Blogs
RCM
We stay up to date on the ever-changing insurance market's impacts on your specialty for you...because it's basically a full time job in and of itself.
JW and JZ on Skin Substitutes: the 2023 Rule Became the 2026 Error
Since October 2023, skin-substitute claims without a JW or JZ wastage modifier auto-deny. Here’s how the modifiers, the vial math, and CPT 15271-15278 fit together.
Gender-Affirming Mastectomy: 19303 or 19318? The Payer Decides
Gender-affirming mastectomy coding: why the cancer code (19303) draws flags, when payers direct chest surgery to 19318, and the documentation that carries necessity.
New ENT Practice Billing: Outsource Before You Hire
Billing for a new ENT practice: every service line has its own credentialing clock, what outsourcing costs during the ramp, and the day-one setup order.
Explaining Out-of-Network Billing to Patients: Why They Panic and What to Say
Start here The short version The whole change in a few lines. Patients do not hear a network status, they hear a surprise bill. The damage happens at the scheduling call, not at the claim. Under the No Surprises Act, an out-of-network surgeon at an in-network facility means the patient owes in-network cost-sharing — same […]
Facial Feminization (FFS): the Most-Denied Gender-Affirming Surgery
Facial feminization surgery is the most-denied gender-affirming procedure — read as cosmetic by default. WPATH letters and the perception argument are what flip it.
How to Outsource Billing for a New Plastic Surgery Practice: What to Sign, What to Cut
Billing for a new plastic surgery practice: why cosmetic cash masks the credentialing gap, what outsourcing costs during the ramp, and the day-one setup order.
Cyst & Lipoma Excision: Depth Decides the Code Family — and the Pay
Start here The short version The whole change in a few lines. A superficial cyst is a skin excision (11400 series); a lipoma is a soft-tissue tumor coded from the musculoskeletal family (2xxxx) by region, depth, and size. Coding a lipoma as a skin excision is the most common and most expensive error here — […]
Wound Repair Coding (12001–13160): The Summing Rule That Downcodes Closures
Start here The short version The whole change in a few lines. Repair is coded three ways by technique, not size: simple (single layer), intermediate (layered, or a heavily contaminated single-layer close), and complex (more than layered — scar revision, debridement, extensive undermining). Within one classification and one anatomic group, you add the lengths and […]
Benign Lesion Excision (11400–11446): The Path Report Is Measuring the Wrong Thing
CPT 11400-11446 is coded by excised diameter, lesion plus margins, not the shrunken pathology size. Here’s the measurement rule and the closure trap that cost you.
Plastic Surgery Billing Outsourcing: What It Actually Costs in 2026
Outsourcing plastic surgery billing costs 4-9% of insurance collections. The cash-revenue trap, the hidden payroll, and the three disciplines one hire cannot cover.
