Part B News | Part B News

Adhere to rules on reporting RTM or RPM during the global period

01/22/2024

Question: I interpret recent CMS rulemaking that the RTM codes (98975, 98977, 98980 and 98981) are bundled in the global period if they are being performed for the same diagnosis and by the same provider who did the surgery. Am I reading that correctly?

Identify proper use of separate-structure modifier XS

01/22/2024

by: Savannah Schmidt

Question: A physician debrides a hyperkeratotic lesion on a patient’s left foot, second toe. During the same encounter, he performs a debridement of the five toenails. Which CPT codes and modifiers would be reported for this procedure?

Subsequent AWVs continue flying, but initial AWV, IPPE stay grounded

01/22/2024

by: Roy Edroso

Regular comprehensive exams are among the few services for which all Medicare beneficiaries are eligible. While initial preventive physical examinations (IPPE) and initial annual wellness visits (AWV) remain mired in their pandemic-era utilization numbers, subsequent AWVs continue a strong recovery.

CPT errata folds interprofessional consults into same-day E/M visits

01/15/2024

by: Julia Kyles, CPC

Flag this update in your 2024 CPT Manual, alert staff and double-check your claims for interprofessional consult requests: The CPT editorial panel issued a late-breaking correction to the guidelines for 99452 (Interprofessional telephone/Internet/electronic health record referral service[s] provided by a treating/requesting physician or other qualified health care professional, 30 minutes). The correction went into effect Jan. 1, 2024.

Health care VR growth slow in reimbursement, quicker as a teaching tool

01/15/2024

by: Roy Edroso

Virtual reality (VR) is advancing as a health care tool -- though, experts agree, not yet as a reimbursable service on its own. In the short run its greater impact will likely be felt in physician training, particularly when new technology that adds tactile functions to it comes of age.

Give providers an illustrated guide to the new SDOH risk assessment code

01/15/2024

by: Julia Kyles, CPC

Make sure your physicians and qualified health care professionals (QHP) are ready for their crucial role in reporting 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).

Med groups make goal-line stand on harsh info-blocking penalties

01/15/2024

by: Roy Edroso

Late in 2023, medical practice and physician groups called for changes in a proposed rule that would add tough “disincentives” for information blocking, including a zero MIPS Promoting Interoperability score and exclusion from the Medicare Shared Savings Program (MSSP). As comments on the rule closed on January 2, it won’t be long before these groups find out whether they swayed the feds, or if penalties await providers who are out of compliance.

How to respond when a Medicare Advantage auditor requests a staff interview

01/15/2024

by: Sam J. Louis

Part B News recently covered an uptick in Medicare Advantage organizations’ provider site audits -- and the possibility that auditors would try to interview providers’ staff. Here with an expert perspective on how to handle that is former prosecutor Sam J. Louis of the Holland & Knight law firm in Houston.

Anesthesia, eyes and more: These new services dominated in 2022

01/15/2024

by: Julia Kyles, CPC

The 2022 CPT Manual included 249 new codes across a range of services. However, analysis of the most recent Medicare Part B data reveals that the top 10 new procedure and service codes in 2022 were represented by additions to the manual’s E/M, anesthesia, eye and ocular adnexa, nervous system and medicine chapters.

Be prepared: Examine 2024 E/M guideline and code changes

01/08/2024

by: Terry Tropin, MSHAI, RHIA, CCS-P

Important changes are coming for physician E/M reporting in 2024. In particular, coders should note the changes for reporting telemedicine services, split or shared visits, multiple visits, and hospital or observation care same day admission and discharge. Be sure to make notes or underline changes in your CPT manuals to remember the changes as they start this year.

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