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Attract patients by adding essential elements to your practice’s website

02/26/2024

Your digital presence is often your first introduction to prospective patients. Tailor the virtual experience to meet your customers’ needs before they meet you in person and your encounters are likely to start off more seamlessly, and your business will benefit.

Most states must follow a new trigger point LCD on April 1

02/26/2024

by: Julia Kyles, CPC

A tough new policy for trigger point injections (20552-20553) will soon hit 38 states. Practices that don’t prepare will trigger denials that can’t be cured with an appeal.

Use a decision chart to train staff on caregiver training codes

02/26/2024

by: Julia Kyles, CPC

Medicare covers two caregiver training services (CTS) that are similar enough to cause confusion, claims errors and denials.

Check the setting and timing on SDOH risk assessments

02/26/2024

by: Julia Kyles, CPC

Question: Can we report G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment, 5-15 minutes, not more often than every 6 months) in the patient’s home? And does the provider have to perform the assessment on the same day as the E/M visit (99341-99345 and 99347-99350), or can they perform the assessment on a different day?

Ease the path to diagnosing chronic pain syndrome

02/26/2024

by: Julia Kyles, CPC

Question: Can you give an example of what needs to be documented for G89.4 (Chronic pain syndrome) showing there is a psychosocial reason for the pain?

Select spinal decompression codes based on diagnosis, AMA states

02/26/2024

by: Laura Evans, CPC

Question: We recently read coding guidance in the AHA Coding Clinic (Q1 2023) that appears to state that spinal stenosis should no longer be used as the primary diagnosis for code 63047 and that the code can be reported for other indications. Specifically, the article describes a scenario where “the diagnosis was listed as L4-L5 lateral foraminal stenosis. The question arose as to whether, based upon the diagnosis of stenosis, would it be appropriate to report CPT code 63047... Can you please clarify?

POS changes reveal hospital outpatient E/M trends

02/26/2024

by: Julia Kyles, CPC

Hospitals report twice as many Part B E/M services in their on-campus outpatient departments compared to services in off-campus outpatient departments. However, overall E/M reporting in outpatient hospital settings didn’t drastically change after CMS instituted new place of service (POS) policies in 2016.

OIG: Major MAO owes $2.2 million on high-risk claims

02/26/2024

by: Roy Edroso

On Feb. 16, the Office of the Inspector General (OIG) released results of an audit of Medicare Advantage organization (MAO) MediGold recommending a refund of more than $2.2 million in estimated overpayments

Fines for lax M.D./NP collaboration warn against loose policies

02/19/2024

by: Roy Edroso

A nurse practitioner and an OB/GYN have both paid fines stemming from their collaborative agreement. Consider this case a warning that such agreements require more attention up front than some practices may assume.

CERT Alert: Part B error rate rises, telephone E/M services debut

02/19/2024

by: Julia Kyles, CPC

The overall improper payment rate for Medicare claims dropped less than 1% in a recent review period, according to the 2023 comprehensive error rate testing (CERT) report, but the total Part B error rate rose almost 2%. The error rate includes over- and underpayments.

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