Blog
Medical Billing and RCM Insights
We write practical articles on denials, credentialing, coding and what it takes to run a healthier revenue cycle.
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CPT 99417: Prolonged Office Visit Add-On Code Explained
What CPT 99417 covers, when it starts for 99205 and 99215, how it differs from Medicare’s G2212, and common mistakes.
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CPT 99211: Nurse Visit for an Established Patient Explained
What CPT 99211 covers, typical nurse visits, Medicare incident-to and virtual supervision rules, and when 99211 should not be billed.
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CPT 99202: New Patient Office Visit, Straightforward MDM
What CPT 99202 requires, who counts as a new patient, straightforward medical decision making, the 15-minute rule and what replaced 99201.
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CPT 99212: Established Patient Office Visit, Straightforward MDM
What CPT 99212 requires, straightforward medical decision making, the 10-minute time rule, typical visits and how it differs from 99211.
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CPT 99205: New Patient Office Visit, High Complexity
What CPT 99205 requires, high medical decision making, the 60-minute time rule, prolonged visit add-ons and common mistakes.
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CPT 99203: New Patient Office Visit, Low Complexity
What CPT 99203 requires, who counts as a new patient, low medical decision making, the 30-minute time rule and typical visits.
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PR-1 Code: Deductible Amount (What It Means and Who Pays)
What PR-1 means, why it is a patient balance rather than a denial, when secondary insurance pays first, and how to collect deductibles.
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CO-4 Denial Code: Procedure Code Inconsistent With Modifier
What CO-4 means, the modifier mistakes that cause it, such as laterality, 26/TC and modifier 25, and how to correct the claim.
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CO-50 Denial Code: Not Medically Necessary (Meaning and Appeal)
What CO-50 means, how coverage policies and diagnosis codes drive it, when an ABN shifts liability, and how to build an appeal.
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CO-197 Denial Code: Prior Authorization Absent (Meaning and Fix)
What CO-197 means, why claims are denied for missing authorization even when one exists, and how to fix, appeal or prevent it.
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