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Practices no longer off-limits to ICE raids; know your rights

02/03/2025

With new emphasis on, and orders for, removal of undocumented immigrants, some physician practices have reason to prepare for federal agents to come to their office looking for documents and, perhaps, patients or staff. Experts say it’s important to understand your rights in this situation — as well as your responsibility to the people under your care.

After ICD-10 update, primary care should study the new eating disorder codes

02/03/2025

by: Julia Kyles, CPC

Primary care practitioners (PCP) should alert their staff to the need for detail when they diagnose or code eating disorders. The FY2025 ICD-10-CM update requires increased specificity to code the disorder.

More than a dozen changes to ICD-10-CM tabular list will go into effect April 1

02/03/2025

by: Julia Kyles, CPC

Check out the ICD-10-CM changes that will go into effect April 1, 2025. The CDC did not release any new codes, but you should review the ICD-10-CM Tabular List of Diseases and Injuries 2025 Addenda April Update with your staff before April 1.

Can you force patients to get an AWV? Not without risk.

02/03/2025

by: Roy Edroso

Question: I’m a patient of a local primary care practice that recently sent me a letter saying they are “required by CMS to perform and submit annual wellness exam information on each Medicare/Medicare Advantage patient each year. Although CMS does not penalize the member when the AWV information is not submitted annually, your PCP/Provider is reported as being non-compliant with patient care, which does affect our standing and reimbursement with CMS.” For that reason, the letter went on, “our office requires that all patients with Medicare/Medicare Advantage coverage undergo an AWV annually to continue to retain [the practice] as their Primary Care Physician (PCP).” Can they do that?

OIG offers advisory opinion on pharma coverage

02/03/2025

by: DecisionHealth staff

On Jan. 15, the OIG published an Advisory Opinion regarding a program that would provide free access to a pharmaceutical product to patients who meet financial and other eligibility criteria and who do not have adequate coverage for the product.

Favorable signs: Subsequent AWV payments stop the slide, denials fall

02/03/2025

by: Richard Scott

Professional payments for the oft-reported subsequent annual wellness visit (AWV) service took a favorable turn in 2023, as national reimbursement levels rebounded from a low point the year before. Overall, claims utilization has remained strong in recent years, and denials show a favorable trend as well.

Explain post-op add-on code with illustration, checklist, descriptor

01/27/2025

by: Julia Kyles, CPC

The treating provider at your practice may be eligible for a one-time additional payment when they provide post-operative care, effective Jan. 1, 2025.

Billing for e-visits proves tough climb; more training needed?

01/27/2025

by: Roy Edroso

If you conduct e-visits and have difficulty billing for them, you’re not alone: Recently released survey data from the Mayo Clinic in Rochester, Minn., shows that even when patients agreed to be charged for queries sent though a portal, only a tiny fraction of these asynchronous encounters were billed.

Can you report audio-only office E/M? Yes, but be very careful

01/27/2025

by: Julia Kyles, CPC

Treating providers can perform audio-only E/M visits via telephone for patients who are at home, regardless of their geographic location, thanks to the three-month telehealth extension.

Don’t be rash: Capture accurate ICD-10-CM dermatology coding

01/27/2025

by: Betty A. Hovey, BSHAM, CCS-P, CDIP, CPC, COC, CPMA, CPCD, CPB, CPC-I

ICD-10-CM coding is one part of the proper claims partnership. While CPT codes indicate to a payer what service was provided to the patient, the ICD-10-CM codes indicate why it was medically necessary.

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