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Left side, right side: Providers go side-specific on injection, X-ray services

09/25/2023

Coders turn to left- and right-side modifiers millions of times per year, and they are most likely to deploy the anatomic modifiers LT (Left side) and RT (Right side) following encounters with patients suffering from osteoarthritis.

Look to 6 Q&As to unravel the nuances of E/M coding, documentation

09/18/2023

by: Julia Kyles, CPC

Increase the E/M knowledge of coding staff and treating providers to ensure your claims are hitting the mark. You can bring these questions and answers to your next E/M training session. The first three questions address medical decision-making (MDM). The subsequent three questions tackle time-based coding.

Behavioral health in the PFS: CMS ignites its approach, adding providers, fees

09/18/2023

by: Roy Edroso

A closer look at the behavioral health changes proposed in the physician fee schedule rule released in July reveals more reimbursement opportunities for practices that are willing to expand their mental and behavioral health offerings but have not yet been able to figure out how to make it pay.

Telehealth, community health service overshadow pay cuts in PFS comments

09/18/2023

by: Julia Kyles, CPC

CMS received 17,614 comments on the proposed 2024 Medicare physician fee schedule, and with the public feedback period closing on Sept. 11, some of the most-discussed topics may surprise you.

October NCCI edit update focuses on revisions to the July update

09/18/2023

by: Julia Kyles, CPC

It won’t take long to train staff on the next National Correct Coding Initiative (NCCI) update. The procedure-to-procedure (PTP) edit update that will go into effect Oct. 1 deletes eight code pairs and revises 18 code pairs. There are no new edit pairs.

CMS previews projected 2024 payments for 52 new, newly active codes

09/18/2023

by: Julia Kyles, CPC

Take a look at proposed physician payments for new services: CMS included fees for 43 new CPT codes and seven HCPCS G codes in the proposed 2024 Medicare physician fee schedule.

Updated E/M manual adds plain-English guidance for popular services

09/11/2023

by: Julia Kyles, CPC

Better late than never: CMS released a new version of its Evaluation and Management Services Guide on Aug. 29. CMS withdrew the 2022 version of the manual on Feb 7. The updated online manual synchs up with guidelines and rules for E/M visits that went into effect Jan. 1, 2023.

M.D. on drugs? Investigate, see about interventions before reporting

09/11/2023

by: Roy Edroso

Medical boards and state laws require practices to report physicians who suffer “impairment” due to drugs or alcohol. But it’s important for practices to protect themselves by closely following the rules — and to protect their physician by checking out sub-governmental groups who may be authorized to help.

How one executive handles impairment investigations

09/11/2023

by: Roy Edroso

This week’s story on physician impairment and how to deal with it talks about protocols a practice may use to decide their response. For Gerda Maissel, M.D., CEO of My MD Advisor in New York City, the substance impairment process starts with an evaluation of the charge.

No LT for PAs: With one exception, locum tenens is physicians-only

09/11/2023

by: Roy Edroso

Question: Some of our clinical staff is going on vacation and we’re going to bring in locum tenens providers to cover for them. We have a physician assistant (PA) who wants us to swap in a fellow PA who freelances in a reciprocal billing arrangement. Can we do that?

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