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Hello, everyone, and thank you for joining us for today's webinar. Before we get started, there are a couple of housekeeping items that I would like to share with all of you. The first is that we will be doing a live Q and A at the end of today's webinar. So at any time during today's webinar, you can feel free to submit your questions under the Q and A tab on your screen. And our speaker today, Rhonda Tues, will answer your questions at that point. Also, we will have a polling question that we would love to have your participation in. And we also have some complimentary resources under the docs tab that you can access at any time. Before we get started, there's a legal disclaimer that I'd like to share with all of you, which materials and other information included in the following presentation are provided as of the date of this session on January twentieth two thousand twenty six unless specifically noted and may be subject to change. Modernizing medicine has no obligation updates to the information provided. Modernizing medicine and the presenters make no warranty regarding the accuracy or completeness of the information provided. This presentation is intended for informational purposes only and does not constitute financial, legal, medical, or consulting advice. Please consult with your legal counsel or other qualified adviser to ensure compliance with applicable laws, regulations, and standards. So the topic of today's webinar is two thousand twenty six coding updates, what's changing and why it matters. And now I will be joined on stage by our speaker for today. Thank you, Rhonda, for joining. And before we get started, I want to remind everybody if you need to see a bigger version of the slides for today, if you just hover over where you see the slides, there should be an expander window on the bottom right, and you can click that to make the slides more easily viewable for yourself. So our speaker today, Rhonda Tuz, who's joined, is the senior director of billing and coding compliance here at ModMed, and we thank her for being our speaker for today. So Rhonda, I will turn the webinar over to you. Thank you, Yvette, and welcome everybody. I guess we should have changed the title now since we're after January first to coding updates, what's changed and why it matters instead of changing. So next slide, Yvette. So today, I'd like to cover, just a little brief, history for you about what we do here at ModMed when we prep for the twenty twenty six changes or any coding changes, for that matter. And I wanna go over the curtain the current codes, with you and supporting documentation. So we're gonna cover the ICD ten updates that occurred, the new CPT updates, as well as the HCPCS quarterly updates, the Medicare physician fee schedule final rule, a brief summary, and next steps for you. Next slide. Alright. So, here at ModMed, there's quite a bit of work that goes into every code change for us to ensure our platforms are correct. While we do still upload the files in total, we also have to confirm that the plans that have a specific code in them, that those are also changed appropriately. So if it's a new code, is it replacing a temporary code? If it's a deleted code, what should we be what should be used in its place? And when it's a revised code, documentation must also be changed if that code is in any of our plans. So our goal is to provide the most current codes available on the effective dates. And remember, this can occur ad hoc, quarterly, annually, and so that's what we keep our eye out for to make sure that we have everything effective on the date that it needs to be. So when the codes are released by the AMA or, Medicare, some files such as NCCI files, We confirm which codes affect our ModMed specialties that we represent. We create tickets within our system to make changes within plans if any are needed. Then we QA all those changes, and then we make sure that we release those on the effective date of the codes. So quite a few steps, and that's for everything. Remember ICD ten, CPT, HCPCS, which is quarterly, all of the files that we upload into our systems. Next slide. Alright. Let's talk about the ICD ten changes that were effective on October first of twenty twenty five. Those are the twenty twenty six changes effective October first of every year. Next slide. So seventy four thousand two hundred and sixty total codes were in twenty twenty five. What did twenty twenty six bring us? A little bit more. Seventy four thousand seven hundred and nineteen total ICD ten codes. And four eighty seven were new codes, thirty eight revised, and only twenty eight deleted. So let's take a look at the next slide. And this is just a breakdown by the body system, which is extremely beneficial in determining how many of the code changes are going to affect the specialist that ModMed supports, as well as you, a practice. So you can easily take a look and identify which areas you need to pay specific attention to, based on the chapter breakdown and know which ones that your practice tends to use the most of or does use quite often. Next slide. So these are just a few ICD ten coding tidbits for you. ICD ten codes can be three, four, five, six, even seven characters. And all categories have at least three characters, which can be a valid code. If a code extends to four or five characters, that is considered to be the code subcategories. And when an x is used, that's a placeholder in certain codes to allow for future expansion. And wherever this placeholder exists, the x must be used in order for the code to be considered a valid code. Along with that is the seventh character. If there is a seventh character, it's going to be a, d, or s. A means it's an initial encounter, d is a subsequent, and s is sequelae. So just some tidbits for you to keep in mind as you see those ICD-ten codes. Next slide. Alright. So, an overview of all the changes. Remember, four eighty seven new codes. Well, the winner for the most changes this year goes to the s and the t codes. The l codes came in at second. Out of these two chapters, there were three hundred and twenty nine new codes out of that four hundred and eighty seven. So within the S and T, that's injury and poisoning, there were two hundred and thirteen new codes and only twelve deletions, twenty four revisions. The l codes, were diseases of skin and subcutaneous tissue, had a hundred and sixteen new l codes with no deletions and only two revisions. So those are the most heavily hit chapters for ICD ten that have the most changes. Next slide. So new ICD ten codes that could be applicable to dermatology, plastic surgery, OBGYN, are on these slides here. We also have disorders of blood. So take a look at these and see if any of these are applicable to your practice and if you've experienced any issues since these went into effect on October first. And remember that if you have submitted a code for a date of service that is after October first, then you have to be sure to use that new ICD ten code. And any deleted code that you may have used will likely return a denial for the code if it's a date of service after October first. IBC, that will stand for inflammatory breast cancer. And then we have some disorders of the blood. Also remember, if you've registered for the webinar today at a later date, you'll receive a copy of the slides and the recording, so you'll easily be able to see that all of these are split for you and can reference those so you know easily and quickly what's applicable to your practice. Next slide. All right. So here are some additional new codes that fall under endocrine, nutritional and metabolic diseases, and make note of the new diabetes mellitus code. Know, diabetes mellitus, been around a long time, same code, so that's kind of a new thing for all of us to pay attention to. We have type two diabetes mellitus without complications in remission. So there you go. And then we have disorders of mineral metabolism, lipodystrophy, not elsewhere classified. So these cover the E00 through E89. Next slide. Other degenerative diseases of the nervous system and inflammation of the eyelid. So there are eight new multiple sclerosis diagnosis codes that fall in this range, and here are some noteworthy additions for the eyelid inflammation. A lot of, new codes for that because, of course, when you're talking about the eyelids, you're gonna have a specific code for each eyelid, left upper eyelid, left lower eyelid, and so on and so on. And then they do even, create, unspecified eyelid, which, of course, you wanna stay away from. You wanna be as specific as possible when you submit your, codes, whether it be ICD ten, CPT, always as specific as you can be. Alright. Next slide. These are the remaining new codes for diseases of the eye and adnexa. We have thyroid orbitopathy, right orbit, left orbit, bilateral, and unspecified orbit. We have neovascular secondary angle closure glaucoma of the right eye, the left eye, the bilateral and unspecified. So with each new diagnosis for your eyes, you're going to see you get four new codes. Next slide. Alright. Here we have circulatory system in the beginning of all of the skin and subcutaneous tissue additions. Remember that was one of the big ones. Look at all of the nonpressure chronic ulcers. A hundred and twelve new codes that are body area specific. So literally for each body area, there's gonna be eight different code choices. So that's why that one contains so many. Diseases of the circulatory system, Fontan related circulation, unspecified, lymphatic dysfunction, Fontan associated liver disease, FALD diseases of skin and subcutaneous tissue cutaneous abscess of flank bronchial of flank, cellulitis of flank, acute lymphangitis of flank, and then we go into all of the non pressure chronic ulcers, which fall into that range that I have listed, L ninety eight point four three one through l ninety eight point a three nine nine, a hundred and twelve new codes within there. Alright. Let's go to the next slide. Musculoskeletal and genitourinary. So we have MO five point a, abnormal rheumatoid factor, and anticitrulinated protein antibody with rheumatoid arthritis. We also have acute nephritic syndrome and nephrotic syndrome with secondary immune complex ICMPGN. Alright, next slide. Congenital malformations. These belong in Q88.87 through QAO. Eight. And then we get into the symptoms, signs, and not elsewhere classified. So here you're going to find in your R ten point twenty pelvic and peroneal pain, unspecified side, and then you go into your right side, your left side, pelvic and peroneal pain, bilateral, suprapubic pain, right flank tenderness, left flank tenderness, suprapubic tenderness, flank tenderness unspecified. We do have R76.81, abnormal rheumatoid factor and anti citrullinated protein antibody without rheumatoid arthritis. So make sure you pay attention if this is an area that your practice, uses quite a bit, these R codes, because we have quite a few new codes in there. Alright, next slide. Chapter nineteen, injury, poisoning, and certain other consequences of external causes. So these are your s zero zero through t eighty eight. Two hundred and thirteen additions in chapter nineteen. So, here's a high level overview of what those include, and I've just given you the range of those. So contusion, that's gonna be by location, and they're covering abdominal wall, groin, and flank. We have abrasion of flank, blister of flank, external constriction, superficial foreign body, insect bite, unspecified superficial injury of flank, an unspecified open wound of abdomen or abdominal wall laceration without and with foreign body of abdominal wall puncture wound of abdominal wall without and with foreign body open bite of abdominal wall unspecified open wound of abdominal wall, laceration, puncture, open bite with penetration into the peritoneal cavity. So quite a few within those areas, and I've given you the whole sequence there to look at if you're interested in any of those codes. But those that's the biggest one is two hundred and thirteen editions in chapter nineteen. So take a look at those. Also, I'm just gonna add in here that all of the resources have been provided to you in the docs tab that you see on the right, right beside the chat. So you have the links to all of the resources for the information that I'm covering today. There'll also be a resource page when you receive a copy of the slides. Alright. Next slide, please. So this wraps up the additions that are in chapter nineteen, which cover poisoning by a specific antibiotics, adverse effect or underdosing. And then T65.841a through T78, toxic effect, gulf war illness, effects of other war theater, anaphylactic reaction due to milk and dairy products, other adverse food reactions not elsewhere classified, anaphylactic reaction due to eggs. So, some interesting additions there. Alright. Next slide, please. These are the remaining new ICD ten codes for twenty twenty six six that fall into w, y, and z. So you can see other sharp object entering into or through a natural orifice initial encounter subsequent. Remember the ending in the a, the d, or the s. Fishing hook entering through skin initial encounter is the w forty five point three x x a. Remember what the x's are for? Because they want to expand upon this code or these codes that have those. So can't wait till we get more ICD ten codes. Low or high level blast over pressure and more operations, And the z codes are covering genetic susceptibility to malignant neoplasm of fallopian tubes, digestive system, and urinary tract, colorectal cancer, kidney disease. So take a look at those, codes that fall in that range of the Z codes. Alright, next slide. That was all of the new codes for ICD-ten, and there were twenty eight deleted codes. And here those codes are. More than likely, just as an example, when you see an area of additions that have been added, you will more than likely find a deleted code or a couple of deleted codes that are in that, and they've expanded upon it. As an example, take a look at g thirty five, multiple sclerosis. Remember the new multiple sclerosis codes that have been added? So they're deleting the g thirty five, and they've added all of the MS codes to make up for that. And then similarly, look at r ten point two, pelvic and perineal pain. They're deleting that one code, r ten point two, and they added all of those other codes to be able to break that down further and be more specific. Food reactions, some codes were deleted, and then some random z codes I also added down there that were deleted. Looks like five z codes. Alright, next slide. Revisions, what does that mean? That means that they usually change something within the description of the code. So there were thirty eight revised codes. As you can see, hopefully you can see if you've enlarged your, slide, but within the green font, that's to show an addition that was made to the description. And look at P09.6. There were words removed, not added. It used to say abnormal findings on neonatal screening for neonatal hearing loss. So now you can see that they've just added to that. And if there was anything removed, I have, placed those within a red font. So if you take a look at z eighty three point seven one eight, they simply removed the word other from the very beginning to the middle of the description. Alright. Next slide. Alright. That covers our ICD ten, which were effective on October first. Now we're going to move on to the CPT updates, were effective on January first of twenty twenty six. Next slide. Alright. So we had approximately eleven thousand three hundred and twenty one codes, and we now have eleven thousand five hundred and twenty five codes. That is, what we've gone up to for twenty twenty six. There were two hundred and eighty eight new codes. So last year, they had about two hundred and seventy new codes. So not much difference there, just eighteen more. We had eighty four deleted CPT codes this year for twenty twenty six. Compared to last year, they had a hundred and twelve deleted. And then we had forty six revised codes, and last year, there was about thirty eight. So not much change in the difference of what was from last year to this year, but overall, we have increased the code set to eleven thousand five hundred and twenty five. Also, I'm going to tell everyone if you have questions, please put those in the q and a tab, and we'll I'll address those when I'm done presenting the materials. Alright. So let's go to the next slide, Yvette. I also will add that, the updates that we're focused on for the new codes seem to address health care services, like including remote patient monitoring, hearing devices services, and services assisted by AI. So that's what, we'll take a look at. Once again, I broke down the chapters of CPT so you can focus on the body systems, which help all of us to easily identify what changes may affect our systems and your practices. So if you take a look at these, you can easily tell, which of the code sets affect your practice. As an example, evaluation and management, the EM codes, ninety nine thousand two hundred two through ninety nine thousand four hundred and ninety nine, pretty, across the board, it would affect any provider. Right? So something that all of us will pay attention to. But if you have nothing to do with anesthesiology, then zero zero one hundred through zero one nine nine nine, no need to worries about any changes in that chapter for you. So just your breakdown, and let's go to the next slide. The remaining breakdown of the chapters is here. And another coding tidbit for you. How about those codes that end with a letter? What does that mean? So any codes that end with a u are proprietary laboratory analyses or PLA codes. Category two codes are for tracking purposes and performance measurement, and those codes end with an f. And then category three codes are emerging technology, and those are temporary codes, usually don't last any longer than five years. And those codes will end with a t. So that clearly helps you see the codes that end with a u, f, or a t, and if those are applicable to your practice at all. All right, let's get going. Next slide. So remote patient monitoring has been in the code news quite a bit. I did come across something where they'd done, the DOJ or OIG had done an audit in twenty twenty four on remote patient monitoring, and they offered some information about documentation that wasn't accurate and things you needed to be sure and do. So if you monitoring at all, I recommend that you review the remote patient monitoring codes and what the requirements are for those codes. You can see the two new codes. I did abbreviate something, OQHCP, which stands for other qualified health care professional. And let's take a look at evaluation and management is ninety nine thousand four hundred forty five. Stay on that slide, please. There we go. And this is initial supply of device for remote monitoring of blood pressure with daily programmed alert transmission. Ninety nine thousand four and seventy, remote physiologic monitoring treatment management services, clinical staff, physician, or other qualified healthcare professional. It's the time in the calendar month requiring one real time interactive communication with the patient or caregiver, and that's for the first ten minutes. So the other new codes we've gotten the musculoskeletal system, these two codes, two seven four five eight and two seven seven one three. So pay attention to those, if you are in musculoskeletal such as orthopedics. And then cardiovascular had quite a few changes within their code subset as well. So if you are in cardio cardiovascular, pay attention to the three thousand codes starting with thirty three thousand eight hundred eighty two and thirty five thousand six hundred two bypass graft with other than vein carotid contralateral carotid, thirty seven thousand two hundred fifty four through thirty seven thousand two hundred and ninety nine. There were forty six new codes in that area, so you definitely want to take a look at that section if you are a cardiovascular provider. Alright. Next slide. Here are the new codes for the digestive system, urology, and the male genital system. So you will see in digestive forty three thousand eight hundred eighty nine and forty seven thousand three and eighty four, Transoral gastric restrictive procedure endoscopic sleeve gastroplasty or an ESG. Percutaneous ablation with irreversible electrocorporation of liver tumor or tumors with imaging guidance. Urology fifty two thousand four hundred forty three and fifty two thousand five hundred and ninety seven. Complete transurethral robotic assisted water jet resection of prostate with intraoperative planning, ultrasound guidance, and control of postoperative bleeding. And then the male genital system. So you need to pay attention to these codes because these are all in relation to biopsy of the prostate. So quite a few new codes here to choose from and of course being very specific to, targeted lesions, first targeted lesion. If there's a guidance utilized like MRI fusion guidance, so quite a few new codes within that section. Next slide. This is the remaining of the male genital system. So as you can see, they're still focused on all of these codes for, biopsies. So we have CT guided biopsy of the prostate, first targeted lesion with biopsy of additional target lesions. First targeted lesion, targeted lesion only. Inboard CT guided biopsy of prostate, each additional targeted lesion. And then laparoscopy with radical prostatectomy and nerve sparing with lymph node biopsies by retro pubic approach with robotic assistance. That is fifty five thousand eight and sixty eight, Also, fifty five thousand eight hundred sixty nine and fifty five thousand eight hundred seventy seven, which is percutaneous ablation with irreversible electrocorporation of prostate tumor or tumors with imaging guidance. So lots of additions in this area that you need to pay attention to if this is one of the services that you provide or your practice performs. Next slide. The nervous system. Here we have some needle decompression of lumbar interspace with partial removal of the ligamentum flavum with laminotomy for access. Epidurography and CT. So sixty two thousand three hundred thirty, three thirty one, and then we move into sixty three thousand and thirty two, hemilaminectomy and foramenotomy of single interspace. Alright. Next slide. The nervous system continued. So here we've got some VAT procedures. Make sure you see all of the description on these and choose the appropriate one for what you're doing and confirm your documentation supports everything that's mentioned within the description as well. Alright. Next slide. Radiology section. So these additions consist of these eight codes. The big changes are with SRT. Note the description of the new codes are surface, radiation therapy rather than what we're all used to, superficial radiation therapy. So you'll you'll see when we get to the deleted CPT codes, the links with some of these additions. And I would recommend that you pay attention to this new section of SRT codes and also the descriptions that follow and confirm what they would consider to be bundled, within these codes, such as maybe you're doing electron beam therapy as well and confirming if you can actually bill both together. So that's some of the tidbits that you can gain from a CPT book, of course, or an e book, eCPT book. And then like I said, within the docs tab here, I've provided links to the CPT page where you can see the files and information. Next slide, please. Alright. This is the pathology and laboratory section. Remember the PLA codes, the ones that end with a u for proprietary laboratory analysis, they had seventy nine new codes. Always quite a few new codes in there because it's ever evolving. Right? New lab tests, that these specialty labs can do and get approval for. So that was the biggest section was the PLA codes that had seventy nine new codes. These are the other lab codes. For instance, eight seven four nine four, detection of chlamydia, tracheomattis, and I'm not going to butcher that, by DNA multiplex amplified probe technique. So take a look at these lab codes. If you do have a lab, in your practice and are able to do some of these tests, you just want to pay attention and, confirm that you've made note of the new lab codes to see if they're applicable to your lab or not, or maybe something that you can order from an outside lab. Alright. Next slide. The medicine section. This is going to include administration codes, immunization counseling, and flu vaccines. Let's see. Nine zero three eight two respiratory, RSV monoclonal antibody, seasonal dose, zero point seven ml for intramuscular use, and influenza virus vaccine codes start with the nine zero six three one through nine zero six one three. So take a look at those. Make sure that you pay attention to the flu vaccines that you're getting within your office and which ones, if any, of these new codes are applicable to those. Alright. Next slide. The medicine section continued for additions. Quite a few regarding hearing aids that we're going to go over on this slide and the following slide. So, the three new or the remaining codes within the medicine section, nine one one, two four, and two five are going to be rectal sensation tone and compliance study like a Verostat. So those two codes are specific to that. And then ninety two thousand two hundred eighty eight, rod recovery intercept time with interpretation and report. Hearing aid additions, quite a few in the hearing aid. Ninety two thousand six hundred twenty eight, evaluation for hearing aid candidacy bilateral with review and integration of audiologic function tests, assessment, and interpretation of hearing needs, like, example, speech in noise, supra threshold hearing measures, and discussion of candidacy results, counseling on treatment options with report, and that's first thirty minutes. So whenever you have codes in the description that have a time component, you need to make sure that you document the time that you spent doing that to support the code that you're billing. So if you're choosing a code that has a time in the description and time is the, only way that that code is, supported, then that's one of the things that you have to make sure and document is the total time. An example where time can be an or is an E and M code. So an E and M code, such as an office visit ninety nine thousand two hundred thirteen, is going to be the medical decision making components or the time. And that is not required to document the time unless you're billing based on the time for that e and m code. Otherwise, you would have to document your medical decision making to support that level. But when a code, as part of the description, contains first thirty minutes like that, you have to document your time. Next slide. Here are the remainder of the new hearing aid codes, no pun intended. And here we have nine six six hundred thirty two, hearing aid selection services, bilateral. And make note that most of these do say bilateral, within the description. Ninety two thousand six hundred thirty eight, behavioral verification of amplification including aided thresholds, functional gain, speech in noise. And then ninety two thousand six hundred thirty nine, hearing aid measurement verification with probe microphone. So they've definitely added a lot more, specificity for the hearing aid codes and for you to be able to capture exactly what you're doing, when you are performing and billing for those codes. Next slide. Alright. This rounds up the new CPT codes for January first with a few in the medicine section specific to cardiovascular, mechanical scalp cooling, remote therapeutic monitoring. Remember, that's a hot topic I told you about to be sure if you use it, you understand what they're looking for for documentation requirements. And then there were about seventy eight new temporary codes as well. Now temporary codes are definitely recommended to utilize when you can because that's gonna support them creating a permanent CPT code to identify those. So always good to pay attention to temporary codes. They're emerging technology, and the only way they know if those codes are needed to actually get their own CPT is by the use of those and, reporting those. So I gave you the areas where those emerging technology codes are placed, zero nine four eight t through zero nine five o t. There were three new codes there. And then the next section had seventy five new codes in that area. So take a look at those and see if any of them are applicable, to your practice. Next slide. Alright. That was the new codes. Let's kick off the deleted codes for twenty twenty six. Let's gonna start with the musculoskeletal system, and then there's quite a few in cardiovascular, like I had mentioned before. So these codes have been deleted. So, reporting them after January first twenty twenty six dates of service would not be applicable. And, I recommend that you take a look and confirm that you have, reported all of your twenty twenty five dates of service and have the appropriate CPT codes at that time, on those claims, or you may possibly receive a denial if you're trying to report a new code on a twenty twenty five date of service. So arthroplasty knee hinge prosthesis two seven four four five has been deleted, and the two seven four six eight combined lengthening and shortening with femoral segment transfer. So pay attention to those three three eight nine one bypass graft with other than vein transcervical performed in conjunction with endovascular repair of descending thoracic aorta by neck incision. And then we have revascularization, thirty seven thousand two hundred twenty through thirty seven thousand two hundred thirty five have been deleted. And then we get into our list of all of those relevant to cardiovascular. So make sure you take a look at those, compare them to the new codes that they created, and confirm if there is a direct crossover. Next slide. Alright. Other noteworthy deletions for urology and a few radiology codes, possibly specific to derm. We've got pathology and laboratory section and the PLA codes, those that end with the u. So we have urinary laser coagulation of prostate, including control of postoperative bleeding, and biopsy prostate needle to punch single or multiple any approach five five seven hundred, really clear they deleted one code and created how many prostate biopsy codes now to choose from, which are definitely more specific. And, that is the purpose is to make sure that you understand the deleted codes and what is taking its place. Because more than likely, when they've added a large number in comparison to only having one before, then your documentation needs to be specific too regarding how how the biopsy was done, how many lesions, and what approach you utilized. Radiology, we had four deleted codes here. It looks like computed tomography guidance for placement of radiation therapy fields, so, radiation treatment delivery superficial and or ortho voltage. So these are in relation to the SRT updates that they did. Pay attention to the deleted codes for SRT and what those have changed to. And then the PLA codes, the end in the u, proprietary laboratory analyses. So, not many that those would be applicable to, but wanted to make sure that those were included here so you can take a look at them if they do apply to your practice. Next slide. Alright. This is the remainder of the deletions. And, you can quickly tell they're in relation to many of the additions that we already went over previously. Right? So, in the medicine section, remember the new codes that were specific to, like, the hearing aids. Right? All of the hearing aid codes, the rectal sensation, tone, and compliance test. So you can easily tell that the codes that were deleted and the new codes that are taking their place. And then we get into the cardiovascular, which I have a range for you to take a look at there of deleted codes, ninety two thousand nine hundred seventy five through ninety two thousand nine hundred seventy seven, nine twenty one through ninety two thousand nine hundred forty four. Please take a look. Those are related to percutaneous transluminal, and make sure you take a look if that is your area of expertise. Nine four six six two, continuous negative pressure ventilation, so CNP, initiation and management of that has been deleted. And then the t codes, remember what those are, temporary codes. There were twenty one deleted codes for the emerging technology. And, you probably wanna take a look if you have used any of the t codes that fall into that section, and then you can identify if they did end up creating a new code for one of those that have been deleted. And if they did not, then more than likely you're gonna go back to before the T code even when all your only choice is possibly an unspecified CPT of the correct area, that is being coded. So, couple of things to keep in mind when you see a deleted t code is did they create a new CPT code for it? And if not, are we going to have to go back into utilizing an unspecified or NEC CPT code? Next slide. All right, revisions. Remember how important the revisions are because that's the description of the CPT code, and that's how your documentation, needs to read to help support billing a code. So make sure you pay attention. I have identified in green additions to that description and in red what was removed from the description. You can easily see in appendix b, the revisions, which are changes to the description. And here you can see that, like, nine nine four five three, there's only a change from a comma to a semicolon. So some things, of course, are pretty irrelevant, but nonetheless, they have to make sure the CPT code book is identified appropriately. So even though it may seem, not very noteworthy for what we need it to be, a comma versus a semicolon, those are gonna be identified every year when they do these revisions. Alright. Let's take a look at the remainder. Cardiovascular. Lots of revisions in cardiovascular. So not only do we have lots of additions and deletions, but lots of revisions for cardiovascular codes. So make sure you pay attention to these to con to make sure your documentation, clearly identifies and supports these codes now if they are something that you bill regularly. Large large descriptions for these four cardiovascular codes. So I've kind of, narrowed it down, only have a portion included here so you can get an idea if that is something that would be applicable to your practice or not, and then you can further look that up more. Next section. Next slide. All right. The first two pertain to urology, and the only revision to fifty five thousand eight hundred sixty six is the addition of a semicolon on the end. So we have three ortho codes and three pertaining to radiation. So those, three radiation ones, of course, are going to be in relation to the SRT code changes. So make sure you pay attention to, for instance, seven seven four zero seven, they removed intermediate. And for seven seven four one two, they removed complex, the word complex. So make sure if you utilize SRT that you pay attention to the revisions, the new codes, the deleted codes. Like I said, here at ModMed, within our platforms for each of our specialties, we've made the changes for SRT to identify what was removed, what was added, new codes, additional boxes possibly that they're looking for or choices to be able to choose from within the SRT plans. And, hopefully, those have, captured everything needed, as we move forward in twenty twenty six. Next slide. This is the last of the revised CPT codes. So these are your laboratory, your PLA codes, and then the medicine section. So we do have, immunization administration by intramuscular injection. They remove the word of severe acute respiratory syndrome coronavirus two. And vaccine, they removed single dose and added first or only component of each vaccine administered. And then nine zero six two o is the meningococcal recumbent protein and outer membrane vesicle vaccine. They removed two dose schedule from that description and, for intramuscular use. And then ninety two thousand two hundred eighty four, that's the rod and cone sensitivities. So remember we had some, new codes and deleted codes in that section, and now this code is a revised one. And it looks like they added to it. And then cardiovascular, I gave you the code sets to look at. Also ninety eight thousand nine hundred eighty through ninety eight thousand nine hundred eighty one, remote therapeutic monitoring, those had revisions, and temporary codes that were revised. One, two, three, four of those. So if you use any of those four temporary codes, please take a look and see what was revised and the descriptions of those so you can make sure your documentation supports those. Alright. I think that covers our CPT. Now let's take a look at the HCPCS. Remember, this is a quarterly update, so they updated, October first would have been quarter four updates, and then, of course, January first for quarter one. Next slide. Alright. This is a breakdown of the HCPCS codes so you can see what they're related to. So October first of twenty twenty five, they added seventy six new codes and discontinued eight codes to the HCPCS. So that was the quarter four update. This is a breakdown of the chapters within the HCPCS book so you can easily identify which areas are pertinent to your practice. Dme is, orthotic procedures and services, administration codes, drugs administered, of course, your J codes, lots of areas that may be applicable. Let's look at the next slide, Yvette. This is the remainder of the breakdown of chapters. And then January first, so quarter one, they added a hundred and sixty new codes and discontinued a hundred and one codes. Quite a bit of changes for quarter one for your HCPCS. See the V codes are your vision services and hearing services. Alright. Let's go to the next slide. Making note of the sections of HCPCS codes that had additions on October first. So just so you can reference these, these were the October first additions and deletions. I just wanted to have these sections, identified for you so you could easily take a look at those. So let's go to the next slide and see for quarter one, the HCPCS editions. So the HCPCS editions, we were notified November twenty fourth, a little late because for us, we like to get those uploaded, confirm that none, need to be changed to specific plans within our systems, QA those, and have them ready to be released on January first. So within the a codes, there were three new codes for intermittent urinary catheters, and I have the a forty two through ninety five through ninety seven. The c codes, nineteen new codes for various procedures in DME such as C1607 for implantable integrated neurostimulator, fourteen new G codes for psychiatric care management, and then we have team remote EM, and we have diabetes mellitus prevention behavioral counseling, g nine eight seven one. That's for online. J codes, several new codes. I've listed those there. There's a nasal spray, testosterone pellet implant, and that code is replacing s o one eight nine. M codes, seventy eight new m codes. An example, m one four twenty six encounters conducted via telehealth. Q codes, there were twenty five new ones. Q4411 skin substitute products. Yes. Please, please take a look at Q4431, Q4432, Q4433. These three codes are directly related to the skin substitute changes that they put in place. And, let's click to the next slide so we'll make sure to have time to go over those, Yvette. Here are the deletions for quarter one. Echo guidance radiotherapy, got some injections, skin substitute NOS. So q four one zero o, no longer use that. And q four one zero six, dermographed, gone, deleted. We've got the revisions listed here. And next slide. Alright. So I quickly went through your HCPCS updates for quarter one because I wanted to make sure that I was able to try to address the Medicare physician fee schedule. Now if you're familiar with following this at all, great. If not, you should. The proposed rule comes out in July. It came out July fourteenth of this year. It allows time for providers' practices to, comment on their proposed changes that are coming. And believe it or not, they listen. They hear what you say and take it into consideration before they determine the final rule. This year, the final rule came out on October thirty first of twenty twenty five. That basically identifies what they've decided, what Medicare has decided to make changes, for Medicare the coming year, and that is, can be some noteworthy items as we'll see on the next slide. So here are the, pretty much highlighted areas that I made note of for the final rule, separate conversion factors, an efficiency adjustment, the major overhaul for the skin substitute payments, a new physician payment rule, telehealth policy updates, drug pricing reform, behavioral health, and enhanced care management, changes to Medicare diabetes prevention program, practice expense methodology refinements, improvements to benchmarking and quality report to support ACO participation and performance, and the addition of five prevention focused quality measures, removing ten quality measures. So those are the highlighted ones. Let's talk about a couple. Next slide. Separate conversion factors. So this is specific to qualifying alternative payment model participants. So unless you are a qualifying APM, you will have the proposed conversion factor for all others, which is thirty three point four zero, an increase of one dollar and fifteen cents or three point six two percent. If you are a qualifying APM, there's a separate fee schedule for you because it has its own conversion factor. Then we have the efficiency adjustment. So that was a two point five percent decrease in physician payment for specific services in twenty twenty six. It roughly applies to nine thousand CPT codes for services including diagnostic imaging, surgical procedures, orthopedic services. Once posted on the CMS website, you can download a codes subject to efficiency adjustment file, but the following are exempt from this efficiency cut. Time based codes, not affected. Services that are listed on c m l the CMS telehealth list, not affected. And then new codes for twenty twenty six, not affected. Like I said, in the docs tab, I have links that will take you to the resources, and I believe I was able to include where you should be able to find the code subject to efficiency adjustment file located. Next slide. Alright. Telehealth update. Unfortunately, when congress, voted on continuing resolution to reopen the government, it extended the Medicare telehealth flexibilities, but only through January thirtieth. And the flexibilities, as you know, are the bullets that I've identified here. So I have heard nothing yet, and this is January twentieth. So we have ten days for the government to either extend these flexibilities again or put something new in place to allow, some of what we were doing, during the pandemic and the flexibilities that were allowed, such as allowing that patient, Medicare patient, to be at their home and receive telehealth. If we hear nothing and the telehealth flexibilities go to way go away on January thirtieth, then this is gonna take us back to pre pandemic, which means that the, restrictions are gonna be in place for the patients to be located in health care shortage areas and go back to originating sites and distant site. So please refresh your memories on those requirements. Many of you probably didn't offer telehealth services pre pandemic because of all of the restrictions. So please make sure that you review those and continue watching the government to see or Medicare to see if they're going to make any changes to this before this becomes effective. Definitely a high area of concern because it's going to go away. This is the link which covers pre pandemic requirements on this slide right here. So that will refresh your memory and see if you're even able to, provide telehealth services if the flexibilities do go away on the thirtieth. Next slide. Skin graft changes. This is the other big item that you need to pay attention to if you use skin grafts. They have definitely made big changes to this. This was all based upon an audit that they performed, and I believe I have that, available as well in the links. So in the doc tab is the audit, so you can read what they discovered. They also had created new LCDs to be effective for all of the local all of the maps, each of them. And then on December twenty third, they, pulled those back. So they were intended to be effective on January first, but then they withdrew the LCDs, but said it did not impact the final rule. So they're still basing what they're gonna pay or not pay, what they will consider to be incidental to the the professional service, and it's definitely something that you need to pay attention to because they are going to expect the HCPCS codes for skin substitutes. And then if those specific HCPCS codes have been determined to be, insult dental to the the procedure itself, they're not gonna be reimbursable. They're gonna convert those to an add on code and put an indicator of z z z on it, so you won't receive a payment for that. So the complete list of codes and the FDA categories are, in a file titled skin substitute products by FDA regulatory category, and they're available on the CMS website under downloads for calendar year twenty twenty six fee schedule final rule. This is the link for you to pay attention to that. Three groups to pay for covered sheet skin substitutes based on their FDA regulatory categories, which they've made it into three, PMA, five ten k, and three sixty one HCTP. So you need to make sure that you, pay attention to that. And then they've also changed those that are covered and made it a flat rate across all that they will reimburse. A hundred and twenty seven, twenty eight per square centimeter and trying to encourage the competition and reduce burden as far as the suppliers of skin substitutes and the reimbursement for those. Final slide. These are the resources. This is the resource page that will be on the slides when you receive your copy of those. And then we've also located these links on the docs tab for you as well. And I am going to turn it back over to Yvette. Awesome. Thank you, Rhonda, and thank attendees as well, for, asking a lot of really great questions and being very engaged in today's discussion. We really do appreciate that. Before we let you go, we want to let you know about a webinar we have coming up that may be of interest to you. It's actually happening in a week. It's our twenty twenty six Medicare Series Part one Deconstructing Physician Fee Schedule Changes. So we'll be doing a two part Medicare Series this year and this is the first of those webinars. This webinar will be taking place next Wednesday, January twenty eighth at twelve p. M. Eastern Time. Our speakers will be my will be doctor Michael Schirling, who is our cofounder and chief medical strategist here at ModMed, Deborah Godis, who is a principal at McDermott Plus, Kristen O'Brien, who's also a principal at McDermott Plus, Ida Montashi, who's who's an associate vice president of software regulatory compliance here at ModMed, Our very own Rhonda Tues from today will be a speaker as well. And Ali Kubashki, who is a senior solutions consultant here at ModMed. So this webinar will address how there's gonna be changes that are coming to how physicians get paid. Medicare's two thousand twenty six physician fee schedule is designed to reward some payment models, but will likely challenge others. So during this part one, we'll unpack the major updates and what they could mean for your practice. Also, we'll wrap things up with a special demonstration by Doctor. Michael Schirling showcasing MonMed Scribe two point zero, which is our latest, most innovative AI powered clinical documentation tool designed to simplify charting and streamline downstream workflows. So if you're interested in learning more about that webinar or registering, I'm going to post here in the chat the link to where you can do that. We hope to see many of you for that webinar next week. And with that, we want to thank you for joining us today for today's webinar. We hope you found it insightful, thought provoking, and beneficial, and we wish you a wonderful rest of your day. Thank you.