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Implement time, location lessons for FTF and telehealth visits: OIG audit

03/04/2024

Take time to assess key details the HHS Office of Inspector General (OIG) found in its review of telehealth services during the first nine months of the COVID-19 public health emergency (PHE). The agency identified documentation errors that might lurk in your face-to-face (FTF) E/M services, as well as your telehealth claims.

Check the payer first when selecting codes for obesity counseling

03/04/2024

by: Laura Evans, CPC

Question: At our orthopedic practice we sometimes must postpone a patient’s total joint replacement because their BMI is too high. We either refer them back to their PCP for weight loss management or to a weight loss program at another facility. One of our providers is working to become certified in weight loss counseling, which would allow her to provide this service at our practice rather than referring the patients elsewhere. How would this service be billed?

How to code when the orthopedist is called to evaluate an inpatient

03/04/2024

by: Laura Evans, CPC

Question: One of the coders I work with consistently uses the subsequent inpatient or observation codes (99231-99233) to bill for hospital H&Ps by their orthopedic surgeons. A typical scenario would be when the orthopedist is called to evaluate a hospitalized patient with a known orthopedic injury who was admitted by another physician. The orthopedist has not previously seen the patient. I am seeing conflicting guidance on this from different sources. Can you please clarify?

CMS affirms billing expansion of pulmonary, cardiac rehab services

03/04/2024

by: Richard Scott

On February 8, CMS published MLN Matters 13513 to ensure medical group billing staff is aware of an expansion of supervising practitioners who can oversee, and bill for, pulmonary, cardiac and intensive cardiac rehabilitation services.

After code switch, psych and neuro tests perform well, with exceptions

03/04/2024

by: Roy Edroso

After a major coding changeover, psychological and neuropsychological testing claims have continued to rise in overall utilization. But watch a few related codes that have had a harder time of it.

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

02/26/2024

by: Roy Edroso

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?

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