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CMS approves implantable pulmonary artery pressure sensors for heart failure
02/17/2025
by: DecisionHealth staff
On January 13, CMS published a Final Decision Memo regarding a national coverage analysis for implantable pulmonary artery pressure sensors (IPAPS) for heart failure management under coverage with evidence development (CED). CMS will cover the implantation of IPAPS for heart failure management when furnished according to an FDA market-authorized indication and specific patient, physician and CED study criteria are met. CMS believes CED is the most appropriate national coverage determination (NCD) policy for these devices, as it simultaneously covers the technology while collecting and analyzing more data to fill evidence gaps.
Psych, neuro tests see double-digit growth, improved denials; but one lags
02/17/2025
by: Roy Edroso
Medical groups reported a series of primary psychological, neuropsychological and neurobehavioral testing codes more often than in previous years, and had a more favorable return on denials. But one of the codes remained a denial trap, and it looks as if a simple misunderstanding of the billing rules may be to blame.
After DEA floats telehealth prescribing rule, experts say it needs work
02/10/2025
by: Julia Kyles, CPC
Look for help submitting a comment on the Drug Enforcement Administration’s (DEA) latest proposed rule if your practice acquired telehealth-only patients during the COVID-19 public health emergency (PHE).
Look for help submitting a comment on the Drug Enforcement Administration’s (DEA) latest proposed rule if your practice acquired telehealth-only patients during the COVID-19 public health emergency (PHE).
Health care legislation in limbo; agencies’ halted communications linger
02/10/2025
by: Roy Edroso
Congressional action that would address providers’ issues with reimbursement, telehealth, Advanced alternative payment model (APM) bonuses and more has been moved to the back burner as Washington focuses on executive action from the Trump administration that has impacted health care in sometimes unprecedented ways.
Heed E/M compliance lessons from UCHealth’s recent settlement
02/10/2025
by: Dom Nicastro
A recent $23 million settlement involving University of Colorado Health (UCHealth) serves as a critical reminder of the complexities and responsibilities inherent in health care billing and compliance. The case, centered on the misuse of E/M codes in emergency department (ED) billing, offers valuable insights for billing and compliance professionals.
When my doctor reports a colleague, should I require it stay in-house — or not?
02/10/2025
by: Roy Edroso
Question: I heard about a doctor who reported a colleague he thought was performing unnecessary surgeries to his employers — and, instead of evaluating his report and sending it on to the medical board, the practice fired the doctor who filed it. If I have a problem with a colleague, should I just go to the board myself and leave the practice out of it?
Coders stitched up new hernia repair codes in 2023; watch suture removal
02/10/2025
by: Julia Kyles, CPC
When introduced, the 2023 CPT manual featured 224 new codes. By plumbing utilization data, you can now see which services medical groups turned to most frequently — an add-on code for suture removal and a group of initial hernia repair codes took the top five spots for new surgery codes (10004-69990) that were introduced in 2023, according to the latest available utilization data for Part B Medicare claims.
After DEA floats telehealth prescribing rule, experts say it needs work
02/10/2025
by: Julia Kyles, CPC
Look for help submitting a comment on the Drug Enforcement Administration’s (DEA) latest proposed rule if your practice acquired telehealth-only patients during the COVID-19 public health emergency (PHE).
Look for help submitting a comment on the Drug Enforcement Administration’s (DEA) latest proposed rule if your practice acquired telehealth-only patients during the COVID-19 public health emergency (PHE).
Practices no longer off-limits to ICE raids; know your rights
02/03/2025
by: Roy Edroso
With new emphasis on, and orders for, removal of undocumented immigrants, some physician practices have reason to prepare for federal agents to come to their office looking for documents and, perhaps, patients or staff. Experts say it’s important to understand your rights in this situation — as well as your responsibility to the people under your care.
After ICD-10 update, primary care should study the new eating disorder codes
02/03/2025
by: Julia Kyles, CPC
Primary care practitioners (PCP) should alert their staff to the need for detail when they diagnose or code eating disorders. The FY2025 ICD-10-CM update requires increased specificity to code the disorder.
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