Jan 15, 2020 | Uncategorized
Last week, we briefly described the X modifier series and when to substitute these new modifiers. Below are a few scenarios from the NCCI policy manual you can refer to when using these modifiers.*n
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- The CCI bundle involving column 1 code 45385 (Flexible colonoscopy with removal of tumor[s], polyp[s], or lesion[s] by snare technique) and column 2 code 45380 (Flexible colonoscopy with single or multiple biopsies) with one of the four X modifiers. However, note the exact CCI guidance: “The use of modifier XS is only appropriate if the two procedures are performed on separate lesions. Use of modifier XE is only appropriate if the two procedures are performed at separate patient encounters. The documentation shall not be reported with a code for the same lesion”.
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- Generally, providers shall not report more than one physical medicine and rehabilitation therapy service for the same 15-minute time period. You’ll find that some CCI edits pair a timed CPT code with another timed, or non-timed, CPT. These edits can be bypassed “with modifier 59 or XU if the two procedures of a code pair edit are performed in different timed intervals even if sequential during the same patient encounter”.
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- The primary graft and skin substitute codes are mutually exclusive since only one type of graft or skin substitute can be used at a single anatomic site. If multiple sites require different types of grafts, use modifier XS to indicate the different sites.
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- You should not report HCPCS code J3471 (Injection, hyaluronidase, ovine, preservative-free, per 1 USP unit [up to 999 units]) with more than 999 units of service (UOS). If you report more than 999 units of the product described by J3471, you “may report HCPCS code J3471 on more than one line of a claim appending modifier XU to additional claim lines and should report no more than 999 UOS on any one claim line”.
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- You can report a diagnostic procedure in cases where the procedure’s findings necessitate a therapeutic response. “A diagnostic procedure is performed on a 60-year-old male complaining of chest pains. Due to the findings, a physician’s decision is then made to perform a therapeutic/surgical procedure. When the diagnostic cardiac angiography leads to a therapeutic angioplasty, use XU as the modifier.”
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n*As with all code reporting, be sure to check with individual payers on their policy regarding the X modifier series.
Jan 10, 2020 | Uncategorized
Welter Healthcare Partners is sharing the new 2020 CPT coding updates! Below you will find the new CPT codes that took effect on January 1st. Read below for more on these updates. Please note that this article is not an all-inclusive list of the updates. Be sure to review the CPT 2020 book for the complete descriptions of the changes.nnn2020 CPT Coding Updates nnWritten By: Ginger Avery, CPC, CPMA, CRC Coding & Compliance Manager nnIt’s that time of the year again! The new CPT®2020 code changes take effect January 1st and are based on input from clinicians, medical societies and the greater health care community. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2020 address a number of interrelated issues. Clinical practice and technology have evolved and several issues required much needed CPT expansion and clarification. CPT®2020 offers changes that affect nearly every specialty.nn*Please note, this article is not an all-inclusive list; review your CPT®2020 book for complete descriptions of all changes. Appendix B on page 816 of AMA’s CPT®2020 provides a summary of additions, deletions, and revisions. Watch for green text throughout the codebook for new information! nnThe American Medical Association’s (AMA’s) 2020 update of the CPT code set comprises 394 code changes, including 248 new codes, 71 deletions, and 75 revisions. Aside from anesthesia, all sections of CPT received changes in codes and guidelines.nnHighlights of the most significant changes are as follows: nnIntroduction Changes (see CPT®2020 pg xvi): n
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- Code Symbols update: “…even though the PLA section is located at the end of the pathology and laboratory section of the codes set, a PLA code does not fulfill Category I code criteria.”
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- Add-on Codes concept updated: “…when the add-on procedure can be reported bilaterally and is performed bilaterally, the appropriate add-on code is reported twice…Do not report modifier 50 in conjunction with add-on codes…See the definitions of modifier 50 and 51 in Appendix A.”
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nChanges to the Appendices (see CPT®2020 Pg 809) nnAppendix A: Modifiersn
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- Modifier 50: This modifier should not be appended to designated “add-on” codes (see Appendix D). If an additional or supplemental procedure is performed bilaterally, report the add-on code twice using the RT and LT modifiers to indicate laterality, rather than modifier 50.
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- Modifier 63: Should not be appended to any CPT codes listed in the Evaluation and Management Services, revised to include medicine section codes that can be reported.
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nAppendix E: CPT Codes Exempt from Modifier 51nnUpdated list of CPT codes exempt from modifier 51nnEvaluation and Management Changes (see CPT®2020 pg 38-56) n
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- Preventive
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- Do not report HBAI’s with Behavior Change Interventions
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- Non-Face-to-Face Services
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- Telephone Services (99441-99443)
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- Remote Physiologic Monitoring Treatment Management Services (99457-99458) was revised to be time-based.
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- E-visits: Six new CPT codes for reporting a range of digital health services including e-visits through secure patient portal messages.
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- Time-based codes 99421, 99422 and 99423 have been created to describe patient-initiated digital communications with a physician or other qualified health professional
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- 98970, 98971 and 98972 represent patient-initiated digital communications with a nonphysician health professional
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- New codes 99473 and 99474 allow reporting self-measured blood pressure monitoring (pg 42).
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- CPT 99473 is used to report patient education, setup, and device calibration.
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- To report 99474, a minimum of 12 recordings must be reviewed, and the provider must render an interpretation that includes average systolic and diastolic pressures and communication with the patient on the treatment plan.
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- Chronic Care Management (CCM) guideline update.
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- Transitional Care Management (TCM) guideline update.
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nSurgery Section Updates nnIntegumentaryn
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- The guidelines for intermediate and complex repairs (12031 – 13160) have been revised to provide a clearer description of what is required for undermining. Intermediate repairs include limited undermining, CPT describes as “a distance less than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect.” Complex repairs include extensive undermining, CPT describes as “a distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect.”
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- New guidelines are also added in each of the subsections for breast procedures (19000 – 19303). An extensive review of these subsections is required. In addition, code 19304 is deleted due to low utilization. Parenthetical notes are added to direct you to the correct codes for this service.
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- New autologous grafting codes have been created. Code 15769 is reported for soft tissue harvested by direct excision. Codes for the harvesting of fat by liposuction are reported based on anatomic site and amount of fat removed. Harvesting codes are reported by the recipient site of the graft, not the donor site.
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- Codes 15771 and +15772 are reported for fat harvested via liposuction for defects of the trunk, breasts, scalp, arms, and/or legs. Code 15771 includes 50 ccs or less, and +15772 is an add-on code for each additional 50 ccs or part thereof.
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- Codes 15773 and +15774 are reported for fat harvested via liposuction for defects of the face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet. Code 15773 includes 25 ccs or less, and +15774 is an add-on code for each additional 25 ccs or part thereof.
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- Codes for the excision for chest wall tumors (19260, 19271, 19272) are deleted and replaced with new codes in the Musculoskeletal System section (21601, 21602, 21603).
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nMusculoskeletal System nnNew codes have been created to report needle insertion into a muscle(s) without injection. Code 20560 is reported for one to two muscles, and 20561 is reported for three or more muscles.nnSix new add-on codes (20700-20705) are now available to report the manual preparation and insertion of drug delivery devices and the removal of the devices. The manual preparation includes the mixing of agents and placing them on the delivery device such as nails, beads, or spacers. Parenthetical notes are included to indicate the primary codes with which the add-on codes can be reported.nnRespiratory Nine nasal/sinus endoscopy codes (31233, 31235, 31292, 91293, 31294, 31295, 31296, 31297, and 31298) are revised. Parenthetical notes have been added for more consistent code descriptors and to clarify use.nnCardiovascular n
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- Codes for pericardiocentesis (33010, 33011, 33015) are deleted and replaced with new codes. Pericardiocentesis is no longer coded based on initial or subsequent service. There is now one code for pericardiocentesis (33016), which includes imaging guidance when performed; and there are three new pericardial drainage codes:n
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- 33017 is for pericardial drainage with the insertion of an indwelling catheter on patients 6 years and older. The procedure includes fluoroscopy or ultrasound guidance when performed.
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- 33018 is for pericardial drainage with the insertion of an indwelling catheter on patients 5 years old and under, or patients of any age with a cardiac anomaly. The procedure includes fluoroscopy or ultrasound guidance when performed.
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- 33019 is for pericardial drainage with the insertion of an indwelling catheter when computed tomography (CT) guidance is used. This code is not age-specific.
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- Ascending aorta graft code 33860 is deleted and replaced by two new codes: 33858 and 33859. When the procedure involves aortic dissection, use 33858. If performed for aortic disease other than dissection, use 33859.
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- The transverse arch graft code (33870) is deleted and replaced with 33871. The descriptor is revised to better describe the service as it is performed now.
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- Pacers or Implantable Defibrillators & device evaluation code instructions
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nDigestive System nnThe descriptors for internal hemorrhoidectomy codes 46945 and 46946 are revised to include “without imaging guidance.” Category III code 0249T is deleted and replaced with Category I code 46948 to report an internal hemorrhoidectomy by transanal hemorrhoidal dearterialization, which is a less invasive procedure than the traditional hemorrhoidectomy.nnNervous System nnInjection, Drainage or Aspiration updates (see codes 62270-62273 & 62328-62329)nnMedicine Section Changes nnNew influenza vaccine code (90694) to report a quadrivalent, inactivated, adjuvanted, preservative-free vaccine that is administered intramuscularly. See specific updates in CPT®2020 for the following bullets:n
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- Implantable, Insertable, and Wearable Cardiac Device Evaluations
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- New add-on code for myocardial strain imaging 93356
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- Cardiac Catheterizations (93451 – 93462)
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- Arterial & arterial-venous studies (93925-93990)
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- DIY Blood pressure monitoring (99473 – 99474)
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- Counseling/Risk Factor Reduction
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nUpdates for health and behavior assessment and intervention services: New codes 96156, 96158, 96164, 96167, and 96170, and add-on codes 96159, 96165, 96168, and 96171 for health and behavior assessment and intervention services will replace six older codes. According to the AMA, this update is intended to “more accurately reflect current clinical practice that increasingly emphasizes interdisciplinary care coordination and teamwork with physicians in primary care and specialty settings.”nnSignificant changes for reporting long-term electroencephalographic (EEG) monitoring services (95700-95726): Monitoring the electrical activity of the brain is critical to diagnose epilepsy. Four older codes have been deleted to make way for 23 new codes for long-term electroencephalographic (EEG) monitoring services. According to the AMA, the new codes provide better clarity around the services reported by a technologist, a physician, or another qualified health care provider.nnAs a reminder, with ALL services, the purpose of documentation is to tell an excellent story about each individual encounter. Why is the patient here today (what is the presenting problem), what are the observations, what is the clinical impression/plan of care? Focusing documentation on clinically relevant details for the unique services provided creates clear notes that help to support excellent patient care, creates clear collaboration between professionals and supports medical necessity for the services reported.nn Welter Healthcare Partners’s team of expert coders can help clinicians report the correct codes and ensure proper reimbursement for their services. We provide ongoing education and update our clients with changes to codes and reporting requirements, as well as provide documentation pointers to ensure clinician documentation is legible, complete, and accurate to help with timely reimbursement. Coding compliance plans, external audits, and annual clinician education is required by the ACA! Contact us today to get started!
Jan 10, 2020 | Uncategorized
It has been several years since CMS released the X modifier series, are you using these correctly or not at all? In an end of year survey, published in Part B News, 78% of respondents said they had reported an X modifier in 2019. The creation of the X modifier series is to report with greater specificity the scenarios when just 59 had been used in the past. Effective July 1, 2019, MAC’s now process modifier 59 when used on either column 1 or 2 codes in addition to the most appropriate X series modifier.nnHere is a great scenario for the use of XU [Unusual non-overlapping service]:nnIf a peripheral nerve block injection is performed for postoperative pain management on the same date as the anesthesia code used for the procedure, the use of modifiers XU is appended to the peripheral nerve block injection to indicate that it was used for the postoperative pain management.nnFor other great scenarios directly from CMS, click here. It has great detailed information about these modifiers and some additional scenarios to help.nnAnother great article on this topic was released in the December 30th issue of Part B News by Jim Dresbach, click here to read!
Jan 6, 2020 | Uncategorized
Welter Healthcare Partners is proud to have earned URAC accreditation for Credentials Verification Organization (CVO)! The designation demonstrates Welter Healthcare Partners is dedicated to quality and safety, and that we strive for continual improvement of the services we offer! Our URAC-accredited CVO meets the strict quality credentialing standards URAC’s other accreditation programs, ensuring healthcare organizations that the credentialing process is in compliance. URAC’s Credentials Verification Organization (CVO) Accreditation ensures a meaningful, rigorous, and fair credentialing process that protects both patients and providers from poor credentialing practices. Credentialing is a critical function that allows health care organizations to properly identify qualified health care practitioners for participation in their networks. The accreditation process is an important way to protect patients and to minimize legal exposure for health care organizations due to malpractice claims.nn“Increased scrutiny of healthcare quality makes credentials verification a vital component in delivering safe and successful care,” said URAC President and CEO Shawn Griffin, M.D. “ Welter Healthcare Partners is showcasing a commitment to quality by achieving Credentials Verification Organization Accreditation from URAC that’s designed to increase patient confidence, maintain provider excellence, and reduce legal exposure.”nnAbout URAC: URAC’s mission is to advance quality in healthcare through leadership, accreditation, measurement, and innovation. Founded in 1990, URAC is the independent leader in promoting healthcare quality through leadership, accreditation, measurement, and innovation. URAC is a nonprofit organization using evidence-based measures and developing standards through inclusive engagement with a range of stakeholders committed to improving the quality of healthcare. Our portfolio of accreditation and certification programs span the healthcare industry, addressing healthcare management, healthcare operations, health plans, pharmacies, telehealth providers, physician practices, and more. URAC accreditation is a symbol of excellence for organizations to showcase their validated commitment to quality and accountability.
Jan 6, 2020 | Uncategorized
The new year is a time for change, and many look at it as a time of reform. So as you make those resolutions to get back to the gym just remember that as we all get older, our bodies take longer to heal. Happy 2020!n
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- X50.0XX- Overexertion from strenuous movement or load [lifting heavy objects; lifting weights]
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- Y93.- Activity codes
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- Y93.A- Activities involving other cardiorespiratory exercises
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- Y93.B- Activities involving other muscle strengthening exercises
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- Y93.K1 Activity, walking an animal
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