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PCP notification, not permission, is required for extended ESI treatments

06/12/2023

Question: We were told that we need to contact the patient’s primary care provider (PCP) before we perform epidural steroid injections (ESI) for Medicare patients. It’s hard to get the PCPs’ authorization for the injections. Where can we find proof that we need a PCP’s permission?

CMS releases HCPCS Level II codes for new products, live July 1

06/12/2023

by: Savannah Schmidt

CMS published its first quarter 2023 HCPCS Application Summaries and Coding Recommendations as part of its April 27 publication of MLN Connects.

After changes, FNA with ultrasound, tangential biopsy dominated

06/12/2023

by: Julia Kyles, CPC

The codes for fine needle aspiration (FNA) and biopsy of skin lesions received a major update in the 2019 CPT manual. The update revised FNA code 10021 to become a primary code for a new add-on code and replaced three outgoing codes with 16 new codes.

With the 3-day SNF rule back, look to build alliances to stay compliant

06/05/2023

by: Roy Edroso

Encouraging results from the use of waivers to the Medicare three-day skilled nursing facility (SNF) rule have prominent health care authorities, including some within the federal health care bureaucracy, challenging the rule’s necessity. But the rule is probably not going away soon, so providers whose patients make heavy use of skilled nursing should consider alliances that will exempt them for it.

Consider updating enrollment, weigh security risks if you offer telehealth from home

06/05/2023

by: Julia Kyles, CPC

Practitioners who perform telehealth from home (TFH) must update their enrollment before the end of the year. The COVID-19 public health emergency (PHE) waiver that allows physicians and non-physician practitioners (NPP) to bill for TFH under the practice’s address will expire Dec. 31, 2023.

Crack the modifier 25 code: Clear confusion, review scenarios

06/05/2023

by: Courtney Crozier, MA, RHIA, CCS, CDIP

The AMA published additional guidance for modifier 25 (Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service) in its recent publication of CPT Assistant, released March 2023.

Sanctions vs. COVID non-compliant docs don’t automatically lift with end of PHE

06/05/2023

by: Roy Edroso

Question: One of our former physicians had his license pulled for passing “COVID misinformation” during the public health emergency (PHE). Now that the PHE is over, what are his chances of getting his license back?

CMS launches application period for ’24 Shared Savings ACO program

06/05/2023

by: Richard Scott

Mark your calendar if you’re interested in entering a value-based care arrangement through the Medicare Shared Savings Program, the federal government's largest accountable care organization (ACO) network. The deadline to apply for 2024 is June 15.

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

06/05/2023

by: Roy Edroso

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.

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