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Becerra confirmed; experts see strong ACA defense, partner for providers

04/05/2021

He’s been a health system trust-buster and a Medicare for All advocate, but in his new role as HHS Secretary you can expect Xavier Becerra to be more of a team player than a firebrand. However, in areas where his instincts and President Joe Biden’s intersect, such as the expansion of Obamacare, you may see a faster-than-normal rate of progress under his leadership.

Medically unlikely edit update caps prolonged office visits at 4 units

04/05/2021

by: Julia Kyles, CPC

You’ll have to go through the cycle of file, denial and appeal if you report more than 60 minutes of prolonged services with office E/M visits 99205 or 99215 when the visit is coded based on time.

10 elements of the mandatory HIPAA security risk analysis

04/05/2021

by: Marla Durben Hirsch

Conducting a security risk analysis to comply with HIPAA’s security rule has become even more paramount now that the HHS Office for Civil Rights (OCR) has released its new audit report.

When figuring out modifier 52 vs. 53, think: What’s the effect on the patient?

04/05/2021

by: Roy Edroso

Question: What’s the difference between modifiers 52 (Reduced services) and 53 (Discontinued procedure)? They seem pretty similar, because in both cases you stop part-way through.

How to set E/M risk level when a different doc does the surgery

04/05/2021

by: Laura Evans, CPC

Question: I am not sure how to set the risk level when a physician refers the patient for possible surgery that will be performed by a different doctor. For example, an orthopedic surgeon sees a patient with Dupuytren’s contracture and discusses the treatment options — Xiaflex injection or fasciectomy with the patient. Please help.

New rule delays MCIT ‘breakthrough technology’ effective date

04/05/2021

by: Roy Edroso

The effect of a last-minute Trump administration rule empowering more and speedier medical device authorization has been delayed by the Biden administration pending collection and analysis of new stakeholder comments.

Interrupted-service modifiers work great with some codes – but wipe out with others

04/05/2021

by: Roy Edroso

It may not be the high overall denial rates that best explain why the two interrupted-service modifiers, 52 (Reduced services) and 53 (Discontinued procedure), are so tricky; it could have something to do with the mix of codes that seldom, if ever, get denied with the modifiers, and those that get rejected most or all of the time.

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