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Benchmark of the Week
Nearly nine out of 10 medical facilities are experiencing personal protective equipment (PPE) shortages due to the novel coronavirus pandemic.
In its quest to provide more remote services, CMS has come up with some new online codes in the past year but still pays for several older codes specifically geared to teleheath. These older codes don’t get much use, but their utilization is growing Ñ steadily and at a faster rate than their denials.  
On March 17, public health statistics confirmed what has appeared inevitable since the COVID-19 pandemic broke out earlier this year: The U.S. has confirmed coronavirus cases in all 50 states.

The specialties that claimed office E/M codes most often in 2017 held steady in terms of volume and payment in 2018. But for some specialties, the denial rates varied widely.

Internal medicine and family practice providers led the charge behind the 15% reimbursement gains for subsequent annual wellness visit (AWV) code G0439 between 2017 and 2018, when payments topped $844 million.

Currently, CERT auditors may be looking into your use of 99238 (Hospital discharge day management; 30 minutes or less) and 99239 ( … ; more than 30 minutes). If so, it may have to do with their unusual usage pattern relative to other pairs of time-based codes, in which the longer-duration, higher-price 99239 has increased in use while the shorter-duration, lower-price 99238 has declined.

The influenza vaccine remains at the fore of preventive medicine, yet reports support the notion that American adults are balking at this type of service.

Modifier 76 (Repeat procedure or service by same physician) is a pretty good bet in most cases, but there are a lot of codes for which it’s seldom or never accepted.

As practices find expanded coverage of Next Generation Sequencing tests, two CPT codes used most frequently — 81432 (Genomic sequencing procedures and other molecular multianalyte assays) and 81445 (Targeted genomic sequence panel, neoplasm, 5-50 genes) — are on divergent paths.

While sleep studies and continuous positive airway pressure (CPAP) devices are getting more popular, Medicare billing for them so far has held pretty steady. But as the tough denial rates for a major CPAP code show, you still have to be careful about billing them.


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