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Navigate billing differences for coming principal care management codes

11/08/2021

Principal care management (PCM) may be more attractive to practices than traditional care management in 2022. The transition from temporary HCPCS codes to permanent CPT codes (99424-99427) includes new add-on codes that will allow practices to increase the revenue they receive for this service.

Audit, monitor, train: Stay compliant as OIG spotlights modifier 25

11/08/2021

by: Joe Rivet

Pay attention to your billing of E/M services and a minor procedure at the same encounter, because federal auditors are taking notice. In April, the Office of Inspector General (OIG) added a new item to its Work Plan titled “Dermatologist Claims for Evaluation and Management (E/M) Services on the Same Day as a Minor Surgical Procedure.” Despite the title, the application and overall concern about this concept is much broader than dermatology.

Patients asking for vaccine exemptions? Stick to medical facts

11/08/2021

by: Roy Edroso

Question: We have had some patients calling for an appointment to “get a COVID vaccine exemption.” They seem to have jobs that mandate their vaccination. Do we need to tell our doctors anything? Should we prepare some kind of form?

It’s official: New epidural policies will go live before the year ends

11/08/2021

by: Julia Kyles, CPC

Practices that perform intralaminar and transforaminal epidural injections to manage chronic pain should add “Implement the new local coverage determination (LCD)” to their to-do list.

Monitor revised CPT codes that take changing descriptors in 2022

11/08/2021

by: Richard Scott

Get ready to sharpen your claims billing when the calendar flips to 2022 by adapting to a slate of CPT code revisions. Of the hundreds of CPT code changes taking effect Jan. 1, you’ll find 93 revised codes, many of which are impacting oft-reported services.

Paying a hacking ransom could bring trouble; take steps to stay safe

11/01/2021

by: Roy Edroso

Can you get in trouble for paying off a ransomware crook? It’s not out of the question, but you can reduce your chances if you follow a sound protocol before attempting to pay. Also be sure to emplace necessary safeguards before you get attacked.

Latest COVID-19 PHE extension activates Category 3 telehealth provision

11/01/2021

by: Julia Kyles, CPC

The COVID-19 public health emergency (PHE) will not end before Jan. 16, 2022, thanks to the renewal of the PHE that went into effect Oct. 18. Make sure your practice understands what the extension does — and does not — mean for telehealth services.

With code switch coming, refresh your principal care management approach

11/01/2021

by: Julia Kyles, CPC

Take a fresh look at principal care management (PCM) services, even if your practice currently reports them using HCPCS codes G2064 or G2065. Four new PCM codes that take effect Jan. 1, 2022 — the series of CPT codes 99424-99427 — will replace the HCPCS series and bring additional reimbursement opportunities. They also will carry over current restrictions.

Status check: Report correct E/M codes for observation services

11/01/2021

by: Joe Rivet

As the status of a patient can change during the course of a patient stay, it can be difficult for providers and coders to accurately code for observation services. Get the basics down to file your observation claims successfully.

OIG review sets guideposts, possibly, for the future of telehealth

11/01/2021

by: Richard Scott

Most virtual encounters during the COVID-induced telehealth spike involved patients who had an established relationship with a provider, and that detail may influence federal policymaking on the future coverage of tech-enabled visits, according to an OIG analysis released Oct. 20.

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