Medical Billing & Coding Guidelines by Practice Specialty

Learn the billing rules for diagnostic versus therapeutic endoscopies, including MPPR and bundled services. Understand the essential documentation required to support GI procedures and ensure compliant claims.

Master GI billing by applying modifiers 22, 25, and 59, understanding NCCI bundling and global periods to ensure compliant reimbursement for colonoscopy with polypectomy.

Learn the documentation elements for GI billing, common denial trends, and audit triggers. Apply best practices in medical necessity, ICD-10 and CPT coding, and internal audits to reduce denials.

Explore the cardiology billing workflow, contrasting diagnostic and interventional cardiology billing and coding. Understand how site of service affects reimbursement and common billing challenges.

Master cardiology billing by applying professional and technical component rules for CPT codes for EKGs, echocardiograms, and cardiac catheterizations, ensuring medical necessity, proper frequency, and detailed documentation for accurate reimbursement.

Understand common cardiology denial reasons, including medical necessity, authorizations, coding errors, and overutilization, and apply accurate documentation, proper modifiers, and pre-submission audits to improve claim acceptance.

Learn billing rules for infusions and injections, including drug units, wastage, and prior authorization for biologics, with documentation of dosage, route, and infusion start and end times to support claims.

Discover how orthopedic billing differs by care setting—office vs facility, professional versus facility charges, and place of service 11, 22, 24—while addressing workflow challenges and ensuring accurate documentation.

Apply orthopedic global surgery rules to ensure the global package covers preoperative assessments through routine postoperative visits, using modifiers 24, 25, and 57 correctly, and avoid unbundling and misdocumentation.

Learn to bill post-operative visits in orthopedics by applying the global surgery package rules, documenting infections or unrelated issues for separate billing, and avoiding audit risks from overbilling or underdocumentation.

Master pulmonary diagnostic billing rules, including professional and technical components, frequency limits, and medical necessity. Learn correct CPT codes for PFTs, ABG, and sleep studies to avoid common billing errors.

Master the billing rules for sleep studies and pulmonary function tests, including authorization, medical necessity documentation, CPT coding distinctions for in-lab vs home studies, and common denial trends.

Navigate pulmonology services that require prior authorization, understand payer frequency edits, and prevent denials by ensuring medical necessity, accurate ICD-10 and CPT coding, and thorough documentation for clean claims.

Learn neurology visit billing patterns for new and established patients, align diagnostic service workflows with CPT codes for EEGs, EMGs, and MRIs, and document medical necessity to prevent denials.

Navigate neurology diagnostic billing for EEG, EMG, and nerve studies, applying modifier rules, bundling considerations, payer limits, and documentation for proper reimbursement.

Learn high-risk neurology denial reasons, audit triggers, and compliance pitfalls, with best practices to manage denials and ensure proper reimbursement through accurate coding and solid medical necessity documentation.

Compare interventional and office-based pain billing, detailing the revenue cycle workflow, place of service considerations, and common coding, documentation, and billing mistakes to ensure accurate reimbursement.

Master frequency limitations in pain management billing, avoid denials by documenting medical necessity, obtaining prior authorization, and preventing overutilization, upcoding, and unbundling.

Explore behavioral health billing models across outpatient, inpatient, and telehealth settings. Distinguish professional and facility billing, and address revenue cycle challenges and payer requirements, including prior authorization and medical necessity.

Learn time-based and telehealth billing rules, including accurate time documentation, CPT code selection, HIPAA-compliant platforms, and strategies to reduce compliance risk and ensure proper reimbursement.

Understand authorization requirements for behavioral health, manage no-show policies, and reduce denials by ensuring medical necessity, prior authorization, CPT/ICD-10 coding, and clear cancellation guidelines.

Compare medical and dental billing to identify services eligible for medical insurance, using ICD-10, CPT for medical, and CDT for dental. Document medical necessity and avoid crossover billing denials.

Learn cross-coding practices, medical necessity documentation, and payer-specific requirements to avoid denials and audits, and master compliant coding across specialties, including upcoding and downcoding risks.

Identify common dental billing denials and coordinate benefits to bill primary and secondary insurers correctly. Apply effective appeals, CDT coding, medical necessity documentation, and compliance to improve reimbursements.