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When drugs are partially discarded: Clarify use of modifier JW

04/24/2023

Modifier JW (Drug amount discarded/not administered to any patient) is used to describe drug amounts that are discarded and not administered to any patient. It does not reduce the payment for the drugs so it is an informational modifier; however, but you’re required to use it on Medicare claims for drug wastage. Wrap in the following guidance and tips to ensure your claims are accurate.

Primary care won CCM, but other specialties rose up for PCM codes

04/24/2023

by: Julia Kyles, CPC

Primary care providers dominated the top five slots in total reporting of traditional chronic care management (CCM) involving at least two chronic conditions. However, a wide range of specialties rose to the top when CMS introduced two codes for the management of one complex chronic condition, also known as principal care management (PCM).

Almost 400 new ICD-10-CM codes proposed for October

04/17/2023

by: Megan Herr with additional reporting by Laura Evans, CPC, and Julia Kyles, CPC

The proposed ICD-10 code changes — released with the FY2024 Hospital Inpatient PPS (IPPS) proposed rule on April 10 — include new codes to enhance the tracking and progression of Parkinson’s disease, including codes for Parkinson’s disease with and without dyskinesia and Parkinsonism, unspecified.

Pinpoint requirements for trigger point injections, watch your MAC

04/17/2023

by: Julia Kyles, CPC

Take your staff through the guidelines for trigger point injections (20552-20553) during your next compliance session. This pain treatment procedure has a 13% denial rate according to the latest Medicare Part B claims data, received a 98% denial rate during a medical review, and is frequently controlled by strict local coverage determinations (LCD) and private payer policies. These factors can combine to make receiving proper reimbursement for trigger point injections a painful undertaking.

Examine 2023 E/M updates for ED services

04/17/2023

by: Hamilton Lempert, M.D., FACEP, CEDC

E/M coding guidelines for emergency department (ED) services (CPT codes 99281-99285) were left unchanged for decades. However, the 2023 update to the CPT code set updated these requirements, along with coding requirements for many other E/M services.

You don’t need ‘health care cleaners,’ but you do need to meet standards

04/17/2023

by: Roy Edroso

Question: We frequently see ads for “medical cleaning” and “health care cleaning” companies that suggest we need to use their specialty services to meet official guidelines. Is there a law requiring this?

59 v. X[EPSU]: Practices see mixed results when using X modifiers

04/17/2023

by: Richard Scott

Instead of modifier 59 (Distinct procedural service), medical groups regularly turned to the CMS-approved series of X modifiers for distinct procedural services in 2021 – and found success with them.

An M.D. retirement ‘wave’? Protect yourself from coming doc drain

04/10/2023

by: Roy Edroso

A new report suggests you face a big wave of physician retirements over the next 10 years. Make sure you’re not only giving your current clinical staff reasons to stay, but also making sure you’re on the same page about when and how they’re leaving.

Track other providers’ remote monitoring programs to guide your practice

04/10/2023

by: Julia Kyles, CPC

Look to providers who currently offer remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services if your practice wants to add a remote program but isn’t sure how to start.

Look to new cyber ‘framework’ to bolster data security, aid insurance claims

04/10/2023

by: Roy Edroso

A new guidance document from the National Institute of Standards and Technology (NIST) is being promoted by HHS as a way for health care organizations to strengthen their cybersecurity via added coordination with top management. Experts think it could be useful — and may also provide added protection if you have a breach and cyberinsurers try to poke holes in your claim.

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