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Patient post-op pain? If it’s really unrelated to surgery, use modifier 24

12/07/2020

Question: Our surgeon did a knee replacement on a patient, which put her on a walker and crutches for an extended period of time. Using the crutches caused her back pain, and she saw the surgeon about it. Can the surgeon claim an E/M with modifier 24? Or is this considered a “related” condition?

2021 conversion factor gets 10% squeeze, E/M revisions remain on track

12/07/2020

by: Decision Health Staff

Physicians are facing a 10.2% drop in the Medicare conversion factor (CF) starting Jan. 1, as an offset to broad new increases in reimbursement rates for E/M office visits and other E/M-like services, according to the final 2021 Medicare physician fee schedule released Dec. 1.

Use of E/Ms with modifier 24 remains stable, but denial rates fall hard

12/07/2020

by: Roy Edroso

Considering its stringent requirements, you may expect claims with modifier 24 (Unrelated E/M service during a postoperative period) to see a lot of denials. But their rates are actually very low, especially compared to where they were four years earlier.

Ransomware on the rise: Protect your WFH, telehealth gaps and update your IT plan

11/23/2020

by: Roy Edroso

Ransomware, a bane of health care providers for years, has gotten even worse, leading to steeper consequences for providers who have been hit by it. Adding to the challenges, the pandemic-induced wave of work-from-home (WFH) orders has made attacks easier for crooks. It’s time to double down on your defenses.

Coalition of physician groups urges Congress to waive budget neutrality

11/23/2020

by: Richard Scott

As medical practices await the release of the final 2021 Medicare physician fee schedule, a number of provider association are calling on lawmakers to stave off a steep cut to the conversion factor, which determines service fees, that’s set to kick in Jan. 1.

The 3 elements of MDM: Document tests, outside input for MDM data review and analysis

11/23/2020

by: Laura Evans, CPC

To help subscribers prepare for the 2021 E/M office visit guidelines, Part B News will examine each of the three elements of medical decision-making (MDM) and how they will change starting Jan. 1. In this issue, you’ll learn about the amount and complexity of data to be reviewed and analyzed.

Following OIG’s lead, CBR scrutinizes critical care code usage; adhere to rules

11/23/2020

by: Roy Edroso

Auditors may be looking at your providers’ critical care codes, so make sure you have the basics right.

Providers again clear $1B in revenue for critical care services

11/23/2020

by: Richard Scott

The critical care code set may be small in size, consisting of two CPT codes (99291, 99292), but it packs a wallop when it comes to provider revenue. In 2019, practices surpassed the $1 billion mark in payments tied to the two codes.

Even with COVID, practice M&A market better than expected; watch terms

11/16/2020

by: Roy Edroso

You might think the mergers and acquisition (M&A) market for physician practices would be weak, thanks to COVID-19. But experts say there’s money out there — and some properties may be almost as hot as they were before March.

The three elements of MDM: Examine the levels of ‘problems addressed’

11/16/2020

by: Laura Evans CPC

Now that documentation of history and exam will no longer be required to assign the appropriate office visit code, some coders may be looking forward to coding E/M encounters (99202-99215) based only on time.

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