Part B News
Observation code crosswalk 2022 to 2023
07/18/2022
by: Julia Kyles, CPC
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.
Proposed PFS chops fees 4%, approves E/M remake, previews code changes
07/18/2022
by: DecisionHealth Staff
Payment cuts are in the offing for Part B providers in 2023, along with a series of other projected changes targeting E/M services, COVID-related billing flexibilities and value-based care, according to the proposed 2023 Medicare physician fee schedule released July 7.
Navigate new combo observation/inpatient codes, more 2023 changes
07/18/2022
by: Julia Kyles, CPC
Juggling codes for observation and inpatient hospital services will soon be a thing of the past. The Jan. 1, 2023, update will shift facility visits, consults and home-based visits to a coding model based on medical decision-making (MDM) or time.
After abortion ruling, watch cross-border jurisdiction issues
07/18/2022
by: Roy Edroso
The legal consequences for providers and patients affected by the overturn of Roe v. Wade by the Supreme Court are still evolving, but experts warn that if those patients are in one of 10 states where abortion care is substantially illegal — even if the provider is not — doing more than consulting on the procedure can put providers in the crosshairs of state medical boards and law enforcement.
2023 E/M update will impact a range of high-volume codes
07/18/2022
by: Julia Kyles, CPC
The next E/M update will affect 69 codes from five code families and will go live in less than six months. Part B News analysis of Medicare Part B claims for 2019 and 2020 reveals that frequently billed E/M services in three of the impacted code families — inpatient hospital, emergency department and nursing facility services — exceeded several office/other outpatient codes.
After Meta pixel HIPAA gaffe, check your online business associate agreements
07/11/2022
by: Roy Edroso
An expose caught major health systems kicking patient data to Meta, Facebook’s parent company, via their online appointment page. The exposure of patient data may have you wondering: Are my online services doing the same thing and, if they are, are my business associate agreements (BAA) protecting me?
AMA unveils anticipated E/M changes for facility-based services
07/11/2022
by: DecisionHealth Staff
The AMA set off its own fireworks during the Independence Day weekend with the early release of new E/M guidelines that will be included in the 2023 CPT manual and take effect Jan. 1, 2023.
OIG finds PBDs overpaid for E/M services; CMS disinclined to act
07/11/2022
by: Roy Edroso
OIG has found, through extrapolated data, that provider-based departments (PBD) in hospitals that bill outpatient E/M encounters are getting more generous reimbursement than freestanding clinic providers who perform them. But it appears the chances that anything will be done about it anytime soon are slim.
Deconstruct ICD-10-CM guidelines for selecting a primary diagnosis code
07/11/2022
by: Holly Cassano, CPC, CRC
From my experience of over 25 years in the industry, I’ve noticed that one of the most challenging aspects of documentation review is accurate identification of a primary diagnosis. The primary diagnosis describes the most time-consuming or resource-intensive problem during an encounter.
In 2020, modifier 78 use less frequent, and much less successful
07/11/2022
by: Roy Edroso
Use of modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) has been in decline for some time. In 2020, as COVID depressed utilization across the board, 78’s claim numbers continued to decline — while its denial rates soared.
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