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Proposed uniform policy would reshape epidurals for chronic pain

07/05/2021

Review the proposed uniform policy for cervical/thoracic and lumbar/sacral epidural injections and use the open comment period to help shape the final policy.

Medical necessity for epidurals – proposed uniform policy

07/05/2021

by: Julia Kyles, CPC

Take note of the proposed medical necessity requirements for epidurals to treat chronic pain. Each service must meet all three of the following elements.

Part II: Plan ahead for a quicker records request mandate in the Privacy Rule

07/05/2021

by: Dom Nicastro

As HHS mulls significant changes to the HIPAA Privacy Rule, it’s likely that the 15-day requirement to share patients’ medical records could easily stick.

Using preventive prolonged service codes? Log at least 16 minutes over

07/05/2021

by: Roy Edroso

Question: Our provider did a depression screening billable with G0444 (Depression screening, 15 minutes) and went a little over the 15 minutes required. The provider thinks we should add the prolonged preventive service code G0513 (Prolonged preventive service[s] [beyond the typical service time of the primary procedure], in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes [list separately in addition to code for preventive service]). Our provider didn’t add anywhere near 30 minutes to the session, however. Can we still claim it?

Reminder: Relaxed NCCI edits have been retired; code accordingly

07/05/2021

by: Julia Kyles, CPC

Question: We often perform trigger points (20552-20553) on the same day that established patients come in for E/M visits (99211-99215). I heard that in 2020 Medicare said that we no longer need to append modifier 25 (Significant, separately identifiable E/M service) when the E/M takes place on the same day as a trigger point injection. Is that true?

Preventive services codes keep going up – and some pay big

07/05/2021

by: Roy Edroso

The series of preventive services codes that practices turned to most frequently did not change much between 2018 and 2019, except that their utilization continues to climb.

Add it up: Latest E/M update clarifies how to calculate data

06/28/2021

by: Julia Kyles

Remind practitioners to document — and coders to count — each medical decision-making (MDM) Category 1 item for data review with care. Recent guidance makes it clear that you have a number of ways meet the requirements for the “amount and/or complexity of data to be reviewed and analyzed” element for E/M office visits that are coded based on MDM.

Part I: Brace for potential records request change in the Privacy Rule

06/28/2021

by: Dom Nicastro

Covered entities (CE) that have flirted with the 30-day mark for response time with patient requests for access to or copies of their protected health information (PHI) should take notice: they may need to get better. Two times better, that is.

Supreme Court upholds ACA for third time, but new threats loom

06/28/2021

by: Roy Edroso

One would think, after last week’s California v. Texas decision in the Supreme Court, that supporters of the Affordable Care Act (ACA) could breathe a little easier. But experts say while future legal attacks on the ACA may not be as sweeping as the one the Court just shut down, and there may be a period of quiet on that front, opponents will continue to come after the law by other means.

Crawling forward, extra-time preventive service codes find small favor

06/28/2021

by: Richard Scott

Providers have made little use of two add-on codes that pay for extended preventive services since they debuted in 2018. Nonetheless, payments recently topped the $1 million mark.

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