Nov 20, 2020 | Uncategorized
There is a new prolonged service code for office or other outpatient services set for release January 1st, 2021. Healthcare practices should prepare for increased payer audits after this new code is released. Continue reading below for more information.nnTo say that this is a long time coming is an understatement! Finally extended care time devoted to patients in the clinic setting can be separately reported. This new code, 99417, will account for increments of 15 minutes above and beyond the allowable time for codes 99205 (60-74 minutes) and 99215 (40-54 minutes). With the publication of the 2021 CPT code books already being distributed, they include a table with a break down of appropriate uses. But do not get your stopwatches out of the junk drawers just yet, clinician. With all the hype we are seeing around the new guidelines for Office E/M encounters, our payers are being eerily quiet and have yet to announce anything regarding reimbursement for this new code. As we have seen in the past, clinicians and practices should be prepared to see an increase in payer audits following this transition and you can bet that code 99417 will be analyzed thoroughly.
Nov 13, 2020 | Uncategorized
The AMA released six new CPT codes for COVID-19 vaccines. The new CPT codes were created to support data-driven planning and allocation in regard to coronavirus. Continue reading below for more information.nnIn the last hours, the CPT Editorial Panel has just released six new CPT codes to capture COVID-19 vaccines and their correlating administration codes. The new CPT codes are designed to support data-driven planning and allocation. The following CPT codes are available to the public prior to the delivery of the vaccines to help facilitate updates that need to occur within our electronic health care systems.nnNow is the time to check with your EMR vendors and top payors to see how they plan to address this new code set:nn91300nSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular usenn91301nSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular usenn0001AnImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dosenn0002AnImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dosenn0011AnImmunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dosenn0012AnImmunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dosennClick here to access November’s Special Edition of CPT Assistant Vaccine Coding for COVID-19
Nov 13, 2020 | Uncategorized
Using modifier-62 to report and charge for co-surgery should be completed using the CPT guidelines for usage. Continue reading below for more information as well as an example of how a procedure would be adjudicated by co-surgeons.nnA patient has been seen in the clinic for recurrent large central/right herniation of L4-L5. Surgery was discussed, risks explained, and consent signed by the patient. This surgery is complex and requires two surgeons to complete the procedure.nnModifier -62 states: When 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier -62 to the procedure code and any associated add-on codes(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. Many physicians work as co-surgeons during complex procedures.nnDifferent specialties may perform distinct parts of a procedure. One may perform the procedure while the other surgeon performs the approach. Medicare reimburses co-surgery procedures by taking 125% of the approved reimbursement and paying each surgeon 62.5%. Other carriers may vary slightly, it is best to check with your specific payer for their contracted rates.nnThe following example shows how a spinal procedure performed by co-surgeons would be adjudicated based on CPT guidelines for the use of modifier -62.nn
Nov 5, 2020 | Uncategorized
With the 2021 CPT data file released, CPT changes are set to take the stage starting January 1, 2020. This new CPT file contains a multitude of changes, codes, deletions, and revisions. Continue reading below to learn more.nnAside from the highly discussed 2021 Evaluation and Management changes that are set to take effect on January 1, 2021, we find the CPT® code set continues to see growth in new and novel areas of medicine. Read below to find out more about these changes.nnCPT® has recently updated their data file to contain 329 editorial changes; including 206 new codes, 54 deletions, and 69 revisions. A majority (63%) of new codes involve new technology services described in Category III codes and the continued expansion of the Proprietary Laboratory Analyses (PLA) section.nnAlthough there are not a record number of new codes, it is evident there are changes to CPT® 2021 in nearly every section. As we start to read through the 2021 CPT® text, you see that illustrations have been updated, allowing users to have a better anatomical understanding. With the notable green text indicated throughout the new codebook, you will find many guidelines and instructions that have also been updated. Correct coding will rely on having the most up‐to‐date coding resources and paying particular attention to these important guideline revisions. The following paragraphs summarize some of the exciting updates headed this way!nThe Introduction section starts with clarifying details about the release of CPT codes and provides a new CPT Code Set Update Calendar table. Several links referencing AMA resources on specific updates are also included.nnThe Evaluation and Management (E/M) section reveals a significant overhaul for the office visit and other outpatient services codes (99202 – 99215). This section provides entirely new guidelines and instructions for documenting and reporting these frequently used services, including definitions of commonly used terms. A new prolonged services code +99417 provides opportunity for clinicians to capture additional encounter time when appropriate.nnAdditional instructions clarify when reporting a preventive visit and an illness encounter on the same date of service should be considered.nCare Management Services, Chronic Care Management and the Behavioral Health Integration Care Management section all have new clarifying guidelines to help understand the type of work that should be performed and documented to report these unique services.nnThe Surgery section starts with updates to instructions in the Integumentary Section for Repairs and/or Reconstruction.nYou will find new instructional guidelines and three new codes (33741,33745, +33746) for shunting procedures in the Cardiovascular System section.nnThe updates in the Medicine section illustrate how the CPT code set continues to be modified to respond to how fast‐paced innovative digital services can improve access to health care and improved health outcomes for patients. A great example of this is the addition of code 92229 for retinal imaging with automated point‐of‐care, and the revision to the descriptions of codes 92227 and 92228.nCodes 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248 have been also updated along with associated guideline revisions. These codes replace Category III codes 0295T, 0296T, 0297T and 0298T, which were deleted. These new codes utilize an innovative algorithmic technology that works in collaboration with a patch that is easier to wear for patients and provides more accurate and complete data for clinician interpretation.nDon’t miss the updated guidelines in the Dialysis section, if that is a service that impacts your organization.nnA quick glance at Appendix C reveals significant changes to the Clinical Examples used to assist clinicians in understanding the meaning of the descriptors and selecting the right code. It is important to notice that each example in the text was developed by physicians in the specialties shown. Clinical examples of Office visit services have been removed from the 2021 edition as the CPT Editorial Panel continues to monitor and update these new services.nnSARS‐CoV‐2 related CPT codes:n
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- Code 86318, effective April 10, 2020, is used to report immunoassay for infectious agent antibody(ies) and to be a parent to 86328; addition of code 86328 to report single step antibody testing for severe acute respiratory syndrome coronavirus 2; addition of child code 86769 to report multiple‐step antibody testing for severe acute respiratory syndrome coronavirus 2; and revision of the Immunology guidelines.
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- PLA code 0202U, effective May 20, 2020, is used to report the BioFire® Respiratory Panel 2.1 (RP2.1) test.
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- Code 87426 is used to report infectious agent antigen detection by immunoassay technique of SARS‐CoV and SARS‐CoV‐2.
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- PLA codes (0223U and 0224U) were accepted for detection of SARS‐CoV‐2. ∙ Codes 86408 for reporting coronavirus 2 (SARS‐CoV‐2) neutralizing antibody screen and 86409 for reporting coronavirus 2 (SARS‐CoV‐2) neutralizing antibody titer were effective Aug. 10, 2020.
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- PLA codes (0225U and 0226U) were accepted for detection of SARS‐CoV‐2. ∙ Code 99072, effective September 8, 2020, is used for additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency, as defined by law.
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- Code, 86413, was created for reporting quantitative antibody detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).
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nAccording to the AMA, the substantive need created by the unique circumstances of the SARS‐CoV‐2 pandemic provides justification to create specific codes to designate certain respiratory viral panels and expand upon code 87631:n
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- Code 87635, effective March 13, 2020, is used to report infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) (Coronavirus disease [COVID‐19]), amplified probe technique.
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- Code 87636 for reporting combined respiratory virus multiplex testing for either SARS‐CoV‐ 2 with Influenza A&B and code 87637 for combined respiratory virus multiplex testing for either SARS‐CoV‐2 with Influenza A&B and RSV and 87811 for antigen detection of SARS‐ CoV‐2 by direct optical (i.e., visual) observation was added October 6, 2020.
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- Two new PLA codes (0240U and 0241U) were accepted for detection of SARS‐CoV‐2, Influenza A and Influenza B; code 0240U also detects RSV. Additionally, Microbiology, Immunology guidelines were also revised, along with codes 87301, 87802 and their subsidiary codes.
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- Per AMA: Please note that, per the standard early release delivery process for CPT codes, you will need to manually upload these code descriptors into your EHR system. Most of these CPT codes will arrive as part of the complete CPT code set in the data file for 2021 later this year. However, as updates are released further into CY 2020, please ensure your systems are updated with the COVID‐19‐related code releases on this page.nReview and download the full CPT code descriptor release: Category I/Pathology and Laboratory
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- Coronavirus (SARS‐CoV‐2): Long descriptors (PDF)
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- Coronavirus (SARS‐CoV‐2): Medium descriptors (PDF)
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- Coronavirus (SARS‐CoV‐2): Short descriptors (PDF)
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nCPT Assistant fact sheets for coding guidance for new SARS‐CoV‐2 (COVID‐19)‐related testing codes can be found in the following links. These fact sheets include the following information:n
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- Codes, descriptors and purpose
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- Clinical examples
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- Description of the procedures
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- FAQs
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nDownload the Oct. 6, 2020 CPT Assistant guide (PDF, codes 87636, 87637, 0240U, 0241U)nnDownload the Sept. 8, 2020 CPT Assistant guide (PDF, information on code 99072)nnDownload the Aug. 10, 2020 CPT Assistant guide (PDF)nnDownload the June 25, 2020 CPT Assistant guide (PDF, information on code 87301)nnDownload the May 20, 2020 CPT Assistant guide (PDF)nnDownload the April 10, 2020 CPT Assistant guide (PDF, codes 86602, 86635)nnDownload the March 13, 2020 CPT Assistant guide (codes 87631, 87632, 87633, 0098U, 0099U, 0100U)nnAMA Coding Advice and Testing Scenarios can be found on the following links: nnQuick reference flow chart for CPT reporting for COVID‐19 testing (PDF)nnCoding scenarios and how to apply best coding practices (PDF)nnAMA CPT public websitennAMA Press Releasesnn
Nov 5, 2020 | Uncategorized
Can you believe that there are less than 2 months until 2021? With everything that has occurred in 2020, I think we can all agree that a new year will arrive with welcome arms. Read below for more information on the 2021 E/M guideline changes that are coming!nnAs we plan for the 2021 Evaluation and Management (E/M) changes it is so important to make sure that your team has the right tools to make the transition as seamless as possible. In addition to Welter Healthcare Partners’s 2021 E/M Guideline Changes Webinars, we have also updated our Welter Healthcare Partners E/M Coding Calculator. This tool is a reference for coders and clinicians alike to quickly navigate the new E/M level requirements.nnContact us today for Welter Healthcare Partners’s 2021 E/M Guideline Changes Webinars registration and receive a free Welter Healthcare Partners 2021 E/M Coding Calculators along with other training material.
Oct 29, 2020 | Uncategorized
The VA and its third-party administrators are now able to consider some denied claims for payment. Continue reading below for more information about reconsideration eligibility.nnVA and its third-party administrators (TPA), Optum and TriWest, will reconsider payment to providers who had a claim denied for simple routing errors. Providers whose claims were denied because they were submitted to the wrong VA payer (VA or a TPA) are eligible for reconsideration if the original claim was filed with a VA payer on time (within 180 days of the date of service). The provider must resubmit a reconsideration request to the correct VA payer within 180 days of the initial denial. A copy of the remittance advice from a claim that was submitted to a VA payer within 180 days of date of service satisfies this requirement.nnOptum and TriWest also have the authority to process provider payment requests that were previously denied prior to this direction and over 180 days after the date of the remittance advice if the original claim was submitted on time. The 180 days from the date of the remittance advice was through Dec. 1, 2020. In addition, claims not submitted because of missing affiliation/network information on the VA referral are also eligible to be reconsidered if the claim is within 180 days of the date of the referral allocation. VAMC staff will send the provider an offline referral created in Health Share Referral Manager (HSRM) to the community provider with the authorization number. The HSRM offline referral will also explain who to correctly bill.nnIn-network providers can view the authorization number and original received date in HSRM. Providers in Optum’s network can also find the original received date in the Optum Provider PortalnnFor more information, visit VA’s “File a Claim for Veteran Care” web page or call the Community Care Contact Center, 877-881-7618.nn
