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After ICD-10 update, primary care should study the new eating disorder codes

02/03/2025

Primary care practitioners (PCP) should alert their staff to the need for detail when they diagnose or code eating disorders. The FY2025 ICD-10-CM update requires increased specificity to code the disorder.

More than a dozen changes to ICD-10-CM tabular list will go into effect April 1

02/03/2025

by: Julia Kyles, CPC

Check out the ICD-10-CM changes that will go into effect April 1, 2025. The CDC did not release any new codes, but you should review the ICD-10-CM Tabular List of Diseases and Injuries 2025 Addenda April Update with your staff before April 1.

Can you force patients to get an AWV? Not without risk.

02/03/2025

by: Roy Edroso

Question: I’m a patient of a local primary care practice that recently sent me a letter saying they are “required by CMS to perform and submit annual wellness exam information on each Medicare/Medicare Advantage patient each year. Although CMS does not penalize the member when the AWV information is not submitted annually, your PCP/Provider is reported as being non-compliant with patient care, which does affect our standing and reimbursement with CMS.” For that reason, the letter went on, “our office requires that all patients with Medicare/Medicare Advantage coverage undergo an AWV annually to continue to retain [the practice] as their Primary Care Physician (PCP).” Can they do that?

OIG offers advisory opinion on pharma coverage

02/03/2025

by: DecisionHealth staff

On Jan. 15, the OIG published an Advisory Opinion regarding a program that would provide free access to a pharmaceutical product to patients who meet financial and other eligibility criteria and who do not have adequate coverage for the product.

Favorable signs: Subsequent AWV payments stop the slide, denials fall

02/03/2025

by: Richard Scott

Professional payments for the oft-reported subsequent annual wellness visit (AWV) service took a favorable turn in 2023, as national reimbursement levels rebounded from a low point the year before. Overall, claims utilization has remained strong in recent years, and denials show a favorable trend as well.

Explain post-op add-on code with illustration, checklist, descriptor

01/27/2025

by: Julia Kyles, CPC

The treating provider at your practice may be eligible for a one-time additional payment when they provide post-operative care, effective Jan. 1, 2025.

Billing for e-visits proves tough climb; more training needed?

01/27/2025

by: Roy Edroso

If you conduct e-visits and have difficulty billing for them, you’re not alone: Recently released survey data from the Mayo Clinic in Rochester, Minn., shows that even when patients agreed to be charged for queries sent though a portal, only a tiny fraction of these asynchronous encounters were billed.

Can you report audio-only office E/M? Yes, but be very careful

01/27/2025

by: Julia Kyles, CPC

Treating providers can perform audio-only E/M visits via telephone for patients who are at home, regardless of their geographic location, thanks to the three-month telehealth extension.

Don’t be rash: Capture accurate ICD-10-CM dermatology coding

01/27/2025

by: Betty A. Hovey, BSHAM, CCS-P, CDIP, CPC, COC, CPMA, CPCD, CPB, CPC-I

ICD-10-CM coding is one part of the proper claims partnership. While CPT codes indicate to a payer what service was provided to the patient, the ICD-10-CM codes indicate why it was medically necessary.

Clarify risk adjustment goals and financial directives

01/27/2025

by: Jennifer Brettler, DO, FACP, CHCQM-PHYADV

Question: We know that risk adjustment can impact reimbursement, quality of care, insurance plan ratings, and overall performance, but what does risk adjustment really mean?

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