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Pandemic cut most nursing facility E/M, but 99309 looks strong

06/05/2023

Notwithstanding the pandemic waivers of the three-day rule, nursing facility E/M and discharge codes, used by skilled nursing facilities, mostly took a hit during the public health emergency (PHE). As noted by the Kaiser Family Foundation, there was a decline in SNF admissions during that period, though the length of SNF stays and spending increased.

DEA extends telehealth prescription waivers, puts proposed rules on hold

05/22/2023

by: Julia Kyles, CPC

Advocacy groups, specialty societies and medical providers praised the extension of waivers that allow practices to prescribe controlled substances via telehealth. The extension will run until Nov. 11, 2024, if a patient establishes a telehealth relationship with a provider by Nov. 11, 2023.

As masks go away, you can keep them in your practice — if you watch the law

05/22/2023

by: Roy Edroso

The PHE is over and only a few states still have a mask mandate for health care facilities. But if you want to continue to require masking at your practice, experts say you can do it — even if patients and staff object — except in certain circumstances.

After correction, review the rules for counting a test interpretation toward MDM

05/22/2023

by: Julia Kyles, CPC

Your providers can get credit for both the order and the interpretation of a test thanks to technical correction issued by the AMA on March 1. You will promote proper coding based on medical decision-making (MDM) if you make sure your team understands that the update did not change the guidelines for calculating the number of tests that the treating provider ordered, reviewed or interpreted.

Records request: Stay compliant with patients’ right of access

05/22/2023

by: Dom Nicastro

The Office for Civil Rights (OCR) reached another resolution in January during its ongoing effort to ensure the comprehensive enforcement of the HIPAA Privacy Rule’s right of access provision. To provide more context behind this important topic, Elizabeth Delahoussaye, RHIA, CHPS, chief privacy officer for Ciox Health, which provides health care data management solutions, answers a series of questions about right of access rules and policies.

You can bill 2-hour esketamine code with therapy, and with prolonged codes

05/22/2023

by: Roy Edroso

Question: Our psychiatric provider will administer Spravato (esketamine) to a patient. I know there are codes for this: G2082 (Office E/M, established patient, w/provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation) and G2083 (... ; greater than 56 mg esketamine). But could we use other E/M codes with prolonged services instead? Also, psychotherapy may be performed prior to giving the medication — can we bill that? And should we report the drug separately?

Revenue up despite claims depression for psych, diagnostic codes

05/22/2023

by: Richard Scott

While mental health surfaced as a big topic during the COVID-19 crisis, most psychiatric evaluation and psychotherapy services didn’t see a major boost in claims. Nearly all saw a dip in utilization between 2019 and 2021, although the lone outlier grew enough, abetted by rate increases, that payments jumped more than $66 million.

Vaccine mandate slated to end; prepare for pullbacks, challenges in personnel

05/15/2023

by: Roy Edroso

The White House hints that the COVID vaccination mandates for CMS-affiliated health care facilities will soon come to an end. If this removes your legal obligation to have vaccinated staff (note: it may not), make sure you’re ready to make personnel changes in keeping with the new order; if you plan to keep the mandate anyway, prepare for possible challenges.

How to capture the visit when key components drive split/shared billing

05/15/2023

by: Julia Kyles, CPC

Medicare’s rules for split/shared visits allow your care team to use the key components of a facility-based E/M visit to determine who performed the substantive portion of the encounter (PBN 11/14/22). But your physicians and qualified health care professionals (QHP) will need to carefully document each encounter, and your coders will need to review each chart with equal care.

Liability premiums up, again; wring value from carrier extras

05/15/2023

by: Roy Edroso

Brace for some bad news: The AMA says a leading indicator of professional liability premium costs shows them going up. Consider shopping for better prices and avail carrier programs that can save you money.

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