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Tool of the Month
Make sure your physicians and qualified health care professionals (QHP) are ready for their crucial role in reporting G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment tool, 5-15 minutes, not more often than every 6 months).
Use this decision tree to illustrate Medicare’s rules for coding prolonged E/M services. Medicare created codes and rules for prolonged services performed by a physician or qualified health care professional (QHP) because it disagrees with portions of the CPT guidelines.
CMS and other federal agencies have opened up telehealth coverage policies during the COVID-19 public health emergency (PHE), while a series of virtual care options have come online in recent months.
Bring your staff up to date on the ICD-10-CM code changes that went into effect April 1.
DecisionHealth has revised its tool for office/other outpatient E/M visits (99202-99215) to include encounters performed in the inpatient or observation (99221-99223 and 99231-99236), emergency department (99281-99285), nursing facility (99304-99310) and home or residence (99341-99350) settings and consults (99242-99245 and 99252-99255).
Take a look at the new, revised and potentially misvalued services that CMS identified in the proposed 2023 Medicare physician fee schedule. The downloadable document (xls) provides current and projected work relative value units (RVU) for each service, allowing you to compare RVU changes between 2022 and 2023.
Observation-only E/M codes are slated for deletion as of Jan. 1, 2023. Part of the second phase of the E/M coding update folds observation codes into existing inpatient E/M codes and revises the inpatient codes’ descriptors. Use this crosswalk to train staff on the pending changes.
On Jan. 4, 2021, CMS updated the Part B conversion factor to $34.89, an increase of 8% over the previously finalized rate. The agency also revised total relative value units (RVU) for hundreds of services. Find the latest fees here.
Through the array of charts and data contained in this special report, you’ll find key characteristics of the medical practice professional working in ambulatory care settings today. From education and credentialing to emerging responsibilities and shifting practice trends, discover an illustrative look at the key personnel keeping medical practices going strong.
About 100 codes, including E/M office visits (99201-99215), are eligible for telehealth reporting under Medicare in 2020. In response to the COVID-19 pandemic, CMS will allow Medicare providers to deliver telehealth services without site-of-service restrictions.


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