Learn How to Code
Accurate debridement documentation is crucial for proper medical coding and reimbursement, yet it is often challenging. The documentation must be sufficiently detailed to paint a clear picture of the procedure performed. However, the procedure title and description in the operative note often do not align, making it difficult to capture the appropriate coding information. Key … Read more
As a medical coder, mastering the language of orthopedics is essential for ensuring your coding is on point—especially when it comes to procedures like arthroplasty and joint replacement. While these terms are often used interchangeably, understanding their subtleties can make a huge difference in accurately translating clinical language into the precise codes used in medical … Read more
There is a common misconception that CPT® add-on code +43273 for cholangioscopy can only be reported when using a SpyGlass™ scope. After conducting research, I can confirm that this is not accurate, and here’s why. Focus on the Procedural Note Endoscopic retrograde cholangiopancreatography (ERCP) involves both diagnostic and therapeutic approaches, with distinct techniques covered under … Read more
Medical coders often face the challenge of decoding complex surgical reports filled with specialized terminology and detailed procedures. When confronted with a lengthy, intricate report, it can be overwhelming. However, breaking the process into manageable steps helps simplify and organize the task. The following six steps will guide you in transforming a complex surgical procedure … Read more
Description of CPT code 38225, 38226, 38227 & 38228 We have new CPT codes for Chimeric antigen receptor (CAR-T) therapy in 2025 and it will be used from new year. Below is the coding description for these codes. CPT 38225 – Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood derived T lymphocytes for development … Read more
Basics of CPT code 25447 & 25448 In Musculosketetal, their is one new CPT code added in 2025, CPT code 25448 was added in this section in new year with revision of CPT code 26447. Below is the code description for both the codes. 25447 – Arthroplasty, intercarpal or carpometacarpal joints; interposition (eg, tendon) 25448 … Read more
For accurate ICD-10-CM and CPT coding of fracture treatments, medical coders should identify the following critical details from the physician’s documentation: Fracture Location and Laterality: Specify the anatomical location (e.g., distal, proximal, mid-shaft) and laterality (if applicable) of the fracture. Common anatomical terms include distal, middle, proximal, mid-shaft, apophyseal, articular, periarticular, and others. Traumatic vs. … Read more
Basics of CPT code 15011, 15012, 15013, 15014, 15015 & 15016 In 2025, their are new CPT codes which includes eight new codes for skin cell suspension autograft (SCSA). This technique includes the harvest and preparation of a liquid solution of skin cells that is applied to a wound site to promote healing. Included are … Read more
Basic of Incision and Drainage (I&D) CPT code Procedures Accurate code selection for Incision and Drainage (I&D) procedures is essential for proper reimbursement. I&D is a common surgical intervention used to treat infections such as abscesses, cysts, and boils. This procedure involves making an incision in the affected area to allow the drainage of infected … Read more
What is Moderate Sedation? Moderate sedation, also known as conscious sedation, is a medical procedure where medication is used to relax a patient, but they remain awake and responsive. The patient can respond to verbal commands or light touch, and they do not need assistance with their airway or breathing. Heart function is generally stable … Read more