Part B News
Settlements in Cardinal case a warning that ‘prebates’ are kickback traps
10/17/2022
by: Roy Edroso
A major anti-kickback case involving “prebates” on bulk specialty drug sales is leading to cash settlements with provider groups. It’s a reminder that even established vendors may offer you deals that aren’t strictly legal — and leave you holding the bag.
Emergency medicine groups: Prepare for a ‘once-in-a-generation change’
10/17/2022
by: Julia Kyles, CPC
Emergency medicine groups should be gearing up for the switch from the traditional coding and documentation guidelines for emergency department services (99281-99285) to the new CPT guidelines that will go into effect Jan. 1, 2023.
SCOTUS rejection suggests vaccine mandate will last into 2023, at least
10/17/2022
by: Roy Edroso
The Supreme Court turned away a challenge by 11 states to the HHS health care worker vaccine mandate, signaling that overturn of the staff vaccination requirement is now all but impossible, at least until the public health emergency (PHE) is over.
CDC fixes ICD-10-CM Table of Drugs code error
10/17/2022
by: Richard Scott
The CDC made a coding correction within the official ICD-10-CM Table of Drugs and Chemicals that was part of the FY2023 diagnosis coding update that took effect Oct. 1.
Office visits in ’21: Slight bounce back from the COVID-19 crash, denials stayed flat
10/17/2022
by: Julia Kyles, CPC
Visits in the office/other outpatient setting (99202-99215) started to recover from the COVID-19 slump in 2021 but they didn’t reach pre-2020 levels, according to a review of the latest Medicare Part B claims data.
4 tips to help coders determine the MDM level for E/M services
10/10/2022
by: Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I
In 2021, the elements used to determine E/M leveling for office or outpatient visits changed to primarily focus on medical decision-making (MDM) and time. Effective Jan. 1, 2023, the same formula applies to facility-based E/M services: history and exam will no longer be used to select the level of code for hospital inpatients, observation care visits, consultations, ED visits, and nursing facility services along with home, rest home and domiciliary services.
Implement 6 tips to manage telehealth compliance risks
10/10/2022
by: Julia Kyles, CPC
Your practice should check its telehealth claims against the information in the recent data brief on telehealth services, health care attorneys advise. The Sept. 2 report from the HHS Office of Inspector General (OIG), “Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks,” contains findings and program integrity measures for telehealth services.
2023 ICD-10-CM refresh: Review new codes for musculoskeletal, genitourinary conditions
10/10/2022
by: Savannah Schmidt
Effective Oct. 1, CMS updated the ICD-10-CM code set to include over 1,100 new codes, before counting revisions and deletions. The codes will further define and give specificity to newly categorized diseases and disorders. Ensure you are up to speed on new codes for musculoskeletal and genitourinary conditions, including muscle wasting, fractures, drug-induced neuropathy and endometriosis.
When the patient brings a drug and you inject? Largely OK; charge a penny
10/10/2022
by: Roy Edroso
Question: We have a patient whose testosterone therapy is ordered elsewhere and will be sent to us for injection. I’ve had it drilled into me that we never leave off the drug code when we bill administration, but we clearly can’t charge for the drug. How do we bill?
AMA releases CPT codes for COVID-19 bivalent booster vaccines
10/10/2022
by: Savannah Schmidt
On Aug. 31, the AMA announced eight new CPT codes for bivalent COVID-19 vaccine booster doses. The vaccine boosters are designed to combat both the original COVID-19 strain and omicron subvariants BA.4 and BA.5. Of the eight new CPT codes, four are to be used for Moderna booster vaccines and four are to be used for Pfizer-BioNTech boosters.
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