Part B News | Part B News

As PHE nears end, know when audio-only care becomes ePHI — and stay compliant

04/24/2023

HIPAA compliance for telehealth services applies to audio-only services, including telephone E/M codes (99441-99443). To protect your practice and patients from breaches, make sure staff understand the security requirements for phone-based care that the HHS Office for Civil Rights (OCR) outlined in a guide on audio-only services.

For providers: An at-a-glance guide for PHE end on May 11

04/24/2023

by: Julia Kyles, CPC

Help your busy providers prepare for the end of the COVID-19 public health emergency (PHE) with this summary of key waiver activities that will and will not be allowed after May 11. For example, providers can continue to perform telephone E/M services after May 11, but they cannot perform virtual check-ins for new patients.

Examine documentation improvement strategies for 2023 CPT updates

04/24/2023

by: Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The January 2023 update to the CPT manual introduced 225 new and 93 revised codes, while 75 codes were deleted, with almost every chapter undergoing some form of change. As expected, the spotlight fell on facility-based E/M services, with changes to codes, descriptions, guidelines, definitions and the medical decision-making (MDM) table.

When drugs are partially discarded: Clarify use of modifier JW

04/24/2023

by: Savannah Schmidt

Modifier JW (Drug amount discarded/not administered to any patient) is used to describe drug amounts that are discarded and not administered to any patient. It does not reduce the payment for the drugs so it is an informational modifier; however, but you’re required to use it on Medicare claims for drug wastage. Wrap in the following guidance and tips to ensure your claims are accurate.

Primary care won CCM, but other specialties rose up for PCM codes

04/24/2023

by: Julia Kyles, CPC

Primary care providers dominated the top five slots in total reporting of traditional chronic care management (CCM) involving at least two chronic conditions. However, a wide range of specialties rose to the top when CMS introduced two codes for the management of one complex chronic condition, also known as principal care management (PCM).

Almost 400 new ICD-10-CM codes proposed for October

04/17/2023

by: Megan Herr with additional reporting by Laura Evans, CPC, and Julia Kyles, CPC

The proposed ICD-10 code changes — released with the FY2024 Hospital Inpatient PPS (IPPS) proposed rule on April 10 — include new codes to enhance the tracking and progression of Parkinson’s disease, including codes for Parkinson’s disease with and without dyskinesia and Parkinsonism, unspecified.

Pinpoint requirements for trigger point injections, watch your MAC

04/17/2023

by: Julia Kyles, CPC

Take your staff through the guidelines for trigger point injections (20552-20553) during your next compliance session. This pain treatment procedure has a 13% denial rate according to the latest Medicare Part B claims data, received a 98% denial rate during a medical review, and is frequently controlled by strict local coverage determinations (LCD) and private payer policies. These factors can combine to make receiving proper reimbursement for trigger point injections a painful undertaking.

Examine 2023 E/M updates for ED services

04/17/2023

by: Hamilton Lempert, M.D., FACEP, CEDC

E/M coding guidelines for emergency department (ED) services (CPT codes 99281-99285) were left unchanged for decades. However, the 2023 update to the CPT code set updated these requirements, along with coding requirements for many other E/M services.

You don’t need ‘health care cleaners,’ but you do need to meet standards

04/17/2023

by: Roy Edroso

Question: We frequently see ads for “medical cleaning” and “health care cleaning” companies that suggest we need to use their specialty services to meet official guidelines. Is there a law requiring this?

59 v. X[EPSU]: Practices see mixed results when using X modifiers

04/17/2023

by: Richard Scott

Instead of modifier 59 (Distinct procedural service), medical groups regularly turned to the CMS-approved series of X modifiers for distinct procedural services in 2021 – and found success with them.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.