Find out what you must do to get significant, separately identifiable E/M services paid. The Cigna Group recently updated its reimbursement policy for modifier 25. Effective May 25, if you are billing this health insurance company for an evaluation and management (E/M) service and a minor procedure, you may need to do more than append […]
Medicare Telehealth Services for 2023, Centers for Medicare and Medicaid Services (CMS) is adding new Healthcare Common Procedure Coding System (HCPCS) codes to the list of Medicare telehealth services, specifically the following HCPCS codes. Prolonged Service Codes G0316: Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary […]
E/M, Gastro, and Lab Coders, take note. The American Medical Association (AMA) announced some last-minute corrections to the CPT® code set effective Jan. 1, 2023. Add these to your code book, along with the previously released corrections, to ensure you start the year off right with accurate codes and guidelines. Evaluation and Management (E/M) In […]
The secret to ensuring both proper payment and compliance is in the details. Why is mental health coding so complex? Laurie Bouzarelos, MHA, CPC, asked and answered that question in her presentation “Coding and Billing for Psychiatry and Outpatient Mental Health Providers” at AAPC’s virtual HEALTHCON 2022, March 27-30. Bouzarelos manages to take much of […]
Recognition of the impact that social determinants of health (SDOH) have on patients’ outcomes is growing, as is the desire to incorporate SDOH factors into patient-care plans. But awareness of an existing data infrastructure that could help physician practices do so is limited. “The clinical care we provide only accounts for about 50% of the […]
Oftentimes a patient’s “Oh, by the way …” comment turns an encounter that was scheduled as a preventive medicine visit or a minor office surgery into something more involved. When the provider goes above and beyond the physician work normally associated with a billable service or procedure, you may be able to report the separate […]
Coding highlights and other insight. The HCPCS Level II code set used to report medical services and supplies will include 37 new codes effective April 1, 2022. Also in the second quarter update, five codes will be deleted and one modifier’s description will be revised. Lay Terms for New Codes Among the new codes being […]
A physician’s workday is often segmented into two major jobs: Seeing patients and performing the necessary administrative duties to ensure they are paid for work they have performed. Burnout is always a significant risk in any medical practice. It’s mostly caused by doctors and other clinicians having to see too many patients in too little […]
MDM elements during a preventive visit Q: Is it appropriate to count laboratory tests and other tests ordered during a preventive medicine service (99381-99397) visit in medical decision making (MDM) selection? No, because the 2021 revisions to the E/M office or other outpatient MDM do not apply to codes 99381-99397 (preventive services). These codes are […]
You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything, you under code! You provide excellent care for your patients and achieve great outcomes. No […]