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Use 4 documentation points to square away modifier 25 troubles

10/28/2024

Your practice can receive separate payment for an E/M visit on the same day as a minor procedure by using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

Will Fla. ruling mean the end of qui tam? Not right away

10/28/2024

by: Roy Edroso

A federal judge has declared the qui tam (whistleblower) provisions of the False Claims Act (FCA) unconstitutional. This ruling has the potential to end the incentives that drive most FCA prosecutions, including those in health care. Experts have mixed opinions as to how this ruling will play out in higher courts, but even before it’s retried it may affect how such cases are brought and defended.

Home BP readings for ‘white coat hypertension’? OK, but probably not RPM.

10/28/2024

by: Roy Edroso

Question: I have a patient who claims “white coat hypertension” — that is, he says his home blood pressure readings are significantly lower than the ones we get in the office. He has a home BP device, a Pressure X Pro, that connects to the internet. Can I take a reading via this device? And, in addition to adding it compliantly to encounter notes, can I claim 99091 (Collection and interpretation of physiologic data [eg, ECG, blood pressure, glucose monitoring])?

When coding eating disorders, start with initial visit, include all services

10/28/2024

by: Son Hoang

Question: What codes should a coder consider for a patient diagnosed with an eating disorder (e.g., anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder)?

HHS issues RFI for Part D ‘$2 drugs’ on some widely-used prescriptions

10/28/2024

by: Roy Edroso

Adding to its other pioneering prescription drug programs under Medicare, the Biden administration announced Oct. 9 that it would issue a request for information (RFI) on a potential “Medicare $2 Drug List Model” that would make some much-used drugs for hypertension, high cholesterol and other common conditions available to Part D beneficiaries for a couple of bucks.

Modifier 25, highly used, tops $4B in associated payments

10/28/2024

by: Julia Kyles, CPC

Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) continues to see high utilization. Providers reported it on more than 65 million claims in 2023.

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