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Use new E/M coding worksheet for level-based E/M encounters

03/06/2023

DecisionHealth has revised its tool for office/other outpatient E/M visits (99202-99215) to include encounters performed in the inpatient or observation (99221-99223 and 99231-99236), emergency department (99281-99285), nursing facility (99304-99310) and home or residence (99341-99350) settings and consults (99242-99245 and 99252-99255).

RTM vs. RPM: Defining remote monitoring techniques for CPT coding

03/06/2023

by: Savannah Schmidt

Question: What are the differences between remote therapeutic monitoring and remote physiologic monitoring and what details should we look for in documentation to report these services with CPT codes?

How to bill Medicare Part B for insulin with new limits on coinsurance

03/06/2023

by: DecisionHealth Staff

On Feb. 13, CMS published an MLN Fact Sheet regarding billing procedures for insulin following the new regulation that limits the Part B coinsurance for a month’s supply of insulin at $35. CMS is instructing providers not to bill for supplies for insulin for July 2023 or subsequent months in advance of July 2023 to ensure patients aren’t charged more than the $35 maximum allowed for that month.

Subsequent AWV code lifts, but PHE suppressed initial, IPPE codes

03/06/2023

by: Roy Edroso

Trends in annual wellness visits (AWV), billed to Medicare as G0438 and G0439, and the initial preventive physical examination (IPPE), aka Welcome to Medicare visit (G0402), show that while the codes did not prosper in the first year of the COVID crisis in 2020, G0439 pulled out of its tailspin in 2021; the others, however, continued to underperform.

Medicare links up with private payers, expands colorectal cancer screening benefit

02/27/2023

by: Julia Kyles, CPC

Take note of an expanded benefit for colorectal cancer (CRC) screening. It’s likely to mean that providers will talk to more patients about the screening, billing staff will collect copays from fewer patients, and if your practice performs non-invasive CRC tests in-house, you’ll see an uptick in lab services.

CMS unveils inflation drug pricing changes, with a Part B wrinkle coming soon

02/27/2023

by: Roy Edroso

A flurry of drug-pricing activity at HHS and CMS shows the agencies looking forward to big changes in what they’ll pay pharmaceutical companies for Medicare drugs. Most of these won’t affect providers and patients directly for some time — except for one shift that will appear as early as April 1 for some practices that dispense Part B drugs.

E/M update includes review warning for time, no help for split/shared billing

02/27/2023

by: Julia Kyles, CPC

You’ll find Medicare’s new and revised rules for hospital visits, nursing facility visits, prolonged services and split/shared visits in CMS 100-04, Change Request 13064, released February 9. The update includes more information on documenting time-based visits but is silent on component-based split/shared billing.

Implant 2023 CPT code changes for integumentary procedures

02/27/2023

by: Savannah Schmidt

The AMA update to the 2023 CPT code set has brought three code additions, one revision and one deletion to the integumentary chapter. Ensure your staff is aware of the changes, effective Jan. 1, to avoid claims disruptions.

Top screenings remained suppressed, down 3%, after 2020 tumult

02/27/2023

by: Richard Scott

The most-billed health screenings covered under Medicare took a big dip in 2020 as the pandemic wrought a utilization depression, and, though some screenings are starting to come back, most of them hadn’t fully recovered a year later.

Private payer updates highlight the two sets of E/M policies

02/20/2023

by: Julia Kyles, CPC

Keep one eye on your private payers’ policies for E/M and prolonged services, the other on your denials and make sure you have a firm understanding of the differences between the AMA’s CPT guidelines and CMS rules for the services. You can reduce denials and improper payments if you understand where AMA and Medicare don’t see eye-to-eye on E/M coding.

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