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Is mental telehealth a dealbreaker? If so, refer or strengthen your approach

05/23/2022

Question: At our practice, the primary care providers (PCP) are aware of the mental health services we can conduct via telehealth during the COVID-19 public health emergency (PHE). But some of us worry that, between our lack of psychiatric credentials and the added difficulty of delivering these services via video or phone, we may be short-changing our patients. Should we be referring these patients to dedicated mental health providers instead?

Refer to AMA guidelines, not Medicare, for approved RTM billing

05/23/2022

by: Laura Evans CPC

Question: We have a provider who is performing knee implants that will allow him to bill for the remote therapeutic monitoring (RTM) codes (98980 and 98981). The vendor is telling us that clinical staff can perform these services based on coding information they found online, but a recent CPT Assistant seems to be saying that a physician or qualified health care practitioner (QHP) must personally perform those services and that they can’t be billed by clinical staff. I am not sure how to proceed.

OIG: N.Y. provider received $1.1M in psychotherapy overpayments

05/23/2022

by: Sarah Gould

A New York City provider received an estimated $1.1 million in Medicare overpayments for behavioral health services that did not comply with billing requirements, according to a recent Office of Inspector General (OIG) report.

Pandemic sharpened decrease in psychiatric evaluation rates

05/23/2022

by: Richard Scott

Despite their addition to the audio-only services list during the COVID-19 public health emergency (PHE), a series of psychiatric evaluation codes took a significant dip in 2020 when the pandemic suppressed claims across the board.

Prepare and monitor: Take extra steps when the patient’s a medical tourist

05/16/2022

by: Roy Edroso

If your patient is getting medical treatment abroad, ensure they’re aware of the risks and counsel them on precautions. If they go without your knowledge, do your best to get the facts on their treatment.

You can fold procedures into time-based office visits, but don’t double dip

05/16/2022

by: Julia Kyles, CPC

You can include procedure time when you report time-based E/M office visits (99202-99205, 99212-99215), but your practice should have a policy for documenting and coding these types of combination encounters.

Did your practice get burned online? Reach out — and redirect

05/16/2022

by: Roy Edroso

When you confront negative reviews of your providers or your practice on review sites, managing a strategic response can be a net plus. Instead of hurling responses online, set up a strategy that involves direct patient outreach and an invitation to share positive news.

The risk of a critical illness does not justify critical care coding

05/16/2022

by: Julia Kyles, CPC

Remind your providers and coders to reserve critical care codes (99291-99292) for the treatment of patients who are currently critically ill. The risk or expectation that a patient will need critical care services during a hospital stay does not meet the definition for the time-based, high-intensity and high-revenue service.

When audit, discipline are not enough, report defrauding providers

05/16/2022

by: Roy Edroso

A recent case of false claims caught in an internal audit — but not reported to authorities — proved costly to both a provider and his employer. The case offers a clear reminder that not every provider audit should remain an internal affair.

Count bilateral facet RFA as one session during 12-month period

05/16/2022

by: Julia Kyles, CPC

Question: We’re having a debate at our practice about frequency limits for paravertebral facet joint denervation (64633-64636). We all understand that a practice can bill two radiofrequency ablations (RFA) for one spinal region in a rolling 12-month period. But we disagree on one main point. Can you tell us who is right?

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