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Consider updating enrollment, weigh security risks if you offer telehealth from home

06/05/2023

Practitioners who perform telehealth from home (TFH) must update their enrollment before the end of the year. The COVID-19 public health emergency (PHE) waiver that allows physicians and non-physician practitioners (NPP) to bill for TFH under the practice’s address will expire Dec. 31, 2023.

Crack the modifier 25 code: Clear confusion, review scenarios

06/05/2023

by: Courtney Crozier, MA, RHIA, CCS, CDIP

The AMA published additional guidance for modifier 25 (Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service) in its recent publication of CPT Assistant, released March 2023.

Sanctions vs. COVID non-compliant docs don’t automatically lift with end of PHE

06/05/2023

by: Roy Edroso

Question: One of our former physicians had his license pulled for passing “COVID misinformation” during the public health emergency (PHE). Now that the PHE is over, what are his chances of getting his license back?

CMS launches application period for ’24 Shared Savings ACO program

06/05/2023

by: Richard Scott

Mark your calendar if you’re interested in entering a value-based care arrangement through the Medicare Shared Savings Program, the federal government's largest accountable care organization (ACO) network. The deadline to apply for 2024 is June 15.

Pandemic cut most nursing facility E/M, but 99309 looks strong

06/05/2023

by: Roy Edroso

Notwithstanding the pandemic waivers of the three-day rule, nursing facility E/M and discharge codes, used by skilled nursing facilities, mostly took a hit during the public health emergency (PHE). As noted by the Kaiser Family Foundation, there was a decline in SNF admissions during that period, though the length of SNF stays and spending increased.

DEA extends telehealth prescription waivers, puts proposed rules on hold

05/22/2023

by: Julia Kyles, CPC

Advocacy groups, specialty societies and medical providers praised the extension of waivers that allow practices to prescribe controlled substances via telehealth. The extension will run until Nov. 11, 2024, if a patient establishes a telehealth relationship with a provider by Nov. 11, 2023.

As masks go away, you can keep them in your practice — if you watch the law

05/22/2023

by: Roy Edroso

The PHE is over and only a few states still have a mask mandate for health care facilities. But if you want to continue to require masking at your practice, experts say you can do it — even if patients and staff object — except in certain circumstances.

After correction, review the rules for counting a test interpretation toward MDM

05/22/2023

by: Julia Kyles, CPC

Your providers can get credit for both the order and the interpretation of a test thanks to technical correction issued by the AMA on March 1. You will promote proper coding based on medical decision-making (MDM) if you make sure your team understands that the update did not change the guidelines for calculating the number of tests that the treating provider ordered, reviewed or interpreted.

Records request: Stay compliant with patients’ right of access

05/22/2023

by: Dom Nicastro

The Office for Civil Rights (OCR) reached another resolution in January during its ongoing effort to ensure the comprehensive enforcement of the HIPAA Privacy Rule’s right of access provision. To provide more context behind this important topic, Elizabeth Delahoussaye, RHIA, CHPS, chief privacy officer for Ciox Health, which provides health care data management solutions, answers a series of questions about right of access rules and policies.

You can bill 2-hour esketamine code with therapy, and with prolonged codes

05/22/2023

by: Roy Edroso

Question: Our psychiatric provider will administer Spravato (esketamine) to a patient. I know there are codes for this: G2082 (Office E/M, established patient, w/provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation) and G2083 (... ; greater than 56 mg esketamine). But could we use other E/M codes with prolonged services instead? Also, psychotherapy may be performed prior to giving the medication — can we bill that? And should we report the drug separately?

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