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Taking history and physical exams out of the calculations for level-based E/M services was on the wish lists of CMS and health care leaders for several years. That wish started to come true in 2021, the first year that office/other outpatient visits (99202-99215) were coded based on medical decision-making (MDM) or time.
A doctor faces a year in prison on HIPAA violation charges — a rare but real threat when prosecutors find providers or other health care workers flouting protected health information (PHI) rules in a way that calls for more than the usual fines and sanctions.
Coders must review updates to the ICD-10-CM code set to stay current, and for 2023 you will find several new codes in the “Mental, Behavioral, and Neurodevelopmental Disorders” chapter for dementia.
Question: One of our commercial payers offers extra payment from the add-on codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [eg, holidays, Saturday or Sunday], in addition to basic service) and 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service). I get the first code, but the second one just sounds like normal service during normal hours. What’s the deal?
Despite a non-payable status under Medicare, a series of six codes that reflect care provided during irregular or emergency hours garnered hundreds of thousands of claims – and returned zero dollars – in 2021.


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