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Select spinal decompression codes based on diagnosis, AMA states

02/26/2024

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.

Doc running for office? Get schedule, contract, outreach sorted out first

02/19/2024

by: Roy Edroso

If your physicians get involved in electoral politics, a former and current contender warns there are a few steps they need to take care of before tossing their hat in the ring, particularly when it comes to how the practice will carry on without them.

CMS releases HCPCS Level II updates including 36 new codes, effective April 1

02/19/2024

by: Savannah Schmidt

CMS published a summary of its fourth quarter 2023 HCPCS Level II code update application decisions to its website January 30. The agency made a total of 58 changes with 36 added codes, four revised codes, and 18 deleted codes. The additional and revised codes mostly consist of injections, medications and skin substitutes. The codes and their respective effective dates are listed below.

Choose the correct modifier for multiple encounters on same DOS

02/19/2024

by: Savannah Schmidt

Question: A patient underwent a diagnostic nasal endoscopy at 10 a.m. At 7 p.m., the patient developed an epistaxis and the physician had to use some complex cauterizing techniques to control the nosebleed. How would the physician’s services in this scenario be reported?

HHS audit uncovers raft of overpayments for E/M services

02/19/2024

by: Richard Scott

Shore up your documentation and strengthen your coding accuracy to ensure your claims aren’t falling into incorrect or fraudulent territory. The Comprehensive Error Rate Testing program under HHS found more than $3.7 billion in improper payments made to a series of E/M services, including more than $660 million in errors for a single E/M office visit code (99214).

Growth in outpatient programs signals opportunities for MFTs, MHCs

02/12/2024

by: Roy Edroso

Marriage and family therapists (MFT) and mental health counselors (MHC), the newest providers empowered to enroll in and be reimbursed by Medicare, have an opportunity to participate in a new CMS program. This could lure more of these providers into Medicare, making them available for partnership in Part B behavioral health.

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