AAPC The Magazine April 2026 MINUTE WITH A MEMBER Getting to Know Betty Hovey Betty Hovey, CPC, CPC-I, COC, CPCD, CPMA, CPB, earned her first AAPC credential in medical coding in 1996. Since then, she has been climbing the ladder to success. In anticipation of seeing her present “Modifier 25: Deal…

National Alliance of Medical Auditing Specialists Article Reference Code: NAMAS.03.20.2026 March 20, 2026 Why a Quick, Memorable Pitch Matters “Hey Doc, you’ve got a packed schedule, patients waiting, and probably zero patience for another hour-long educational session that feels like death by PowerPoint.  So, let’s cut to the chase: I…

Hey Y’all!  As physician educators, we have a tough job.  Sometimes it’s like herding cats through a minefield-exhausting, unpredictable, and we sometimes get a few scratches.  I mean, you’re speaking to physicians that may be able to diagnose a patient from across the room, but glaze over at the mention of modifier 25.  Some physicians are very open to education and some see…

The appeals process is a critical component of health care compliance, ensuring that denied claims are appropriately challenged and reconsidered. When providers and health care organizations receive claim denials, they often require skilled professionals to navigate the appeals process. In these cases, auditors play a crucial role, serving as subject…

Telemedicine has emerged as a routine component of modern healthcare delivery, enabling providers to connect with patients efficiently and effectively. The updated 2025 Current Procedural Terminology (CPT) codes reflect significant strides in formalizing and enhancing telemedicine services. This article explores the nuances of these new codes and guidelines, providing healthcare…

Question: We had a patient that called in and left a message for the doctor to contact her about a visit she had for bronchitis just over a week ago. The doctor called her back and they had a 10-minute discussion about how she was feeling. She stated that she…

Question: An established Medicare patient was seen in our primary care office for a follow-up from the Urgent Care to have sutures removed. Do we need to report modifier 25 on our E/M code with 15853 for the suture removal? The doctor also talked to the patient about their hypertension…

Question: I am unsure what ICD-10 diagnosis codes should go on a claim for an encounter.  Here is an example: a patient is seen for a nagging cough/cold symptoms.  Since the patient has hypertension, the doctor told her there are certain over-the-counter medications she should not take.   He then gives…

Question: A patient came in for two punch biopsies due to dermatitis that wouldn’t clear after treatment for a few months.  The doctor thinks that he should be able to bill an E/M with the visit, but I say no.  Who is right?  Answer:  I don’t like giving this answer,…

Question: One point of clarification I’ve wondered about. What defines the chronicity of the condition? Is it if it’s lasted more than one year already for the patient or is it if we know that it’s going to last more than a year even if it’s only lasted a few months?…

Question: When I am performing a shave biopsy, I append diagnosis code D48.5 to the service.  My coder is telling me that it is incorrect, and I should use D49.2 instead.  Who is correct?  Answer: The coder is correct on this one.  D48.5 is Neoplasm of Uncertain Behavior of Skin…

In CPT this year, there are new Category I codes for Principal Care Management (PCM). CPT CODE DESCRIPTION #•99424 Principal care management services, for a single high-risk disease…; first 30 minutes provided personally by a physician or OQHCP, per calendar month #+•99425       each additional 30 minutes provided personally by…