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Use these strategies when a payer inappropriately uses modifier 50

08/29/2022

Question: We recently sent a claim to Blue Cross of Alabama that included 20610-LT for a left shoulder diagnosis and 20610-RT for a right knee diagnosis. The payer responded that we should have billed these procedures on one claim line with a 50 modifier (bilateral procedure). We replied that this was not a bilateral procedure, but rather two separate procedures done in two separate joints. The payer then stated that because code 20610 has a bilateral surgery indicator of “1” in the Medicare physician fee schedule, modifier 50 should be used rather than RT/LT. There doesn’t seem to be any way to report a major joint arthrocentesis done on different joints on opposite sides of the body. Is there a way to correct the situation?

Turn to modifier 91 for repeat laboratory testing

08/29/2022

by: Sarah Gould, CPC

Question: We are getting some National Correct Coding Initiative (NCCI) edits for repeat laboratory services. What modifier do we use if a component of a panel test is repeated later?

Part D plan preference for higher-cost hepatitis C drugs led to higher Medicare and beneficiary spending

08/29/2022

by: DecisionHealth

On August 11, the OIG published a review of the utilization of hepatitis C drugs in Medicare Part D compared to utilization of the same drugs in Medicaid in 2019 and 2020. The review was conducted because preliminary research indicated that Part D beneficiaries were using higher-cost hepatitis C drugs rather than the generic versions that were increasingly being used by Medicaid beneficiaries.

Medicare costs, enrollment inch up, and so does patient burden

08/29/2022

by: Roy Edroso

While some of your patients will find relief under the Inflation Reduction Act (IRA), their financial contributions to coverage continue to rise, according to CMS’ most recent FastFacts program data. Federal health care programs continue to grow, as well, although none of the Medicare programs are picking up members as quickly as Medicaid.

Closing practice? Make patients aware, records available, responsibility clear

08/22/2022

by: Roy Edroso

If you’re closing down a practice, make sure patient records aren’t ignored or you may face potential professional and legal consequences.

AMA shakes up prolonged services codes with 2023-effective changes

08/22/2022

by: Julia Kyles, CPC

Streamlined coding and shorter time requirements for prolonged services are on the horizon for physicians and qualified health care professionals. The pending update to the E/M chapter of the CPT manual, effective Jan. 1, 2023, will replace four prolonged services with two 15-minute codes.

Prolonged E/M visit time chart

08/22/2022

by: Julia Kyles, CPC

While you wait for your 2023 CPT Manual, use this chart to prepare staff for the update to prolonged E/M visits.

Confirm medical necessity of same-day telehealth and in-person encounters

08/22/2022

by: Julia Kyles, CPC

Telehealth visits are still an option under the COVID-19 public health emergency (PHE) waiver even though medical practices are returning to pre-COVID patterns for face-to-face encounters. As a result, it has become more likely that your practice may provide an E/M visit by telehealth and an in-office procedure on the same date of service.

Clarify ICD-10-CM and CPT coding and billing for wound care

08/22/2022

by: Savannah Schmidt

Coding for wound procedures is notoriously difficult, as the process can seem as messy as the injuries themselves. Ensure your staff is prepared to code correctly by fully understanding wound documentation and guidance for reporting wound diagnoses and procedures using ICD-10-CM, CPT and HCPCS Level II codes.

Initial hospital fees take a dive, but subsequent visits spike

08/22/2022

by: Richard Scott

With big changes coming to the inpatient E/M code family in 2023, the fees associated with facility codes 99221-99223 and 99231-99233 are also in flux. Initial visit fees are down, while subsequent encounters are on the rise.

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