Urgent April Update: Medical Coding Cuts That Save You Thousands

Executive Overview

This week’s top RCM developments for U.S. medical practices (ex. dental & dermatology):

• 50 New ICD 10 PCS Codes went live April 1, 2025—spanning robotics, nextgen implantables, and advanced imaging procedures. 
• CY 2025 PFS Conversion Factor cut to $32.35 (–2.83%), dragging physicianoffice reimbursements down an estimated 3%. 
• Telehealth Waivers Extended through September 30, 2025 (originationsite & geographic flexibilities retained for non behavioral visits). 

Must Read: 5 Steps to Slash Denials for Mental Health Services

1. Telehealth & Coverage Updates

H.R. 1968 Implementation

Congress’s Full Year Continuing Appropriations Act, 2025, pushed the telehealth geographic/origination site waivers—and FQHC/RHC distant site privileges—out to September 30, 2025. 

• Non Behavioral Visits: Home based telehealth remains reimbursable nationwide.
• Behavioral Health: Existing audio only flexibilities and virtual supervision rules remain through year end. 

2. Coding & Documentation Focus

ICD 10 PCS Deep Dive

• The 50 new PCS codes address robotics (e.g., neurovascular thrombectomy series, 00D1–00D4) and advanced device insertions (0JH–0JJ). Update your charge masters and OR documentation templates. 

HCPCS Q1 2025 Highlights

• CMS published Q1 2025 HCPCS Level II drug & biological determinations on April 2, 2025. Review application summaries for new supply/drug codes and billing nuances. 

Pro Tips:

• Audit your chart to code workflows to ensure device model numbers and laterality fields are populated pre bill.
• Reinforce Excludes1 discipline in ICD10CM to avoid cascading audit flags on immunodeficiency and postCOVID conditions.

3. Reimbursement & Cash Flow Trends

Physician Fee Schedule Impact

• The 2.83% PFS cut ($0.94 decrease) means your typical E/M code mix must shift toward higher RVU services (e.g., favor 99215 over 99213 where clinically appropriate). 

Denial Spike Watch

• Early April data point to a 12% uptick in “medical necessity” denials on home infusion and genetic panel claims. Introduce a pre bill clinical attestation step—use templated MD sign off to head off denials.

AR Acceleration Metrics

• Aim for <30 day AR in high volume specialties. Deploy automated payment posting bots: clients have seen an 8 day AR reduction in 60 days by cutting manual posting lags.

4. Case Study: Slashing AR from 35 to 20 Days

A 12provider multispecialty group faced a 35day average AR. We rolled out:

1. Task Segmentation: Front desk eligibility checks became a standalone codable task.
2. Denial Dashboard: Real time payer risk flags surfaced at check in.
3. AR Sprints: Weekly two hour “deepdive” sessions on the top 25 stale accounts.

Result: AR dipped to 20 days within 90 days, unlocking $1.2 million in cash flow.

5. Action Plan & Next Steps

1. By Wednesday: Load the 50 new ICD10PCS codes and April HCPCS file into your codemaster.
2. Mid Week: Host a 30 minute coder huddle on Excludes1 nuances and new device specific PCS entries.
3. Friday: Audit telehealth claims for correct place of
4. service and modifier usage under the extended H.R. 1968 waivers.

Don’t forget to post this week’s briefing on LinkedIn—and I’ll remind you again next Monday (and each time we reconnect). Let’s keep optimizing your revenue cycle!