There are new CPT® codes effective July 1, 2023, which are published in MLN Matters 13210 dated June 13. There is a companion Change Request 13210 document which provides greater detail.
The new COVID vaccine and administration codes are 0174A for the administration of Pfizer-BioNTech COVID vaccine, Bivalent for patients six months through four years of age. The vaccine is CPT 91317.
There are 15 new CPT Proprietary Laboratory Analyses codes effective July 1. The change request document will provide a detailed list with long descriptors and status indicators. The new codes fall between 0387U through 0401U.
There are 20 new CPT Category III codes that were released in January but were effective July 1. CPT 0791T through 0810T are the codes that have been added. For example, 0793T has the description of percutaneous transcatheter thermal ablation of nerves enervating pulmonary arteries and includes right heart catheterization, pulmonary artery angiography, and all imaging guidance.
There are some new HCPCS procedure codes including the following:
There are six new HCPCS codes for reporting drugs and biologicals with status indicator of G. For example, J1440 is new with the description of fecal microbiota, live-jslm, 1 ml.
There are three new HCPCS codes for high-cost skin substitute and 12 new HCPCS codes for low-cost skin substitutes.
If you collaborate with outpatient cases, perform charging, or are a chargemaster coordinator, it is imperative that you review MLN 13210 and/or Change Request 13210 for all the details.
The next Coordination and Maintenance Committee meeting will be held on Sept. 12 and 13. The tentative agendas have not been posted.
The National Center of Health Statistics (NCHS) released an erratum for FY24 ICD-10-CM on July 26 which corrected the Index entry for cachexia to R64. Dr. James Kennedy spoke about this issue during Talk Ten Tuesday, July 25.
Another inclusion in the errata was the correction of the spelling of thalassemia which is found in the inclusion terms for code H35.2 (Other non-diabetic proliferative retinopathy). A second update was made to this area with the correction of the code associated with the inclusion terms under category H35 (Disorders of endocrine glands in diseases classified elsewhere).
The diagnosis code associated with the inclusion term late congenital syphilis of thymus gland [Dubois disease] was corrected from A50.5 to A50.59.
Programming note: Listen to live coding reports by Laurie Johnson every Tuesday on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer.
Resources:
MLN 13210
CR 13210
https://www.cms.gov/Medicare/Coding/ICD10/C-and-M-Meeting-Materials
https://www.cms.gov/medicare/icd-10/2024-icd-10-cm
Here at MedLearn, we know cardiology coders are the unsung heroes of patient care. Every day, as a cardio coder you navigate complex cardiovascular procedures, including the constantly –changing CPT® and ICD-10-CM
The recent settlement between Kaiser Permanente and the federal government marks a pivotal moment in the ongoing debate over risk-adjustment practices in Medicare Advantage (MA)
Please log in to your account to comment on this article.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
