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Virtual incident-to is an option through 2023

10/31/2022

Physicians can provide virtual direct supervision thanks to one of the many waivers that CMS created in response to the COVID-19 pandemic. Virtual direct supervision gives the practice more flexibility to bill incident-to services, but it is not a permanent policy.

Check state scope laws on who may debride mycotic nails

10/31/2022

by: Laura Evans, CPC

Question: I would like clarification on whether only MDs, DPMs, APRNs or PAs are allowed to perform and bill Medicare for debridement of mycotic nails (codes 11720 and 11721) in the office setting, when all the other criteria for the procedures have been met. Recently, I have been asked about a nail technician or medical assistant performing these procedures under supervision of a MD or DPM and billing the services to Medicare as incident to. I have found no information to suggest that this is appropriate. Am I correct in stating that nail technicians or medical assistants are not qualified to perform this service?

CMS releases deductible, premium rates for CY2023

10/31/2022

by: Richard Scott

On Oct. 13, CMS published 2023 rates for Medicare Part B premiums and deductibles, and beneficiaries will see a slight decrease in out-of-pocket costs compared to current-year rates. The 2023 Part B deductible will be $226.00, a modest decrease from the revised 2022 amount of $233.00.

After emergency medicine, PCPs and surgeons take over ER

10/31/2022

by: Julia Kyles, CPC

Thanks to popular media, the public may think that physicians and nurses who specialize in emergency medicine are the only providers who work in the emergency department. But the latest Medicare Part B data for emergency department E/M visits (99281-99285) reveals that members of any specialty can and do provide emergency department services.

For E/M visits, remind providers they can rein in the review of systems

10/24/2022

by: Julia Kyles, CPC

Taking history and physical exams out of the calculations for level-based E/M services was on the wish lists of CMS and health care leaders for several years. That wish started to come true in 2021, the first year that office/other outpatient visits (99202-99215) were coded based on medical decision-making (MDM) or time.

Not fine: Jail threat in compounded drug HIPAA breach serves warning

10/24/2022

by: Roy Edroso

A doctor faces a year in prison on HIPAA violation charges — a rare but real threat when prosecutors find providers or other health care workers flouting protected health information (PHI) rules in a way that calls for more than the usual fines and sanctions.

Look for severity of dementia to discern ICD-10-CM code selection

10/24/2022

by: Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I

Coders must review updates to the ICD-10-CM code set to stay current, and for 2023 you will find several new codes in the “Mental, Behavioral, and Neurodevelopmental Disorders” chapter for dementia.

‘After-hours’ codes can add dollars, and so can ‘during-hours’ codes

10/24/2022

by: Roy Edroso

Question: One of our commercial payers offers extra payment from the add-on codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [eg, holidays, Saturday or Sunday], in addition to basic service) and 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service). I get the first code, but the second one just sounds like normal service during normal hours. What’s the deal?

Heaps of ‘after-hours’ codes reported, and all denied

10/24/2022

by: Richard Scott

Despite a non-payable status under Medicare, a series of six codes that reflect care provided during irregular or emergency hours garnered hundreds of thousands of claims – and returned zero dollars – in 2021.

CY2023 CPT update ushers in 200-plus new codes

10/17/2022

by: DecisionHealth Staff

Practices can expect nearly 400 code changes in their CPT manuals for 2023, including 224 new codes, 93 revised and 74 deleted codes.

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