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4 tips to help coders determine the MDM level for E/M services

10/10/2022

by: Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I

In 2021, the elements used to determine E/M leveling for office or outpatient visits changed to primarily focus on medical decision-making (MDM) and time. Effective Jan. 1, 2023, the same formula applies to facility-based E/M services: history and exam will no longer be used to select the level of code for hospital inpatients, observation care visits, consultations, ED visits, and nursing facility services along with home, rest home and domiciliary services.

Implement 6 tips to manage telehealth compliance risks

10/10/2022

by: Julia Kyles, CPC

Your practice should check its telehealth claims against the information in the recent data brief on telehealth services, health care attorneys advise. The Sept. 2 report from the HHS Office of Inspector General (OIG), “Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks,” contains findings and program integrity measures for telehealth services.

2023 ICD-10-CM refresh: Review new codes for musculoskeletal, genitourinary conditions

10/10/2022

by: Savannah Schmidt

Effective Oct. 1, CMS updated the ICD-10-CM code set to include over 1,100 new codes, before counting revisions and deletions. The codes will further define and give specificity to newly categorized diseases and disorders. Ensure you are up to speed on new codes for musculoskeletal and genitourinary conditions, including muscle wasting, fractures, drug-induced neuropathy and endometriosis.

When the patient brings a drug and you inject? Largely OK; charge a penny

10/10/2022

by: Roy Edroso

Question: We have a patient whose testosterone therapy is ordered elsewhere and will be sent to us for injection. I’ve had it drilled into me that we never leave off the drug code when we bill administration, but we clearly can’t charge for the drug. How do we bill?

AMA releases CPT codes for COVID-19 bivalent booster vaccines

10/10/2022

by: Savannah Schmidt

On Aug. 31, the AMA announced eight new CPT codes for bivalent COVID-19 vaccine booster doses. The vaccine boosters are designed to combat both the original COVID-19 strain and omicron subvariants BA.4 and BA.5. Of the eight new CPT codes, four are to be used for Moderna booster vaccines and four are to be used for Pfizer-BioNTech boosters.

Gastro codes do well with modifier 53, but 52 has some denial traps

10/10/2022

by: Roy Edroso

The modifiers 52 (Reduced services) and 53 (Discontinued procedure) often confuse providers. While total utilization remains low – 184,489 claims with 52 in 2021 and 30,850 for 53 the same year – your personal patterns may warrant another look, particularly if your practice performs a lot of the tests and exams that make up the bulk of services tied to these claims.

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