April 17, 2019
Evaluation and Management Documentation Changes in 2019
by: Carol Hoppe
The Patients Over Paperwork initiative was
designed to “cut the red tape” and streamline administrative tasks placed on
physicians so they can focus on patient care. In the 2019 Final Rule, CMS has
agreed to:
·
Continue
using 1995 and/or 1997 guidelines;
·
Base the
level of services solely on medical decision making (MDM);
·
Choose the
level based on total time of the visit, not only when 50% is spent in
counseling and coordination of care;
·
Two new
bundled codes for Medicare that will combine levels 2 – 4, but only require the
documentation of a level 2 new or established patient visit.
Deciding which method to use will be a
challenge at first, but it will be important to use the method that results in
the highest reimbursement for the provider. If you need assistance conducting
an analysis on the impact to your revenue, please contact the Integrity
Health Strategies for assistance.
· Continue using 1995 and/or 1997 guidelines;
· Base the level of services solely on medical decision making (MDM);
· Choose the level based on total time of the visit, not only when 50% is spent in counseling and coordination of care;
· Two new bundled codes for Medicare that will combine levels 2 – 4, but only require the documentation of a level 2 new or established patient visit.
March 26, 2019
2019 CPT and HCPCS Changes
by: Carol Hoppe
New CPT® codes and telehealth HCPCS codes from CMS were effective 1/1/2019 and could be significant for you depending on your specialty. Here is a brief summary of just a few of the key changes you should be aware of as they may affect your practice. This is not an all-inclusive list, so please refer to the 2019 CPT®, HCPCS, and ICD-10 codebooks for a full description of the codes to ensure appropriate coding and reimbursement in 2019.
TWO NEW E/M TELEHEALTH CODES (99451 and 99452) are now available for written interpersonal telehealth communication between consulting and treating/requesting providers. Three codes (99453, 99454, 99457) were added for remote physiologic monitoring services.
NEW MEDICARE TELEHEALTH CODES
Two HCPCS add-on codes are for Prolonged preventive service(s) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (G0513) and each additional 30 minutes (G0514).These codes are billable with appropriate telehealth preventive services (available on the CMS website).
Medicare also added code G2012 for a “virtual check” – 5 to 10 minutes of medical discussion with the billing provider when an office visit is not deemed necessary. Code G0212 requires documentation of the patient’s verbal consent as well as the total time spent discussing the patient’s condition.
MODIFIER G0 was added for telehealth services furnished for diagnosis, evaluation, or treatment of symptoms of acute stroke.
INTEGUMENTARY SYSTEM – 16 NEW BIOPSY CODES
Codes 10022, 11100 and 11101 were deleted for fine needle aspiration (FNA) and skin biopsies. Code 10021 was revised to include “without imaging guidance”, while several new codes represent FNA biopsies with imaging.
The other sections of CPT® had various changes as new and advanced procedures made their way into CPT®. There are many new and revised codes in the Medicine section and Category III codes, including one new flu vaccine code, electroretinography services, developmental, psychological and neuropsychological testing just to name a few. Please refer to 2019 CPT® for a full description of all changes. If you have any questions about the new codes or need education for your practice on the changes, please contact Carol Hoppe at carol@medludicsolutions.com.
REFERENCESCPT© 2018 American Medical Association. All Rights Reserved. CPT® is a registered trademark of the American Medical Association.New Modifier for Expanding the Use of Telehealth for Individuals with Stroke MLN Matters Number: MM10883 Related CR Release Date: September 28, 2018 Related CR Transmittal Number: R2142OTN Related Change Request (CR) Number: 10883 Effective Date: January 1, 2019 Implementation Date: January 7, 2019
Medicare also added code G2012 for a “virtual check” – 5 to 10 minutes of medical discussion with the billing provider when an office visit is not deemed necessary. Code G0212 requires documentation of the patient’s verbal consent as well as the total time spent discussing the patient’s condition.
MODIFIER G0 was added for telehealth services furnished for diagnosis, evaluation, or treatment of symptoms of acute stroke.
Carol Hoppe, CPC, CCA-P, CPC-I
p: 317.819.7709
January 10, 2019
Are You Ready For 2019?
by: Carol Hoppe
It's hard to believe it's already January 2019. As we look at the year ahead, there are so many uncertainties in healthcare. It seems like changes are occurring faster than we can keep up with. Do you have a game plan for 2019?
- Are your providers ready for the changes in E/M documentation requirements being implemented by CMS?
- How will you address these changes with commercial payers?
- Are you performing and capturing all that can and should be billed for including Annual Wellness Visits, Transitional Care Management, and Chronic Care Management services, which are covered by Medicare and most commercial payers?
- Are you ready for the new CMS Targeted Probe and Educate (TPE) medical reviews focused on commonly found documentation and coding errors?
- Are you working with your providers on value-based reimbursement methodologies and the importance of accurate HCC-based diagnosis coding?
- E/M Coding Education
- E/M and Surgical Chart Reviews
- Physician Shadowing and Side by Side Training
- HCC Coding Education
- ICD-10 Training
- Payer Fee Schedule Analysis
- A/R Analysis
- Denial Management Solutions
- Payer Audits and Appeals
- Revenue Cycle and Efficiency Assessments
- Interim Onsite Project, Planning and Consulting Services
Please let me know if you have plans for E/M or specialty specific coding education and/or chart reviews in 2019, so we can plan accordingly and get you on our schedule.