revenue from high-volume CT and MR procedures. But could your department be doing better? Miscoding and non-compliant billing continue to be rampant across the country, according to our radiology experts. Certain areas, such as combination studies (e.g., CTA with CT, MRA with MRI) and the documentation required for CTA studies, are especially problematic.

Our CT/MR Coder book is specifically focused on empowering you to capture every dollar of revenue that’s rightfully yours — regardless of the complexity involved. Using easy-to-understand language, we define and dissect every CPT® code: what it is, what it isn’t, exactly how it should be used, and the documentation needed to support its assignment. Augmenting these explanations are actionable tips, case examples, at-a-glance tables and other timesaving tools to give you the answers you’re seeking.

Features and Benefits

Updated and expanded content, including:

• New, deleted and revised codes for CT/MR services, including the new category III codes.
• Instruction for new parenthetical guideline revisions
• Information on the AUC/CDSM program
• Updated tips, guidance and FAQs addressing common problem areas, such as CT/CTA, breast MRI, soft tissue MRI and code unbundling

Our experts address common questions, concerns, and problem areas:

• In-depth guidance with commonly miscoded procedures and areas of confusion, including 3D post-processing (reconstructed spines), CT guidance, CT vs. CTA, CTA of the abdominal aorta, MRA and whole-body scans
• Guidance with codes for breast MRI, breast CT and MR elastography
• Answers to frequently asked questions, such as "What documentation is needed to code CTA"
• Confusion surrounding the use (and overuse) of codes CPT codes 76376/76377 for 3D rendering

Clear, step-by-step guidance through the tasks you perform every day:

• Coding for a full range of CT and MR procedures, including CTA, CTC, MRI, MRA, MRS and MRV
• Covers code assignments by both hospital (technical) and physician (professional) entities
• Help with accurately interpreting physician documentation to determine correct coding

A proven quick-reference approach for busy professionals:

• Codes are grouped by body system (e.g., head and neck) and then by code sequence
• Each section includes:
  • Procedure definitions with corresponding CPT/HCPCS codes
  • Coding guidelines and billing tips
  • Payment tables with codes, MPFS status, RVUs, OPPS APC information, and payment rates
  • Numerous case examples to help you make the connection between procedures and correct code assignments

Put an end to the areas of uncertainty and confusion that lead to missed revenue opportunities

Confused by conflicting guidance for ultrasound coding? Struggling with gray areas in documentation, frequency limitations, and billing requirements? Wondering about new codes and how to incorporate them into your coding workflow? Unsure about coding for duplex and doppler studies?

Resolve these areas of uncertainty and confusion with the help of Ultrasound Coder. Fully updated for 2022, this resource delivers the guidance you need to avoid missed revenue opportunities and noncompliant practices. Plus, you get actionable instruction covering what each code means, its correct usage and documentation requirements.

Features and Benefits

Updated and expanded content, including:

• Explanations and the practical application of coding changes, including the new code for 3D echocardiographic imaging
• Guidance with parenthetical guideline revisions
• Updated tips, guidance and FAQs, based on commonly asked questions and chronic problem areas, including fine-needle aspiration (FNA), ultrasound elastography, contrast-enhanced ultrasound and noninvasive vascular ultrasound

Our experts address common questions, concerns, and problem areas:

• In-depth coding guidance with noninvasive vascular studies, including what constitutes a complete vs. limited study
• Special help with areas of confusion, such as coding for:
  • Duplex exams
  • OB ultrasound and non-OB pelvic ultrasound
  • Soft-tissue ultrasound
  • Breast ultrasound
  • Elastography
  • Contrast-enhanced ultrasound
  • Bone density ultrasound
  • Echocardiography
  • Testicular ultrasound
  • Intravascular ultrasound (IVUS)
  • FNA biopsy
• Instruction to help you avoid costly miscoding of abdominal aortic aneurysm (AAA) ultrasound screening, ankle brachial index (ABI) assessments, and other recurring trouble spots

Clear, step-by-step guidance through the tasks you perform every day:

• Coding for a full range of ultrasound procedures, including diagnostic ultrasound, ultrasound guidance procedures, echocardiography (fetal and non-fetal), noninvasive vascular diagnostic studies and IVUS
• Covers code assignments by both hospital (technical) and physician (professional) entities
• How to accurately interpret physician documentation, including keywords to look for, critical omissions and subtle word variations that can lead to substantially different results

A proven quick-reference approach for busy professionals:

• Codes are grouped for fast navigation: by body system (e.g., head and neck) and then by CPT® code sequence
• Each section includes general coding guidelines; tables with CPT/HCPCS codes, modifier information, RVUs and hospital OPPS payment rates; definition of each procedure with its corresponding CPT code; and billing tips
• Case examples, augmented with insightful commentary, throughout the book, to reinforce correct code selection and identification of key terms in documentation