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Congress expected to reduce some, but not all, provider cuts

12/05/2022

With Congress working on its usual year-end fiscal legislation, experts think the 8.5% in pay cuts that providers face in 2023 will be pared back by year’s end — but they don’t expect a blanket pardon.

MDM in focus: CPT changes simplify complexity of problem addressed

12/05/2022

by: Julia Kyles, CPC

Look beyond the big shifts that are in store for level-based E/M services. The new CPT guidelines revised the number and complexity of problems addressed section and the changes apply to all level-based E/M visits. Peter Hollman, M.D., co-chair of the AMA E/M workgroup, dug into the details of the update on Nov. 16, the first day of the 2023 CPT and RBRVS Symposium.

Providers respond sharply to No Surprises RFI, but reforms may be limited

12/05/2022

by: Roy Edroso

Health care industry groups have responded forcefully to CMS’ and its fellow Departments’ request for information (RFI) on the No Surprises Act (NSA) rules, hoping the agency will ease off on some of the requirements that providers find most troublesome, as well as enforcement discretion that is scheduled to end on Jan. 1. But so far there have been no guarantees.

Give coders a chart, not a calculator to find new prolonged threshold times

12/05/2022

by: Julia Kyles, CPC

Question: We are trying to understand the time requirements for G0316, G0317 and G0318. We thought CMS added an extra 15 minutes to the threshold times listed in the new CPT guidelines.

Know how to report a hypertensive crisis in ICD-10-CM

12/05/2022

by: Savannah Schmidt

Question: What is a hypertensive crisis and how is it reported in ICD-10-CM?

With one exception, selected codes take big hit in 2023

12/05/2022

by: Roy Edroso

When Part B News looked at the “Impact on CY 2022 payment for selected procedures” that came with the physician fee schedule last year, there was not a single rate gainer among the 23 codes with non-facility rates. Flash forward to that list for 2023, and you’ll find that – with one significant exception – the situation is even worse.

Prepare for debut of chronic pain management services, billing rules

11/21/2022

by: Julia Kyles, CPC, and Roy Edroso

Take note of a new billing opportunity if your Medicare patients suffer from chronic pain. Medicare finalized a care management service for chronic pain management (CPM), and type of specialty isn’t a barrier to reporting it. The agency stressed that the CPM services can be reported by a wide range of providers, including primary care practitioners, according to the final 2023 Medicare physician fee schedule. The services take effect Jan. 1.

CMS adds 151 days to telehealth waivers – but that’s it

11/21/2022

by: Roy Edroso

In the 2023 Physician Fee Schedule final rule, CMS has pulled the last ace for providers who have come to rely on the hundreds of service codes that have been authorized for telehealth payment outside the usual telehealth rules since 2020: It has authorized a 151-day extension of those codes from the last day of the COVID-19 public health emergency (PHE).

CMS nixes G codes for RTM services, will allow general supervision

11/21/2022

by: Laura Evans, CPC

In an apparent about-face, CMS has decided not to adopt four HCPCS codes the agency had proposed to cover in place of remote therapeutic monitoring (RTM) treatment management services CPT codes 98980 and 98981. Instead, the agency established a new policy stating that “any RTM service may be furnished under our general supervision requirements,” according to the final 2023 physician fee schedule.

Medicare opens care management services to psychologists, social workers

11/21/2022

by: Roy Edroso

To complement the existing general behavioral health intervention (BHI) code 99484, CMS is authorizing service codes for use by clinical psychologists (CP) and clinical social workers (CSW).

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