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Home BP readings for ‘white coat hypertension’? OK, but probably not RPM.

10/28/2024

Question: I have a patient who claims “white coat hypertension” — that is, he says his home blood pressure readings are significantly lower than the ones we get in the office. He has a home BP device, a Pressure X Pro, that connects to the internet. Can I take a reading via this device? And, in addition to adding it compliantly to encounter notes, can I claim 99091 (Collection and interpretation of physiologic data [eg, ECG, blood pressure, glucose monitoring])?

When coding eating disorders, start with initial visit, include all services

10/28/2024

by: Son Hoang

Question: What codes should a coder consider for a patient diagnosed with an eating disorder (e.g., anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder)?

HHS issues RFI for Part D ‘$2 drugs’ on some widely-used prescriptions

10/28/2024

by: Roy Edroso

Adding to its other pioneering prescription drug programs under Medicare, the Biden administration announced Oct. 9 that it would issue a request for information (RFI) on a potential “Medicare $2 Drug List Model” that would make some much-used drugs for hypertension, high cholesterol and other common conditions available to Part D beneficiaries for a couple of bucks.

Modifier 25, highly used, tops $4B in associated payments

10/28/2024

by: Julia Kyles, CPC

Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) continues to see high utilization. Providers reported it on more than 65 million claims in 2023.

Discover guideline revisions, 400+ code changes in 2025 CPT update

10/21/2024

by: Laura Evans, CPC, Julia Kyles, CPC, and Richard Scott

Get ready to dig into more than 400 code changes as part of the 2025 CPT code set. That includes 270 new codes, including dozens of surgical codes, as well as 112 deletions and 38 revisions.

MA plans lose stars, customers; will they also lose their enrollment lift?

10/21/2024

by: Roy Edroso

A big drop in the star ratings for Medicare Advantage plans is just the latest in a series of recent challenges to the public-private coverage program. MA enrollments are increasingly up and set to outstrip traditional Medicare, but challenges like this one are increasingly noisy. While this doesn’t mean the program will reverse course, some payers already are making big changes to cope.

Share details, 6 tips on the 16 new telemedicine E/M codes

10/21/2024

by: Julia Kyles, CPC

Take in the details of the 16 new telemedicine codes for real-time encounters in the CPT 2025 manual while you wait to see whether private payers adopt the services or CMS sways from proposed non-coverage of the codes.

RPM, RTM codes on the rise, denials down; but warning signs flash

10/21/2024

by: Roy Edroso

The 2023 Medicare utilization numbers for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) are in, and the results show all of them up from the previous year, with some services rising sharply.

AMGA warns of service, staff cuts if 2.8% CF cut sticks; few alternatives seen

10/14/2024

by: Roy Edroso

A major medical group association sounds the alarm on the effect of impending Medicare cuts on physician practices, and experts agree that, if Congress doesn’t act, the alternatives are either longer hours for providers or cuts in staff and services. Yet there are options you can try to partly stanch the financial bleeding.

CMS adds more counseling, screening services to new HIV PrEP benefit

10/14/2024

by: Julia Kyles, CPC

Medicare patients who qualify for the new preventive service designed to protect them from the human immunodeficiency virus (HIV) will be eligible for up to eight counselling and screening services a year, according to the final version of the Preexposure Prophylaxis (PrEP) Using Antiretroviral Therapy to Prevent HIV Infection determination.

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