Jan 17, 2017 | Uncategorized
Tom Price’s Vision – Commercial & Individualn
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- Encourage Private Exchanges for purchase of individualized products across state lines
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- Create federal Grants for States to create high-risk pools
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- Eliminate individual Mandate
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- Comprehensive Medical Liability Reform allowing conformity to clinical guidelines to serve as an affirmative defense to liability
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- Claims Transparency from insurers to employers and individuals
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- Freedom of choice for any patient to contract directly with any willing provider
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- Anti-trust Exemption for non-economically aligned physicians to negotiate collectively with insurers (except Medicare, Medicaid, SCHIP, FEHB, or Indian Healthcare)
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Jan 4, 2017 | Uncategorized
Written By: Toni Elhoms, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainern Director of Coding/Compliance Consulting ServicesnnIt’s that time of the year again! The new 2017 CPT code changes take effect January 1st. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2017 address a number of interrelated issues. Clinical practice and technology have evolved and several issues required much needed CPT expansion and clarification. CPT 2017 offers the most changes in spine and orthopedic procedures, chronic care management, physical and occupational therapy, as well as significant changes in the reporting of moderate sedation services.n*Please note, this article is not an all-inclusive list; review your 2017 CPT book for complete descriptions of all changes. Appendix B of 2017 CPT provides a summary of additions, deletions, and revisions.nnHighlights of the most significant changes:n
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- Moderate Sedation
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- Chronic Care Management
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- Flu Vaccinations
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- Spinal Instrumentation
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- Orthopedics
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- Physical and Occupational Therapy
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- Diagnostic and Interventional Radiology
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- Spinal Steroid/Epidural Injections
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Jan 4, 2017 | Uncategorized
Moderate sedation services have historically always been bundled into the majority of all applicable CPT procedures. More than 400 codes that were previously defined as including moderate sedation have been deleted from Appendix G. In addition to six new CPT codes and one new endoscopy-specific HCPCS code, CMS intends to create a “uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure” with this year’s CPT updates. Providers who perform moderate sedation with a procedure must report the appropriate new moderate sedation codes to receive full reimbursement. As a result of removing this long time bundling edit, many procedures will see a slight reduction in RVU.n
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- 99151 – Moderate sedation services provided by the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
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- 99152 – Initial 15 minutes of intraservice time, patient age 5 years or older
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- 99153 – Each additional 15 minutes intraservice time
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- 99155 – Moderate sedation services provided by the physician or other qualified health care professional other than the physician performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
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- 99156 – Initial 15 minutes of intraservice time, patient age 5 years or older
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- 99157 – Each additional 15 minutes intraservice time
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- G0500 – Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports
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Jan 4, 2017 | Uncategorized
Effective Jan. 1st, CMS will begin paying for complex CCM services (99487-99489) in addition to normal CCM (99490). These CPT codes have been around for a while, but CMS has always refused to reimburse for them. Keep in mind, to get paid, you must be able to properly note all the moving parts of this service in the medical record as indicated by the coding guidelines.nnCMS has also created a new add-on G code — G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services [List separately in addition to primary monthly care management service]).nnIt covers the additional work associated with assessing CCM services and generating a care plan. This used to be bundled into payment for an office visit (99201-99215), but in 2017 you can get paid EXTRA for it if you nail down your documentation. You’ll also find relaxed billing rules for CCM services in 2017, which include getting rid of a beneficiary consent form and removing the requirement for 24/7 access to care.n
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Jan 4, 2017 | Uncategorized
Several new codes will replace long time spinal biomechanical device code 22851. The new codes are more specific regarding the type and location of the biomechanical devices.n
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- 22853 – Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)
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- 22854 – Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
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- 22859 – Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
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nAdditional codes have been created to replace temporary codes for interspinous process decompression devices (IPD).n
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- 22867 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level
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- 22868 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure)
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- 22869 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level
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- 22870 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure)
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