Part B News
Doc to doc: Use of interprofessional consults surged in 2020
05/16/2022
by: Julia Kyles, CPC
The 2020 proliferation in communications-based services extended beyond patient encounters, as physicians increasingly consulted with one another via phone, internet or other electronic channels.
For patient notes, copy and paste with care to keep MDM on the level
05/09/2022
by: Julia Kyles, CPC
Set the record straight if your treating practitioners interpreted the guidelines for office E/M visits (99202-99215) as permission to use boilerplate or cloning to justify a higher code. Two recent CPT Assistant articles make it clear that cloning and coding based on medical decision-making (MDM) don’t mix.
Evolving ‘equity’ push by CMS signals a new front for providers
05/09/2022
by: Roy Edroso
A flurry of new proposals from HHS and CMS centered around “health equity” suggests that federal agencies may soon require providers to perform equity-related tasks, and experts believe data collection is likely to be the first attainable goal.
Watch federal ‘network adequacy’ standards for ACA plans
05/09/2022
by: Richard Scott
On April 28, CMS released the 2023 Notice of Benefits and Payment Parameters Final Rule, which issued new provisions for health plans operating on the federally-facilitated marketplace (FFM). The rule may serve to buoy access to physician providers, but in the longer term it could also have implications on your patient intake policies.
Unpack CPT coding for implant and foreign body removals
05/09/2022
by: Sarah Gould
When coding for removal or insertion, it’s imperative to understand the difference between a foreign body and an implant, and coders must be familiar with new CPT definitions for implants and foreign bodies that went into effect Jan. 1.
No time limit on incident-to billing if problems are unchanged
05/09/2022
by: Richard Scott
Question: I read your recent article about incident-to billing. One of my practitioners has a question I am unable to answer. Is there a time limit on what is considered a new problem? For example, if a patient is not treated for a particular problem in over a year, is it now considered a new problem? Please advise.
Hospital code use took double-digit hit in 2020, but denials stayed light
05/09/2022
by: Roy Edroso
Like many other services, hospital inpatient and observation numbers took a hit in the first pandemic year of 2020. But providers performed better in getting their claims accepted than before.
CMS adds flexibilities to final Aduhelm NCD, but usage could be rare
05/02/2022
by: Roy Edroso
CMS’ final national coverage determination (NCD) on the Alzheimer’s drug Aduhelm may provide a clearer path to use, but critics warn the way CMS handled the approval issues could presage problems with other big-ticket drug decisions down the line.
ABN guide: How to apply HCPCS modifiers for non-covered services
05/02/2022
by: Sarah Gould, CPC
When you know a service will not be covered under Medicare, you are required to issue an advance beneficiary notice of non-coverage (ABN). Sharpen your modifier know-how so that you can accurately report claims when an ABN is involved.
T is for telephone: Appendix T lists 38 audio-only CPT codes
05/02/2022
by: Julia Kyles, CPC
You won’t find the new appendix for audio-only services in the print version of your CPT manual until the 2023 edition. But Appendix T (CPT codes that may be used for synchronous real-time interactive audio-only telemedicine services) went into effect April 1 and was added to the electronic version of the CPT manual in March.
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