Category: Medical Coding

Prolonged Services in CPT versus Medicare

Prolonged Services in CPT versus Medicare

The code 99417 is invalid for Medicare and MA reimbursement. When the CPT® Guidelines were updated for 2021, one of the options for leveling an office or other outpatient evaluation and management (E&M) service was to use time as the leveling agent. The time thresholds for each E&M office visit were also changed from “typical” […]
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CMS Updates Medicare Part B Drug Prices

CMS Updates Medicare Part B Drug Prices

Retroactive code pricing updates may require claims lookback. The Centers for Medicare & Medicaid Services (CMS) has posted a retroactive update to the April Average Sales Price (ASP) pricing file for three Medicare Part B drugs. Also now available are the July ASP and Not Otherwise Classified (NOC) pricing files and the ASP NDC HCPCS […]
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CMS Releases PCS Codes Final Rule

Medical/Legal Impact of 2021 E&M Changes

Without detailed documentation, providers may face an uphill battle in defending themselves from quality audits and even malpractice issues. Up until 2021, at least for the prior two decades, coders and clinicians relied upon the established Evaluation and Management (E&M) guidelines to determine which E&M code was appropriate for each specific encounter. The 1995 guidelines […]
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E_M Coding for 2021_ What’s New and Different

E/M Coding for 2021: What’s New and Different

After three years of policy proposals, the American Medical Association Current Procedural Terminology (CPT) panel responses, and substantial guidance from gastroenterology and other specialty societies, changes to the office/outpatient evaluation and management (E/M) codes became effective as of January 2021. Some aspects of these revisions took effect for telehealth services since spring 2020 for Medicare, […]
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CPT Coding For Excisional Wound Debridement With VAC

CPT Coding For Excisional Wound Debridement With VAC

Q: What CPT codes and modifiers would be used to report excisional debridement for removal of a 2×4-cm ulcer on a patient’s right buttocks with vacuum-assisted closure (VAC)? A: The debridement would be reported using CPT code 11042 (debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less). This procedure […]
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CPT Coding for E_M Visits with Wound Care

CPT Coding for E/M Visits with Wound Care

The service must be performed for a condition unrelated to the scheduled visit and must be a new condition that requires further evaluation. A version of this article was first published April 16, 2021, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders. Q: Is it appropriate to report an E/M code for visit […]
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AHA Coding Clinic on ICD-10-CM_PCS for First Quarter of 2021 Released

AHA Coding Clinic on ICD-10-CM/PCS for First Quarter of 2021 Released

Current issue includes most frequently asked questions about coding COVID-19. The American Hospital Association (AHA) central office is the official United States clearinghouse on medical coding for the proper use of the ICD-10-CM/PCS systems and Level I HCPCS (CPT-4 codes) for hospital providers – and certain Level II HCPCS codes for hospitals, physicians, and other health professionals. The […]
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