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Before dismissing intoxicated patient, try to see beyond to root cause

12/11/2023

You may occasionally encounter a patient who, in the provider’s opinion, is intoxicated, either by drugs or alcohol. Given informed consent issues, you may be inclined to refuse treatment -- but be careful that you’re not missing a chance to throw the patient a lifeline.

Social determinants of health assessment tools must cover 4 core domains

12/11/2023

by: Julia Kyles, CPC

Question: I am looking for more specific information on code G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment tool, 5-15 minutes, not more often than every 6 months).

PFS pain for 2024 selected codes is spread out, but still hurts

12/11/2023

by: Roy Edroso

With a 3.4% conversion factor (CF) cut looming in 2024 and Congress looking less likely by the day to deliver timely relief, providers who routinely bill services from CMS’ “selected codes” chart can at least take comfort that none of the 23 non-facility codes are taking too big a loss.

Physician regulatory burden persists; likelihood of relief spotty

12/04/2023

by: Roy Edroso

A new survey of health care executives finds them at least as bothered by regulatory burdens such as prior authorization and QPP/MIPS as they’ve ever been. While modest reforms are coming to prior auth, however, the status quo isn’t likely to change in the near future.

AMA’s interactive symposium session tested participants’ E/M IQ

12/04/2023

by: Julia Kyles, CPC

Attendees of the CPT & RVBRVS 2024 Symposium tested their coding know-how during an interactive E/M question and answer session. The 43-minute presentation included poll questions that allowed attendees to enter answers to five questions that were part of the main session as well as answers to several questions about the new split or shared policy.

Doc made a bad tweet? Before disciplining, consider possible legal comebacks

12/04/2023

by: Roy Edroso

Two physicians’ recent social media reactions to the Israel-Gaza conflict, and their fallout, serve as a reminder that First Amendment defenses don’t always override contract terms. But when they do, it can mean legal trouble for employers.

Primary care management surged with switch to CPT codes

12/04/2023

by: Julia Kyles, CPC

Primary care management (PCM) services, the care management service for patients with one high-risk and complex, chronic illness, experienced a massive boost the year the codes migrated from the HCPCS to the CPT code set.

Office visits: No CMS shift on split/ shared billing, prolonged visit code

11/20/2023

by: Julia Kyles, CPC

It’s official: CMS will not allow split or shared billing for E/M office visits next year. In addition, CMS will not change prolonged visit code G2212 in response to the updated descriptors for office/other outpatient visits (99202-99205 and 99212-99215).

Direct primary care remains a slow build, but big players are interested

11/20/2023

by: Roy Edroso

While interest in the direct primary care (DPC) model of patient-pay physician practice remains keen, evidence of its adoption and efficacy is elusive, suggesting the decision to switch from a traditional insurance model is a highly personal one.

CMS streamlines diabetes prevention program, adds dental, and more

11/20/2023

by: Roy Edroso

The final 2024 Medicare physician fee schedule brings a bevy of new services and modifies current policies and coverage options. Find all the latest updates to prepare for a successful 2024, with revised policies and additions below.

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