Specialty billing

Every specialty we bill for, and what changes in each one

Two practices can bill the same payer in the same state and face different rules. This is the index of the specialties we work in, with the codes and payer patterns that actually decide whether a claim is paid.

55Specialty pages
50+Specialties served
48 hrsTarget charge lag
50States covered

Most billing problems are not billing problems. They are specialty problems that surface in billing.

A claim denied for medical necessity on an epidural injection is not a coding error. It is a payer policy and documentation question that should have been answered before the injection was scheduled. Moving that claim through a general billing queue does not fix it, because nobody in the queue owns the policy. Anesthesia bills in base units and time units. Pathology splits technical and professional components on surgical specimens. Behavioral health authorizes by units per week and expires quietly. The code set and the payer’s medical policy are different in each case, and so is the evidence the payer accepts.

01

Behavioral health and psychiatry

Authorization is the center of gravity here, because these services are approved per unit or per visit rather than per procedure.

Behavioral HealthAutism assessment 97151, applied behavior analysis units, reauthorization windows and visit caps
PsychiatryTime-based add-ons 90833, 90836 and 90838, ECT 90870, telehealth parity and payer enrollment
ABA Therapy97151 to 97158 with the technician and QHP split, units per week, reauthorization lead time
Mental Health Counseling90832, 90834 and 90837 by time, 90833, 90836 and 90838 add-ons, LCSW and LMFT enrollment
Addiction MedicineScreening 99408 and 99409 against G0396 and G0397, H0015 per diem, OTP bundles, Part 2 rules
02

Primary care and family practice

High volume, low unit value, and Medicare’s own rules for preventive visits. Small coding errors here cost repeatedly because they repeat every day.

Family MedicinePreventive visits 99381 to 99397, Medicare G0402 and G0438, chronic care management and modifier 25
Internal MedicineOffice and hospital E/M levels, transitional care 99495 and 99496, care plan oversight
PediatricsWell visits 99381 to 99394, vaccine administration 90460 and 90474, VFC handling and E/M levels
GeriatricsAnnual wellness visits G0438 and G0439, advance care planning 99497 and 99498, complex chronic care
Hospice and Palliative CarePer-diem levels, visit levels 99307 to 99310, advance care planning and election paperwork
03

Surgical specialties

Global periods, modifier sequencing and multiple procedure reduction decide the payment here. One wrong modifier can halve a claim that was coded correctly otherwise.

General SurgeryGlobal periods, multiple procedure reduction, modifiers 58, 78 and 79 for return trips to the OR
Bariatric SurgerySleeve 43775, gastric bypass 43644 and 43645, revisions 43770 to 43774 and global periods
Colorectal SurgeryColectomy 44140 to 44145 and 44204, laparoscopic coding, ostomy supplies
ENT and OtolaryngologySinus surgery 31256 and 31267, tubes 69436, audiometry and modifier 25 rules
Gynecologic OncologyRadical hysterectomy 58210, debulking, chemotherapy administration hierarchy
NeurosurgeryCraniotomy, spinal fusion, intraoperative monitoring and global period management
OB/GYNGlobal OB package, preventive versus problem visit billing, delivery coding
OphthalmologyCataract 66984, intravitreal injections with J-code capture, modifier 25 and global care
OrthopedicsFracture care versus separate E/M, MPPR sequencing, joint injections and DME
Plastic SurgeryReconstructive versus cosmetic distinction, wound repair, breast reconstruction
PodiatryDebridement 97597 and 97598, nail avulsion, orthotics and routine foot care exclusions
Thoracic SurgeryVATS 32507 against open 32480, global periods and post-operative care
UrologyCystoscopy, TURP, urodynamics, catheter and supply coding
Vascular SurgeryRevascularisation, dialysis access, vein ablation and the 26 and TC split
04

Medical specialties

Infusions, injections and drug codes drive the revenue, and prior authorization decides whether any of it is payable.

Allergy and ImmunologyAllergen immunotherapy 95115 and 95117, testing panels, drug administration
CardiologyMulti-vessel PCI coding, MPPR sequencing, stress testing and device monitoring
DermatologyDestruction versus excision, surgical pathology, Mohs 17311 to 17315
EndocrinologyContinuous glucose monitoring 95249 and 95250, insulin pumps, thyroid ultrasound and FNA
GastroenterologyScreening colonoscopy conversion, polypectomy, modifiers 33 and PT
Hematology and OncologyChemotherapy administration 96413 to 96417, J-code capture, drug wastage
HepatologyLiver biopsy 47000, transient elastography, hepatitis C treatment monitoring
Infectious DiseaseInfusion 96365 to 96368, prolonged services, outpatient antibiotic therapy
NephrologyDialysis 90935 and 90945, ESRD 90951 to 90970, vascular access coding
NeurologyEEG 95816 to 95819, EMG 95886, nerve conduction 95910 and botulinum toxin J0585
PulmonologyBronchoscopy 31622 and 31623, pulmonary function testing, modifier 25
RheumatologyBiologic infusion 96365 to 96368, joint injections, prior authorization
05

Therapy and rehabilitation

Billed by the minute, capped by the payer and renewed on a plan of care. The unit math decides the payment before the coding quality does.

Physical TherapyThe 8-minute rule, 97110 and 97140 timed units, KX at the threshold, certified plans of care
Occupational Therapy97535 and 97542 selection, the separate OT threshold, CO modifier rules, functional documentation
Speech Therapy92507 and 92526 unit rules, the threshold shared with PT, swallowing code families
06

Diagnostics and imaging

Technical and professional components are split here, and the split is where claims quietly lose half their value.

Cardiac ElectrophysiologyAblation add-on capture, electrophysiology studies, device interrogation
PathologySurgical pathology 88305 to 88309, immunostains 88342, molecular testing and TC/26 splits
Radiation OncologyIMRT 77301, treatment delivery 77417, image guidance and dosimetry coding
Radiation TherapyIMRT 77385 and 77386, SBRT 77373, simulation 77280 and weekly management 77427
RadiologyModifier 26 and TC splits, contrast studies, global versus professional reads
Interventional RadiologyImaging guidance 77012 and 77003, catheter and embolization codes, 26 and TC splits, sedation
Sleep MedicineHome sleep testing 95800 and 95801, in-lab 95810 and 95811, CPAP titration and adherence
07

Hospital, acute and procedural

Time-based codes and units of service where the documentation has to justify the level as well as the service.

AnesthesiologyBase units, time units, ASA modifiers 99100 and 99140, medical direction splits
Critical Care99291 and 99292 time rules, the 30 minute threshold, concurrent care documentation
Emergency MedicineED visit levels 99281 to 99285, critical care 99291, observation codes
HospitalistInitial and subsequent hospital care 99221 to 99233, discharge 99238 and 99239
Wound CareDebridement 97597 and 97598, skin substitutes, application 15271 to 15278
Pain ManagementEpidural and facet injections, fluoroscopic guidance, units of service
ChiropracticSpinal adjustment 98940 to 98943, exam and x-ray bundling, visit limits
Urgent CareE/M 99202 to 99215, same-day procedure capture, in-house x-ray splits, POS 20 claims
Home HealthPDGM 30-day periods, OASIS review, LUPA control and the face-to-face encounter window

Not sure which page covers your practice?

Tell us your specialty and your top three payers. We will point you at the right page and tell you where we would expect the money to be leaking before you send us anything.

Request a free billing audit Call (480) 599-9904

Book An
Appointment

Request a Call Back