Part B News | Part B News

Asymptomatic but wants a COVID test? Press for medical necessity in notes, use Z-code

10/05/2020

Question: My patient is visiting aged relatives and wants a COVID test before she goes to reduce the chance of infecting them. How should I code this? And will Medicare deny the charge for lack of medical necessity, as my patient lacks any symptoms?

In recent years, nurse practitioners gobble up shares of E/M office visit claims

10/05/2020

by: Richard Scott

The number of office E/M codes that nurse practitioners (NP) are reporting under Medicare Part B has been on a significant upswing in recent years. Total claims for their most-billed office code, 99214, are up 114% from 2014 to 2018.

Flu season plus COVID-19 ‘twindemic’ could get rough; push shots early and hard

09/28/2020

by: Roy Edroso

COVID-19 complicates your flu season immunization picture, but experts say it may become an opening that not only gets more patients interested in having their shots, but also gets them to receive other needed care.

Next NCCI edit update will revive thousands of code pairs, reset MUEs

09/28/2020

by: Julia Kyles, CPC

Prepare your practice: CMS will roll back many of the National Correct Coding Initiative (NCCI) edits that it temporarily extended during the COVID-19 public health emergency (PHE) and add a few hundred more. But the latest quarterly update, effective Oct. 1, it doesn’t spell the end of all health emergency-related flexibilities.

E/M coding scenario: Work out new MDM rules for a 99214 encounter

09/28/2020

by: Richard Scott

For the first time in more than two decades, the E/M office visit code set (99202-99215) is subject to a coding and documentation overhaul. Starting Jan. 1, 2021, you’ll find that previously vital components of code level selection — namely, the history and exam components — no longer factor into your level of decision-making. Instead, determining a level of service will come down to one of two components: Medical decision-making (MDM) or time.

High-profile taskforce urges CMS to retain telehealth changes, add HIPAA enforcement

09/28/2020

by: Roy Edroso

In a show of unity by major telehealth advocates, a Taskforce on Telehealth Policy released a series of advocacy proposals Sept. 15 that call for the retention of the major telehealth flexibilities that providers have enjoyed since the start of the COVID-19 public health emergency (PHE) in March.

New set of COVID-19 ICD-10-CM codes proposed for Jan. 1 launch

09/28/2020

by: Laura Evans, CPC

Practices may have at least five new COVID-related diagnosis codes to use starting in January 2021, according to updates announced Sept. 9. The new codes would be in addition to the ICD-10-CM code and guideline changes set to take effect Oct. 1 this year.

Flu vaccine code 90662 leads pack; watch specs on your codes to avoid denials

09/28/2020

by: Roy Edroso

Both utilization and denial rates fluctuate wildly among different flu vaccines paid for by Medicare, and the differences remain stark even among places of service.

With 99201 on the chopping block, prepare for shifting MDM elements, audit concerns

09/21/2020

by: Roy Edroso

Among other big E/M changes arriving soon, Level 1 new patient office code 99201 is going away in 2021. The transition shouldn’t hamstring your coding efforts. But keep two important elements in mind to avoid disruptions: Follow the AMA and CMS guidelines for the remaining E/M codes and resist the temptation to simply kick your former 99201 cases up a level without proper documentation.

Consider options for deaf patients in telehealth, and add a plan for prompt follow up

09/21/2020

by: Roy Edroso

Providers are required to help patients with hearing issues understand their treatment, and experts point out that the shift to telemedicine can help — or potentially complicate — the process, depending on how you approach it.

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