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Medically unlikely edit update caps prolonged office visits at 4 units

04/05/2021

You’ll have to go through the cycle of file, denial and appeal if you report more than 60 minutes of prolonged services with office E/M visits 99205 or 99215 when the visit is coded based on time.

10 elements of the mandatory HIPAA security risk analysis

04/05/2021

by: Marla Durben Hirsch

Conducting a security risk analysis to comply with HIPAA’s security rule has become even more paramount now that the HHS Office for Civil Rights (OCR) has released its new audit report.

When figuring out modifier 52 vs. 53, think: What’s the effect on the patient?

04/05/2021

by: Roy Edroso

Question: What’s the difference between modifiers 52 (Reduced services) and 53 (Discontinued procedure)? They seem pretty similar, because in both cases you stop part-way through.

How to set E/M risk level when a different doc does the surgery

04/05/2021

by: Laura Evans, CPC

Question: I am not sure how to set the risk level when a physician refers the patient for possible surgery that will be performed by a different doctor. For example, an orthopedic surgeon sees a patient with Dupuytren’s contracture and discusses the treatment options — Xiaflex injection or fasciectomy with the patient. Please help.

New rule delays MCIT ‘breakthrough technology’ effective date

04/05/2021

by: Roy Edroso

The effect of a last-minute Trump administration rule empowering more and speedier medical device authorization has been delayed by the Biden administration pending collection and analysis of new stakeholder comments.

Interrupted-service modifiers work great with some codes – but wipe out with others

04/05/2021

by: Roy Edroso

It may not be the high overall denial rates that best explain why the two interrupted-service modifiers, 52 (Reduced services) and 53 (Discontinued procedure), are so tricky; it could have something to do with the mix of codes that seldom, if ever, get denied with the modifiers, and those that get rejected most or all of the time.

Coders, clinicians report broad approval of new E/M guidelines, yet questions remain

03/29/2021

by: Laura Evans

They have lingering questions and scramble to keep up with corrections and updates, but coders and medical practice staff say they and their clinicians are mostly happy about this year’s revised E/M office visit guidelines and that the transition, so far, has been smooth.

Should you offer separate protocols for vaccinated patients? Experts advise wait-and-see

03/29/2021

by: Roy Edroso

With more Americans becoming vaccinated against COVID-19, you may be thinking about a change in patient infection protocols based on patient status. But it may be prudent to wait until you get more back-up from the law and government agencies.

Add appropriate sources and independent historians to your MDM calculations

03/29/2021

by: Julia Kyles

Don’t forget to track your clinician’s dialogue with outside sources: A practitioner’s conversation with a parent or a parole officer may be used to code Levels 3, 4 and 5 E/M office visits (99203-99205, 99213-99215).

Cue up best practices for ending pandemic-related work-from-home arrangements

03/29/2021

by: Courtney Bru

Many employers turned to telework during the COVID-19 pandemic. Often they will tell you the arrangements “weren’t perfect” but were necessary to survive the unprecedented circumstances.

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