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$850K for misusing modifier 25? Tighten up on policy and patterns

10/02/2023

An $850,000 DOJ settlement over alleged misuse of modifier 25 serves as a reminder that sometimes modifier misuse rises to something more than a coding dispute and can put you in False Claims Act jeopardy.

COVID comeback may call for masks – and delicacy in reintroducing them

10/02/2023

by: Roy Edroso

As COVID creeps back onto the scene, practices that relaxed their masking and social distancing requirements may want to bring them back. One expert suggests that you use caution lest you turn off patients who have been made skeptical by years of pandemic measures.

Take steps to minimize confusion, ensure compliance if you report telehealth consults

10/02/2023

by: Julia Kyles, CPC

Train coders and providers on Medicare’s rules for telehealth consults (G0406-G0408 and G0425-G0427) and keep a close eye on claims and documentation if your practice performs these services.

Split visits in the office should follow incident-to rules

10/02/2023

by: Julia Kyles, CPC

Question: I recently read that practices can use CMS’ model for split/shared visits in the facility setting to report joint or collaborative visits in the office (99202-99215). Here’s a sample scenario. Can you shed some light on how we should bill these services?

AMA and CMS seem to disagree on bundling of hip arthroscopy codes

10/02/2023

by: Laura Evans, CPC

Question: Medicare’s National Correct Coding Initiative (CCI) includes a code pair listing CPT codes 29916 and 29915 as mutually exclusive procedures but allows you to unbundle the edit with a modifier. But the AMA says not to report the two codes together. Any explanation as to why CMS and the AMA conflict on these codes, other than that CMS is sometimes at odds with the AMA and private payers?

CMS accepts new POS code for outreach involving site/street services

10/02/2023

by: Julia Kyles, CPC

Ignore the earlier version of CMS 100-04, Change Request 13314 and use new place of service (POS) code 27 (Outreach site/street) when appropriate.

Telehealth consults stayed above pre-COVID-19 levels

10/02/2023

by: Julia Kyles, CPC

Medicare claims for telehealth consults fell somewhat in 2021 after a sharp rise in 2020, but the overall total exceeded claims submitted in 2019, according to Part B News analysis of the latest Part B claims data.

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