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Hi, everyone. This is Lukas Voss with Becker's

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HealthCare. Thanks so much for joining us here

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today for the Becker's HealthCare podcast series.

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I'm really excited to have, 2 great guests

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today to discuss the 2025

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CPT changes and

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their impacts. This is a very large topic

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with a lot of different implications, so I'm

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excited we get to talk about it.

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And I have 2 guests, as I mentioned,

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Elaine Dunn, chief administrative officer, Nimble Solutions, and

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Jessica atmiston, SVP, coding Nimble Solutions. Elaine and

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Jessica, thanks so much for joining us today.

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Excited to have you. Yeah. Thank you, Lucas.

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Excited to be here. Absolutely. And before we

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get into it, I also wanna mention that

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if you're listening to today's podcast,

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the thing that you have to do, right,

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you have to listen to the end. We

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have a little bit of a surprise for

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our our listeners here today, so make sure

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that you listen all the way to the

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end. Not just because we're gonna have a

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great, conversation, of course, but also because we're

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gonna have a little bit of a surprise

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for you at the end here. Elaine and

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Jessica, again, once again, welcome to the podcast.

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If you could get us started here, we'll

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start with you, Elaine. Share a little bit

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about your experience and and your role at

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Nimble.

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Yeah. Sure. So I lead the Nimble's coding

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service delivery team, our implementation

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methodology,

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and then also head up our discovery and

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diligence processes for new clients and then have

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responsibility

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for our compliance and and regulatory

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teams as well.

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Just a little bit about, Nimble from a

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background perspective.

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We are a full service end to end

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surgical revenue cycle management

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company, and and our goal is to achieve

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exceptional

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financial results for our clients very specifically

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in that outpatient surgical market.

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Awesome. Jessica, we'll head over to you.

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Great. Thank you. So I am a certified

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ASC coder as well as the senior vice

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president of coding at Nimble.

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I'm responsible for implementing best coding practices,

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deepening our coding team's expertise through continuing education,

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and I collaborate closely with Nimble's performance review

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team to ensure coding compliance and to optimize

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revenue capture.

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Awesome. And we have a a a quite

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a bit to cover today, and it it

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it can be very technical as you both

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know.

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It is a standardized

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system we're talking about that always comes with

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a lot of technical questions and a lot

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of details,

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and and the American Medical Association,

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the EMA, recently announced

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that the current procedural terminology or CPT as

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it's commonly known,

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for 2025,

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the 25 to 25 code set is going

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to be updated.

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So before we get into some of that,

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I I'd look just like you.

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We'll we'll start with Alain just to go

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over

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what is the CPT code set to get

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us started,

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and and why is it so important

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today? Elaine, again, we'll we'll start with you.

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Yeah. So CPT codes are the uniform

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data coding set for medical procedures

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and services. As you mentioned, it is published

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by the AMA,

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and then they have an oversight function with

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the CPT editorial

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panel.

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Basically, it codifies

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complex procedures. So it's there's a standard reporting

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mechanism

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for health care agencies and payers. So we're

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all identifying

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the same procedure in the same way.

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A little bit on on the CPT editorial

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panel,

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it's an independent body,

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that gets convened by the AMA, and they

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oversee all of the updates that are going

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into CPT. And they have a a pretty

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rigorous process,

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that they do that to ensure that codes

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are reflecting

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just the evolving needs of our providers and

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and to continue to deliver modern health care

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in the United States.

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You know, I think CPT decisions are so

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important for providers,

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to understand because as it is, the primary

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mechanism for you to report your services,

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reimbursement

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then gets tied back to each of those

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CPT codes.

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So understanding fully the intent of a CPT

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code,

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any changes to that code, and how that

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impacts how you report that code can have

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a pretty significant impact on your reimbursement, your

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net revenue.

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Yeah. And I just wanted to really quickly

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just ask a follow-up question that just out

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out of interest.

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If this didn't exist, Elaine, right, if we

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didn't have this or

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it it doesn't it it exists, but we

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don't quite understand it, what impact would that

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have

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if if we didn't have this?

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Yeah. So I think, the the short answer

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would be probably chaos

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in terms of claims,

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both from a reporting standpoint

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trying to get, correct payment. You know, if

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you think about a really simple example like

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a chest X-ray.

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A chest x-ray has a specific CPT code

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that gets assigned to that. If we didn't

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have that code, could you imagine trying to

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report and then adjudicate claims on

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free taxes as chest x-ray, c x r,

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cxdashray.

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So codifying that system and fully understanding all

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of the details behind the CPT code

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really allows us to kinda streamline that process,

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again, for payers, reporting agencies.

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But I think when you think about CPT

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as well, it's important that you drill down

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a level that it's not just reading that

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high level description.

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There's, usually a significant amount of source guidance

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and reference material that also gets published, managed

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by AMA CPT

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But, again, kind of provides a lot of

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details about when it's appropriate to use that

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CPT code and when it is not. So

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it's just as important to understand that element

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of CPT code versus just the the actual

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code set itself.

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Yeah. Again, it's it's

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as as a standardized system, right, that's why

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we're doing this so that everybody has a

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system that we can follow and be able

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to to make things more round, have a

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have a an approach to it, not just

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a a shot in the dark, essentially. Jessica,

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I'd I'd like you to touch on this

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as well and and talk a little bit

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about the importance and and what the CPT

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code set is from from your perspective, from

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your unique perspective as well.

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Yeah. So this is a bit of an

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exciting time for the coding world,

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when all the

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the CPT updates are announced and revealed.

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So for this year, we're looking at 420

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CPT updates

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that include 270

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new codes, a 112 deleted codes, and then

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38 revised codes. And many of those include,

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updates to the general surgery section

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that will impact surgical centers and ASCs.

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Category 3 codes, which are temporary codes established

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for new and emerging technologies to allow data

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collection,

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and they're not reimbursed by the way, account

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for 30% of the new codes. So the

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CPT code set continues to expand in new

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areas of medicine with proprietary laboratory analysis assigned

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to the largest proportion of new codes at

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37%,

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mostly for novel genetic testing.

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And then key updates in the CPT 2025

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code set include digital medicine,

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augmented and artificial intelligence,

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and general surgery.

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I feel like that's the most interesting part

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too is that this evolving

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need to to add to the list, right,

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to be able to say, okay. Now here

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is something completely new. You mentioned AI. I

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think that that's really the the key piece

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too is it it's constantly evolving. There's new

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technologies

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on a on a monthly basis, so there's

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really this need to evolve simply because

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of the advancement within technology. If we were

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just to stay with the status quo, I

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don't think that that would go over very

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well. Elaine, I I I suppose you you

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see it the same way, and and and

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what are what have you observed as some

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of the more notable changes? I'm assuming it

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it goes along the lines the same with

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with, tech and and some of the AI

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changes.

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Yes. I I think, and you touched on

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this is that, to me, one of the

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most exciting updates is that this year, there

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have been CPT codes,

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around automated artificial

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intelligence.

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So looking at how do we classify those

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AI medical services and procedures,

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you know, whether those are assistive technology,

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augmentative,

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or autonomous technology.

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You know, obviously, AI is a a very

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big, topic in the medical world right now.

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So

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seeing CPT keep up with that and then

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acknowledge that that is going to be an

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important part of the health care ecosystem

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moving forward. You know, they've gone and released

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codes around

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electrocardiogram

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measurements,

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medical chest, imaging,

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image guided prostate biopsies,

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all of those are gonna be included in

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the the 2025

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code set. And, again, I I I think

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it's very promising that AMA and CPT is

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acknowledging the impact

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that AI is having on medical practice.

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It can't be ignored. I think I'm I'm

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glad that they're, that that that's part of

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the process.

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Again, if they were to ignore that or

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if if it there was just a general,

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yeah, just a general

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idea of, like, hey. We're just gonna not

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address that. I think, we would all be

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in a different space.

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It's I think it needs to be it

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needs to be part of all of the

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processes itself.

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So what's interesting to me about this conversation

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is the fact that this is a a

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highly complex area

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that not only is it complex from the

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start,

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but it's evolving.

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Right? So I can't just I can't just

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sit and say, okay. I learned this. I

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know

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the code piece to it. I understand it.

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I'm done.

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It's an evolving

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piece that really needs attention on a regular

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basis. And quite frankly, and I say this,

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you know, having done a little bit of

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research and obviously part of our conversation today,

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I wouldn't wanna do this on my own.

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Right? I wouldn't wanna be the sole sole

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person responsible for this. I think that that's

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a key piece.

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Elaine, I want you to start off with

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this.

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Why do you need a partner to do

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this correctly?

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Why do you need a partner to be

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able to do this where it actually benefits

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an organization,

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benefits revenue cycle management,

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especially in the ASC space?

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Yeah. I I think it's I think it's

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twofold. So the first set, probably a little

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bit of more of a macro level. A

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lot of times, we'll see that

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ASCs just get lumped in with outpatient

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services and in turn, kinda standard outpatient coding

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and billing rules get applied.

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But in reality, there are some pretty significant

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differences in how you report and receive optimal

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reimbursement

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in the ASC space.

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Mhmm.

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Also specific to CPT encoding,

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it's not just getting the list of codes,

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you know, come January 1, 2025.

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As you mentioned, that's very much an iterative

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process. So there is continually new guidelines,

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references being released

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to augment the instructions

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of CPT.

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So really keeping up on those is is

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a Herculon task, and that's where having a

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partner that's laser focused

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on your business

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and your delivery of care, that specialty,

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is really important.

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And then I think one of the things,

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you know,

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ASC market, you know, accurate transcription, coding, billing,

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you know, it's really allowing ASCs, which a

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lot of them function like small businesses,

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small business owners

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to maintain their cash flow and and really

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drive overall financial health. I think that's where,

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you know, nimble being in the market for

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over 20 years, we've been trusted,

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with our clients to manage over 10,000,000,000

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in net collections.

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And, again, we're very passionate about the ASC,

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the surgical space, and and helping those business

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owners drive to that peak financial health.

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Yeah. Jessica, I'd like to you to touch

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on this as well in terms of the

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the partnership piece and and why that's so

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so critical.

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Yeah. I mean, you hit the nail on

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the head. I am so thankful that I

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have a team that I work with to

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work through all these challenges and Mhmm. Updates

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on, an annual basis. I can't imagine doing

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it on my own.

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But in addition, staffing shortages are a major

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problem in health

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care, and we're expecting to continue to see

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a shortage moving forward. So we also advise

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clients on ways they can move important and

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necessary work they don't have expertise in, like

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coding, to our experts at Nimble.

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Since we provide expertise in every aspect of

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the revenue cycle, we remain focused on providing

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support to staff strap ASCs

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by offering an end to end workflow,

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starting at the front desk to handle physician

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credentialing, patient demographic entry,

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insurance verification,

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prior authorizations,

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scheduling, chart management,

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transcription, and then, of course, coding and billing

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to provide our clients with the most efficient

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turnaround times in the industry. We do this

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by streamlining revenue cycles starting with decreasing the

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manual and administrative tasks so

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our clients can focus on our patients. And

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we get claims out the door faster so

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they can ultimately get paid faster.

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And that's the most important piece, I think,

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is is that patient focus. Right? We don't

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wanna necessarily get bogged down by all of

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these processes, but we wanna focus on the

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patient. I think that that's a that's a

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key piece to it. Elaine and Jessica, thanks

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so much for your insights today. I think

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this was a very interesting conversation on a

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on a very complex topic.

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Yeah. Thank you. Yeah. Thanks for having us.

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And I also wanna thank our podcast sponsor,

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Nimble Solutions. And, again, I did mention in

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the beginning, I did have a little bit

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of a surprise. But, again, if you listen

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to this and you felt like, man, this

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is so

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I really, want to encourage you all,

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to join Nimble's 2025 coding update webinar on

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December 17th. It will dive into a lot

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of these things that we discussed today. It's

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at 1 PM

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CST, and it will have a lot more

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detail on the challenges that we discussed today.

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So you can go to nimble,

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crmnimblesrcm.com/codingresources

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and click on the 2025

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00:14:13,320 --> 00:14:15,580
CPT Code Changes Webinar

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00:14:16,200 --> 00:14:18,840
right there. And now you need to pay

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00:14:18,840 --> 00:14:21,639
attention to this. For a limited time, if

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you enter the code 2025

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CPT

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updates,

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you will

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be able to attend that live webinar at

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00:14:29,954 --> 00:14:33,095
no charge. Again that website is nimblercm.com/codingcourses,

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and you can click on the 2025

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CPT code changes

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00:14:41,370 --> 00:14:44,350
webinar there. And then use your code 2025

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CPT updates

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to attend that live webinar at no charge.

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You'll learn more about some of the things

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that we discussed today. Again, Elaine and Jessica,

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thanks so much for being here today. Really

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enjoyed our conversation.

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Thank you. Looking forward to all the attendees

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on the webinar.

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00:15:00,465 --> 00:15:01,904
Yes. And make sure to tune in to

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more podcasts from Becker's Healthcare by visiting our

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podcast page at beckershospitalreview.com.