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Monitor 2024 ICD-10-CM guideline revision for COVID-19

10/16/2023

Question: Are there any ICD-10-CM 2024 code or guideline updates related to COVID-19 screening or diagnosis?

AMA consolidates COVID vaccine, admin codes; CMS approves

10/16/2023

Make sure you’re staying accurate with an overhaul to the COVID-19 vaccine and administration codes. The AMA announced it is deleting a significant number of codes, replacing them with new codes and striking Appendix Q from the CPT Manual.

Payments lag though claims jump for 99214, as 99215 surges

10/16/2023

by: Richard Scott

Two years after the pandemic dealt a blow to the health care ecosystem, one key marker of the system’s vitality – routine office visits – had largely not recovered. The most-reported office visits, reflected in codes 99213 and 99214, sat at a depressed rate of -23% and -8%, respectively, in the four-year period from 2019 to 2022.

IRS crackdown shows your COVID program responsibilities aren’t over

10/09/2023

by: Roy Edroso

An Internal Revenue Service (IRS) “moratorium” on a COVID relief program serves as a warning to providers who received tax credits, and it may speak to dangers beyond this specific program. Several other loan and grant opportunities, some of which stretch back to the early days of the pandemic, have requirements that you might have missed or not yet been asked for.

HHS disability rule may require new equipment, from kiosks to scanners

10/09/2023

by: Roy Edroso

A proposed rule from HHS’ Office for Civil Rights (OCR) sets new standards for the accessibility of a variety of medical practice equipment to the disabled and may leave non-compliant practices vulnerable to fines and even lawsuits.

Pay attention to Medicare POS limits for procedures in non-facility (office) setting

10/09/2023

by: Laura Evans, CPC

Question: We had a provider perform an excision of prepatellar bursa (27340) in the office, place of service (POS) code 11. Patient has United Healthcare Shared Services-GEHA insurance. They denied the claim stating that CPT 27340 is not billable with POS 11. I have never had this issue before. Are there any coding rules/guidelines that prohibit use of some CPT codes at certain places of service or is this some weird payer-specific rule?

Capture the beat: Correctly report CPT codes for cardio testing, monitoring

10/09/2023

by: Savannah Schmidt

Review the most common types of external diagnostic cardiology tests, examine relevant CPT coding guidelines, and offer reporting advice from expert sources to ensure your billing patterns are capturing the right services.

2022 saw historic drops in Part B utilization and payment; tests rise

10/09/2023

by: Roy Edroso

Based on just-released Medicare Part B claims data, the 15 most-billed codes in 2022 were similar to those in 2021 and 2020, with one major COVID-related exception. But overall Medicare utilization and reimbursement took a big hit compared to prior years.

$850K for misusing modifier 25? Tighten up on policy and patterns

10/02/2023

by: Roy Edroso

An $850,000 DOJ settlement over alleged misuse of modifier 25 serves as a reminder that sometimes modifier misuse rises to something more than a coding dispute and can put you in False Claims Act jeopardy.

COVID comeback may call for masks – and delicacy in reintroducing them

10/02/2023

by: Roy Edroso

As COVID creeps back onto the scene, practices that relaxed their masking and social distancing requirements may want to bring them back. One expert suggests that you use caution lest you turn off patients who have been made skeptical by years of pandemic measures.

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