Three significant changes that will affect reimbursement rates go into effect January 1, 2026:
Conversion factor changes
Relative Value Unit (RVU) efficiency adjustment
Practice Expense changes
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tci ED Coding & Reimbursement Alert - 2009 Issue 9
READER QUESTIONS :Does a Single Cut Lead to Excision Exception?
Question: Our nonphysician practitioner (NPP) discovers a pair of benign lesions on a patient's right hand. One of the lesions was 0.5 cm, and the other was 0.3 cm; the injuries were 1.0 cm apart. Using a scalpel, the NPP removes both lesions with a single excision. Should I report one or two excision codes? Indiana Subscriber Answer: Since the NPP performed both excisions with a single incision, you should group the excisions together and report one code for both. Add the lengths of the two excisions to the margin between the lesions, and choose a...
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