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Reminder: Relaxed NCCI edits have been retired; code accordingly

07/05/2021

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.

Low claims clearance? Before blaming billers and coders, check chain of custody

06/21/2021

by: Roy Edroso

Standards for judging coding and billing performance should go beyond simple measurement of denial rates. To achieve better assessments, you also should weed out other causes to accurately measure their effect on the bottom line.

CMS offers bonus for vaccinating patients in the home, but restrictions apply

06/21/2021

by: Greg Hambrick

CMS will pay more money to Medicare providers for administering the COVID-19 vaccine in the home, beginning with vaccines administered on June 8, 2021.

CMS pushes high-payment cognitive assessments; prepare to do them right

06/21/2021

by: Roy Edroso

CMS and the U.S. Congress are pushing for you to provide the cognitive assessment and plan of care service billed to Medicare with 99483. You don’t have to be a behavioral health or gerontology specialist to do so, but you should make sure you’re prepared.

OSHA issues new rules for health care employers, relaxes guidance elsewhere

06/21/2021

by: Tammy Binford

On June 10, the Occupational Safety and Health Administration (OSHA) announced updated guidance along with new rules for frontline health care employers. The latest word from OSHA reflects new guidance from CDC in May that says fully vaccinated people can safely go without masks and physical distancing in most situations.

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