Jan 21, 2021 | Uncategorized
CMS puts patients over paperwork with a new rule that addresses the prior authorization process. The new rule will empower patients, lower costs, and give providers the ability to give better care to their patients. Continue reading below to learn more about the new final rule.nnToday, the Centers for Medicare & Medicaid Services (CMS) finalized a signature accomplishment of the new Office of Burden Reduction & Health Informatics (OBRHI). This final rule builds on the efforts to drive interoperability, empower patients, and reduce costs and burden in the healthcare market by promoting secure electronic access to health data in new and innovative ways. These significant changes include allowing certain payers, providers and patients to have electronic access to pending and active prior authorization decisions, which should result in fewer repeated requests for prior authorizations, reducing costs and onerous administrative burden to our frontline providers. This final rule will result in providers having more time to focus on their patients and provide higher quality care.nn“Today, we take a historic stride toward the future long promised by electronic health records but never yet realized: a more efficient, convenient, and affordable healthcare system,” said CMS Administrator Seema Verma. “Thanks to this rule, millions of patients will no longer have to wrangle with prior providers or locate ancient fax machines to take possession of their own data. Many providers, too, will be freed from the burden of piecing together patients’ health histories based on incomplete, half-forgotten snippets of information supplied by the patients themselves, as well as the most onerous elements of prior authorization. This change will reverberate around the healthcare system for years and decades to come.”nnThe “CMS Interoperability and Prior Authorization” rule is the next phase of CMS interoperability rulemaking, aimed at improving data exchange while simultaneously reducing provider and patient burden. This final rule requires the payers regulated under this rule (namely, Medicaid and CHIP managed care plans, state Medicaid and CHIP fee-for-service programs (FFS) and issuers of individual market Qualified Health Plans (QHPs) on the Federally-facilitated exchanges (FFEs)) to implement application programing interfaces (APIs) that will give providers better access to data about their patients, and streamline the process of prior authorization. APIs are the foundation of smartphone applications, and when integrated with a provider’s electronic health record (EHR), they can enable data access at the touch of a button. By exchanging relevant health information between patients, providers and payers, APIs support a better health care experience for patients. Patients have easier access to their own health information, their providers have a more complete picture of their care, and patients can take their information with them as they move from plan to plan, and from provider to provider throughout the healthcare system. This ensures more coordinated, quality care, and less repetitive and unnecessary care that is costly.nnToday’s final rule requires Medicaid and CHIP (FFS) programs, Medicaid and CHIP managed care plans, and issuers of individual market QHPs on the FFEs to include, as part of the already established Patient Access API, claims and encounter data, including laboratory results, and information about the patient’s pending and active prior authorization decisions. These payers are also required to share this data directly with patients’ providers if they ask for it and with other payers as the patient moves from one payer to another. In this way, patients, providers, and payers have the data when and where they need it, to help ensure that patients receive the best possible care. While Medicare Advantage plans are not included in and therefore not subject to this final rule, CMS is considering whether to do so in future rulemaking.nnPrior Authorization Burden ReductionnnPayers use prior authorization as a way to manage health care costs and ensure payment accuracy. For certain services, providers request approval from payers before rendering care to ensure that the payer will determine that the care is medically necessary, a threshold requirement for care to be reimbursed under the patients’ health coverage. This administrative process can be burdensome, and the challenges of the prior authorization process have motivated industry efforts to develop tools to increase automation. This final rule aims to reduce the inefficiencies and burdens of the prior authorization process for providers, and give them back time to focus on what matters most, treating patients in a timely manner.nnThe final rule requires Medicaid and CHIP FFS programs, Medicaid and CHIP managed care plans, and issuers of individual market QHPs on the FFEs to build, implement, and maintain APIs using the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard to support automation of the prior authorization process, specifically addressing the challenges raised by both providers and payers. The requirements of this rule specify that each of these payers will build an API-enabled documentation requirements look-up service, and make these public so providers may access documentation and prior authorization requirements from their EHR platforms. Once a provider knows what is required for each prior authorization, the next step is submitting it electronically. The final rule also requires Medicaid, CHIP, and QHP payers to implement and maintain prior authorization support APIs using the HL7 FHIR standard, which will advance a streamlined approach for communicating prior authorization requests and responses between those payers and provider EHR platforms or other practice management systems.nnThe final rule also requires Medicaid and CHIP (FFS) programs, and Medicaid and CHIP managed care plans to meet reduced decision timelines for prior authorizations. These payers will now have a maximum of 72 hours to make prior authorization decisions on urgent requests and seven calendar days for non-urgent requests, and all payers subject to the rule are required to provide a specific reason for any denial, which will allow providers some transparency into the process beginning January 1, 2024 or the rating period that starts on or after January 1, 2024. In addition, to promote accountability, the rule requires these payers, to make public, prior authorization metrics that demonstrate how they operationalize the prior authorization process. All of these requirements together will promote a more streamlined and efficient prior authorization process for providers and payers alike.nnThe rule will improve the patient experience as well. When a patient sees, for instance that a prior authorization is needed and has been submitted for a particular item or service, they will better understand the timeline for the process and be able to work with their provider to plan accordingly.nnToday’s final rule aims to improve longstanding inefficiencies in the healthcare system —including the lack of data sharing and access. This final rule expands the current Administration’s goals of quality and lower costs in health care as payers and providers will now have access to more complete patient histories, allowing for more coordinated and seamless patient care.n
Click here to review the final rule.
n nnOriginal article published on cms.gov
Jan 21, 2021 | Uncategorized
There is a new HCPCS code G2212 for prolonged services with or without direct patient contact on the date of service. This new code has changes that influence when extra time starts during patient encounters. Continue reading below to learn more.nnWith All the changes come up in 2021 for Office and Outpatient encounters, if you are a CMS credentialed provider this topic cannot be emphasized enough. Part of the overhaul of the Evaluation and Management (E/M) guideline changes was the creation of a prolonged service code, 99417. Unfortunately, the requirements for this code will not be support by CMS, thus the creation of HCPCS code G2212. Below you will see two tables taken directly from CMS Manual, transmittal 10505.nnThe biggest difference is that extra time does not start once the maximum time for your base code, 99205 or 99215, has been exceeded but rather it begins at minute 89. (i.e. if your total encounter time for a particular encounter was 100 minutes, according to CPT you would report 99205 + 99417×2 vs. CMS you would report 99205 + G2212x1).nnThese charts should be printed out and added to you CPT manual for comparison to what AMA has released for code 99417 or kept in with your other quick reference tools.nn nn
nn n
Click here to view the CMS Manual System
Jan 18, 2021 | Uncategorized
A new year means new CPT changes have been released. These changes apply to E/M office and other outpatient visit reporting. We’ve compiled a list of 30 FAQ’s so that you can start your 2021 reporting off right. Continue reading below to learn more.nnBy Ginger Avery, CPC, CPMA, CRCnJanuary 5, 2021nn1.Where can the CPT E/M code and guidelines be found? The CPT E/M code and guideline changes for 2021 can not only be found on the American Medical Associations (AMA) site at this link, but they can also be found in their entirety within the 2021 CPT Code books themselves. These guidelines include the new level of medical decision-making table and the 22 new definitions that help clarify what the MDM terms mean.nn2.Does pulling the lab results into the note constitute a “review of results” or do I need to document by stating that I have reviewed them? Moving forward information from old notes without comment does not add any value to the work that was performed and does not count. Did you review/analyze these results, what impact does this have on today’s visit? What is the clinical significance of this additional work?nn3.When tests are ordered during one visit and reviewed the same test during the next visit, can that count as a data point for both visits? With the new guidelines, we no longer have data “points”. Both encounters would support Limited data (low) with Category 1. The first encounter supports Category 1 for ordering of the test, the follow up encounter would support Category 1 for review of the results.nn4.Where does lifestyle counseling come into this? Preventive medicine counseling and/or risk factor reduction interventions (99401-99412) are time-based codes but do NOT follow the office visit E/M guidelines. Relevant visit details and total F2F time should be documented appropriately. Code selection is based on the F2F time spent with the patient.nn5.When reporting for total time, is it just time spent with patient at the encounter? No, in 2021, time is defined as the total encounter time on the date of service. This includes both F2F work and non-F2F work personally performed by the clinician.nn6.When dealing with complex patients where time is difficult to track will we have to revert to Medical Decision Making? With the new guidelines, you now have a choice, MDM or total encounter time. If total encounter time runs outside of the date of service or is challenging to track, then reporting based on the medical decision making may be a better choice. Do not undervalue the complexity by not documenting all the relevant work you do.nn7.Seeing how we cannot estimate for time that could be spent, say for a possible follow up phone call, how should we code to earn credit for that work? Time based reporting is only appropriate for time spent on the date of the encounter. Follow up phone calls on a later date cannot be reported based on time. MDM should be considered. In column 2 of the level of MDM chart, Category 3 provides credit when discussing the case with other clinicians or appropriate source. Be sure to document these details when true.nn8.Providers do use outpatient codes in the hospital if patient is in Observation status “not Inpatient”, I would assume these rules would apply to bill new/vs est pt when appropriate? Yes, the guideline updates are for office visits and other outpatient services.nn9.With the new time-based reporting, it seems that we absolutely need to sign off on our notes on the day of service. This is not always feasible given a busy day. In 2021, total encounter time includes completing documentation. If a clinician is unable to complete their note on the date of the encounter, reporting based on MDM may be a better choice.nn10.Some of these activities occur after the visit (complications/adverse reactions) – how can you account for that in your note for that day? Complications and adverse reactions may support an additional encounter when the need for evaluation and management may arise but would not be included on the date of the encounter unless that presentation was true during the visit.nn11.Do the E/M changes apply to outpatient or inpatient services? The 2021 E/M changes only apply to Outpatient services. Inpatient visits still need to follow the key component guidelines (1995 or 1997).nn12.Since history and physical exam are no longer required to level the visit, should these elements still be documented? Yes, history and exam are still part of an evaluation. The documented content should be focused on the clinically relevant details and cognitive thoughts of the clinician, not checkboxes or templated details. What is the nature of the presenting illness(es) (subject details with pertinent ROS)? Document a medically necessary exam. Documentation is about the quality of the story, not the quantity of details. Don’t import pages of past medical history or medication lists that aren’t relevant. Clinicians are encouraged to write notes that they would like to read.nn13.Do I still have to document ROS and PFSH? Yes, when clinically relevant. For example: Patient presents with chest pain. Has been having intermittent chest pain at rest for two weeks. No notable triggers. Positive for headaches and dizziness, no SOB. Patient has a past family history of CAD. Remember, documentation is all about the medically necessary story.nn14.When coding based on total time does the assessment and plan still need to be documented? Yes. Quality documentation should always be captured. Clinical impressions and plans that are well documented support the medical necessity for the services provided, regardless of how you choose to report the visit. Again, clinicians are encouraged to write notes that they would like to read.nn15.When coding based on total time and have also provided additional time-based services (advance care planning, counseling, etc.) how should those services be documented? The time associated with each visit should be separate and clearly identified to support each unique service.nn16.Are commercial plans required to adopt the revisions to E/M codes? Yes. The CPT code set, together with the U.S. Department of Health and Human Services’ Healthcare Common Procedure Coding System, has been adopted as the nation’s standard medical data code set. HIPAA requires that health plans use the most recent version of the medical data code set, they should be ready to implement the revisions Jan. 1, 2021.nn17.Who else besides clinicians needs to implement the 2021 E/M office visit changes? Other clinicians, coders, third-party plan administrators, and other health care-related entities should start using the revised code set Jan. 1. Physician practices should confirm that their contracted health plans and EHR vendors are integrating the revised codes into their software systems and will be ready Jan. 1, 2021.nn18.Can I still use my EHR’s coding calculator? Technically, Yes. It is important that clinicians confirm with their EHR vendor that their system’s code-selection application conforms to the revised codes and descriptors because the billing provider has the ultimate responsibility for appropriate coding. The EHR’s coding calculators are simply bean counters driven by templates and checkboxes; medically necessity cannot be quantified utilizing a point counting system. Often these systems are not set up with the appropriate guidelines and do not include additional instruction.nn19.Can we still bill 99201-99205 and 99211-99215 based on the 1995 and 1997 guidelines for dates of service on and after January 1, 2021? Office/outpatient visits PRIOR to January 1, 2021 may still be billed using the 1995 or 1997 guidelines. Clinicians must bill office/outpatient visits provided ON or AFTER January 1, 2021 using the CPT E/M code and guideline changes for 2021. Note: Based on the CPT changes, code 99201 is no longer valid for dates of service on and after January 1, 2021.nn20.Do the 2021 E/M code and guideline changes apply to all categories of E/M services? No. The E/M code and guideline changes are specific for office and other outpatient visits and apply only to codes 99201–99205 and 99211–99215.nn21.For dates of service on and after January 1, 2021, how are the levels of E/M services provided in an office/outpatient setting determined? For dates of service on and after January 1, 2021, select the appropriate level of E/M service based on the following (you choose): The level of the medical decision making as defined for each service; OR the total time personally spent by the clinician for all services related and dedicated to that patient on the date of the encounter.nn22.Does the revised medical decision-making table for 2021 provided by the AMA apply to all E/M services? No. The CPT E/M code and guideline changes for 2021 and subsequent MDM table only apply to office/outpatient E/M services beginning January 1, 2021. All other E/M categories and codes continue to follow the 1995 and/or 1997 E/M guidelines. However, the additional clarification provided in the new guidelines displays the importance of documenting clinically significant details (medically necessary), avoiding templated checkbox information and provides definitions for many of the terms on the table of risk to help the reader understand appropriate considerations of Medical Decision Making.nn23.Is the documentation of history and examination required when scoring office/outpatient services under the revised 2021 guidelines? The approved revisions do not materially change the three current MDM elements, but instead provide extensive edits to the elements for code selection and revised or created numerous clarifying definitions in the E/M guidelines. While the provider’s work in capturing the patient’s pertinent history and performing a relevant physical exam contributes to both the time and medical decision making, these elements alone should not determine the appropriate code level. The revised code descriptors state a “medically appropriate history and/or examination” is required.nn24.Is time defined differently for office and outpatient E/M services effective for dates of service on and after January 1, 2021? According to the AMA, for dates of service on and after January 1, 2021, time is defined as minimum time, not typical time, and represents the total encounter time personally spent by the clinician on the date of service. This definition applies only when code selection is based on time and not MDM.nIs time defined differently for office and outpatient E/M services effective for dates of service on and after January 1, 2021? According to the AMA, for dates of service on and after January 1, 2021, time is defined as minimum time, not typical time, and represents the total encounter time personally spent by the clinician on the date of service. This definition applies only when code selection is based on time and not MDM.nn25.When coding by time, is the day of encounter by calendar date or 24-hour period? When coding by time, only the time spend on the actual calendar date of the encounter is applicable.nn26.How is time counted under the CPT E/M code and guideline changes for 2021? Except for code 99211, per AMA, beginning with CPT changes 2021, time alone may be used to select the appropriate code level for the office or other outpatient E/M service codes (99202-99205, 99212- 99215). Time may be used to select a code level in office or other outpatient services regardless or not counseling and/or coordination of care dominates the service. When time is used to select the appropriate level for E/M service codes, time is defined by the service descriptors. The E/M services for which these guidelines apply require a face-to-face encounter with the clinician. For office or other outpatient services, if the clinician’s time is spent in the supervision of clinical staff who perform the face-to-face services of the encounter, use code 99211.nn27.What activities can be counted towards total clinician time? Time includes the following activities when personally performed by the clinician:n
n
- Preparing to see the patient (e.g., review of tests).
n
- Obtaining and/or reviewing separately obtained history.
n
- Performing a medically appropriate examination and/or evaluation.
n
- Counseling and educating the patient/family/caregiver.
n
- Ordering medications, tests, or procedures.
n
- Referring and communicating with other health care professionals (when not separately reported).
n
- Documenting clinical information in the electronic or other health record.
n
- Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver.
n
- Care coordination (not separately reported).
n
n28.How do other requirements (e.g., teaching physician, incident to, new vs. established) apply when using the CPT E/M guidelines for 2021? CMS is adopting the AMA’s guidance on coding office/outpatient E/M visits. Most rules remain unchanged.nn29.Can the independent visualization of a test be counted in the medical decision making if the physician is also billing for the test? Per AMA, the actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the level of E/M service when reported separately. Clinician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The clinician’s interpretation of the results of diagnostic tests/studies (i.e., professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. If a test/study is independently interpreted in order to manage the patient as part of the E/M service but is not separately reported; it is part of medical decision making.nn30.When considering High Risk MDM, there is an example listed: “drug therapy requiring intensive monitoring for toxicity”. What constitutes supporting this definition? When considering this complexity, both the drug and the monitoring must qualify. The new guidelines provide this definition when considering this High Risk example: “Drug therapy requiring intensive monitoring for toxicity: A drug that requires intensive monitoring is a therapeutic agent that has the potential to cause serious morbidity or death. The monitoring is performed for assessment of these adverse effects and not primarily for assessment of therapeutic efficacy. The monitoring should be that which is generally accepted practice for the agent but may be patient specific in some cases. Intensive monitoring may be long-term or short term. Long-term intensive monitoring is not less than quarterly. The monitoring may be by a lab test, a physiologic test or imaging. Monitoring by history or examination does not qualify. The monitoring affects the level of medical decision making in an encounter in which it is considered in the management of the patient. Examples may include monitoring for a cytopenia in the use of an antineoplastic agent between dose cycles or the short-term intensive monitoring of electrolytes and renal function in a patient who is undergoing diuresis. Examples of monitoring that does not qualify include monitoring glucose levels during insulin therapy as the primary reason is the therapeutic effect (even if hypoglycemia is a concern); or annual electrolytes and renal function for a patient on a diuretic as the frequency does not meet the threshold.”nnAs a reminder, documentation is about painting a clear picture of today’s encounter. The power of storytelling is evident with these new revisions. Quality documentation (not quantity or checkboxes) provides details to support the medical necessity and appropriate complexity of each unique encounter, as well as improves overall patient care and clinical outcomes. Clinicians are encouraged to focus their energy and documentation on the cognitive clinically relevant details, regardless of the clinical setting. Document what you do, code what you document.nn Welter Healthcare Partners provides robust coding and documentation training for these updates, as well as other topics. Please contact cwhitworth@rtwelter.com to book your training now.nnReferences:nAMA CPT® E/M Code and Guideline Changes for 2021nAma-assn.orgnNovitas E/M Documentation RequirementsnNoridian E/M Documentation Requirements
Jan 13, 2021 | Uncategorized
The reports below describe a patient undergoing a tracheostomy operation and a bronchoscopy operation. Both procedures have been documented in detail, describing the step-by-step process used by doctors to carry out each surgery. Keep reading for more on how each procedure was performed.nnDo you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. nn– Click Here to Submit Redacted Surgery Case Study –nn nnOPERATIVE REPORT (1 of 2)nn12/XX/20nnPREOPERATIVE DIAGNOSIS: Ventilator Dependence, Metabolic EncephalopathynPOSTOPERATIVE DIAGNOSES: SamenPROCEDURES: Tracheostomy with 8-French Shiley tracheostomy under moderate sedation.nSURGEON: M. K., D.O.nASSISTANT: W. F., DO.nANESTHESIA: General. (the patient is already intubated and sedated on precedex with fentanyl. 5mg of versed was administered)nBLOOD LOSS: Less than 1 mL.nBLOOD REPLACEMENT: None.nPOSTOPERATIVE CONDITION: Stable.nnDESCRIPTION OF PROCEDURE:nAfter all risks and benefits were explained and discussed with the patient’s husband including but not limited to blood loss, infection, as well as injury to the tracheal structures and intraabdominal perforation. All questions were answered. Written informed consent was obtained and is in the chart for review. The patient is already intubated in the ICU, she is on precedex and fentanyl. 5mg of versed is given. A time-out was completed. Neck was prepped and draped in a sterile fashion. Sterile technique was utilized throughout the procedure with gown, gloves, face mask, and hat. The abdomen was also prepped in a similar fashion. Local anesthetic was provided. 2 cm cephalad to the suprasternal notch, a transverse incision was created, and the trachea was palpated. The assistant is doing the bronchoscopy and the endotracheal tube is full back by the assistant until the finder needle was fully visualized by bronchoscopy. The wires passed into the trachea, the needle is removed, the dilator is placed over the wire and then removed, the larger dilators placed over the wire and then removed. Finally, the final dilator inside of the tracheostomy tube is passed until the balloon is within the trachea, the dilator is removed and the tracheostomy tube is left in place. It is attached to the ventilator and bronchoscopy confirms is physician above the level of the carina. The endotracheal tube was removednfrom the mouth. The tracheostomy is sutured in place. She tolerated the procedure well.nn nn nn
OPERATIVE REPORT (2 of 2)nnPREOPERATIVE DIAGNOSIS: Respiratory FailurenPOSTOPERATIVE DIAGNOSES: SamenPROCEDURES: BronchoscopynSURGEON: William Fulton, DO, FACOSnASSISTANT: Majid Kianmajd, DOnFINDINGS: Intact trachea with minimal mucous secretionsnSPECIMEN(S) REMOVED: NonenBLOOD LOSS: NonenANESTHESIA: General Endotracheal nANESTHESIOLOGIST(S): NonenCULTURES: NonenDRAINS: NonenBLOOD REPLACEMENT: NonenPOSTOPERATIVE CONDITION: StablenCOMPLICATIONS: Nonenn nnDESCRIPTION OF PROCEDURE:nnPatient was prepared for procedure of bedside bronchoscopy to use concurrently with placement of a tracheostomy. The bronchoscope was advanced into the ET and the trachea was directly visualized. Minimal saline irrigation was utilized to assist with visualization. The carina was visualized and the tracheobronchial tree grossly appeared intact with polyps or lesions or bleeding noted. During the bronchoscopy placement of the needle and guidewire were visualized for the procedure of percutaneous tracheostomy. Ventilation and O2 saturation were monitored through the procedure and patient remained stable throughout. The tracheostomy was visualized in placed with the bronchoscope also advanced directly into the tracheostomy as well. The bronchoscope was withdrawn without difficulty. Patient tolerated procedure well.n
n
Jan 6, 2021 | Uncategorized
The pandemic may have negatively impacted many things, but the health industry may emerge stronger in 2021 because of Covid-19 impacts. Virtual care, clinical trials, and digital relationships between patients and physicians are a few of many areas that executives should focus on. Continue reading below to learn more about how healthcare might change or continue to improve in 2021.nnWhat will the healthcare landscape look like in 2021?nnPricewaterhouseCoopers (PwC) Health Research Institute (HRI) released its annual health industry forecast Wednesday morning detailing how the healthcare system of 2021 can be reimagined and emerge from the COVID-19 pandemic in a stronger position. While the 2020 forecast focused on returns from digital investment, M&A activity, and DEI, the top health industry issues of 2021 are likely to center around how the healthcare system will built itself back up after the struggles created by the coronavirus outbreak. Healthcare organizations saw struggles with finances, the national supply chain, staffing shortages, and staying afloat during the pandemic. According to PwC, there are opportunities for the health industry to rebound in a stronger and smarter way in 2021. “As this pandemic makes painfully visible, medicine alone—ventilators, drugs, ICUs—will not save us. Medical care contributes only 10% to 20% of positive health outcomes. Rather than facing these realities, we too often continue to reactively Band-Aid,” Dr. Mona Hanna-Attisha said during PwC’s 180 Health Forum in October. “We can’t afford to do that anymore. … Addressing the upstream root causes is the only answer … with crisis comes opportunity.”nnBelow are some key areas of the report that healthcare executives should focus on:nnVIRTUAL CAREnPwC found that over 90% of surveyed healthcare organizations are using telehealth for primary care services. Nearly 70% of those leaders said that “telehealth has been most useful for follow-up appointments. According to PwC, health leaders should “pay equal attention to revenue and customer experience” when it comes to the success of telehealth in their organizations.nnCLINICAL TRIALSnDue to the pandemic, pharmaceutical and life sciences, companies recognized that clinical trials can be conducted remotely. These companies are hoping to continue this trend by conducting trials with “few in-person interactions.” The FDA created special guidance for trial sponsors during the pandemic, and PwC stated that these changes could be here to stay. Pharmaceutical and life science executives were nearly unanimous in saying that they expect digital investments in clinical trials to increase in 2021.nnDIGITAL RELATIONSHIPS FOR PHYSICIANSnMore than 90% of executives from the provider, life sciences, and health plan sectors answered that “improving the clinician experience is a priority for their organizations as they enter 2021.” According to PwC, digital technology can help improve the physician experience. Due to the pandemic, “administrative burdens” for physicians were reduced due to relaxed rules from CMS. Some private insurers also made claims a faster and easier process, and PwC believes there will be an increase of payers’ investments in automation by 2021. Health plan executives also said that a big focus for 2021 will be on “the physician-patient relationship verses members directly.”nnHEALTHCARE FORECASTINGnAlmost three-quarters of healthcare executives said that their organizations will be investing more in predictive modeling in 2021. According to PwC, “this capability to forecast the future could be as important to healthcare survival in 2021 as a mask may be for slowing the spread.” Moving forward, healthcare executives should focus on regional forecasting and collaborating with others in their area. More than 70% of healthcare executives said they were either starting to collaborate with other healthcare organizations or had plans to, due to the pandemic. Nearly two-thirds of leaders said they were either starting to collaborate or were planning to collaborate with public health agencies.nnHEALTH PORTFOLIOSnIn 2021, PwC expects healthcare organizations to increase their investments in the “gaps exposed by the pandemic.” Hospitals and health systems who had invested in telehealth, home care, and digital capabilities that laid the groundwork for the rapid expansion of telemedicine due to the pandemic, have also “mostly recovered” from the initial hit of the pandemic. Meanwhile, organizations who are struggling financially may look into options such as M&A.nnSUPPLY CHAINnForward-looking, PwC expects there will be a transformation of the national supply chain after the pandemic revealed flaws in the current system. “In 2021, HRI expects distributors and health systems to consider establishing contracts with secondary suppliers, joining new group purchasing organizations, relocating facilities and approaching storage and distribution on a more regional scale,” the report stated. Ninety-four percent of life sciences executives and 86% of provider executives see “improving supply chain transparency” as their top priority for 2021.nnINTEROPERABILITYnAlmost a quarter of providers and health plan executives said that their organizations view the new federal rules on interoperability as a “strategic opportunity.” PwC suggests that healthcare organizations should have a “compliance-focused approach” and develop strategies for interoperability if they don’t want to be left behind. More than two-fifths of executives said that they have identified a leader to guide interoperability efforts for their organizations going into 2021. PwC also stated that consumer education should be a priority in 2021 so there is trust built between healthcare organizations. According to the report, “A comprehensive strategy that considers how the rules can lead to a more effective healthcare system that puts the consumer in the center would put the organization on offense in this new data-sharing environment.”nn nnOriginal article published on healthleadersmedia.com
Jan 6, 2021 | Uncategorized
nn2021 has brought on new CPT changes and they’re not just in E/M. We’ve compiled a list of 30 FAQ’s so that you can start your 2021 E/M office and other outpatient visit reporting off right. Continue reading below for the top 5 FAQ’s or click here for the complete list! nnBy Ginger Avery, CPC, CPMA, CRCnJanuary 5, 2021nn1.Where can the CPT E/M code and guidelines be found? The CPT E/M code and guideline changes for 2021 can not only be found on the American Medical Associations (AMA) site at this link, but they can also be found in their entirety within the 2021 CPT Code books themselves. These guidelines include the new level of medical decision-making table and the 22 new definitions that help clarify what the MDM terms mean.nn2.Does pulling the lab results into the note constitute a “review of results” or do I need to document by stating that I have reviewed them? Moving forward information from old notes without comment does not add any value to the work that was performed and does not count. Did you review/analyze these results, what impact does this have on today’s visit? What is the clinical significance of this additional work?nn3.When tests are ordered during one visit and reviewed the same test during the next visit, can that count as a data point for both visits? With the new guidelines, we no longer have data “points”. Both encounters would support Limited data (low) with Category 1. The first encounter supports Category 1 for ordering of the test, the follow up encounter would support Category 1 for review of the results.nn4.Where does lifestyle counseling come into this? Preventive medicine counseling and/or risk factor reduction interventions (99401-99412) are time-based codes but do NOT follow the office visit E/M guidelines. Relevant visit details and total F2F time should be documented appropriately. Code selection is based on the F2F time spent with the patient.nn5.When reporting for total time, is it just time spent with patient at the encounter? No, in 2021, time is defined as the total encounter time on the date of service. This includes both F2F work and non-F2F work personally performed by the clinician.nnAs a reminder, documentation is about painting a clear picture of today’s encounter. The power of storytelling is evident with these new revisions. Quality documentation (not quantity or checkboxes) provides details to support the medical necessity and appropriate complexity of each unique encounter, as well as improves overall patient care and clinical outcomes. Clinicians are encouraged to focus their energy and documentation on the cognitive clinically relevant details, regardless of the clinical setting. Document what you do, code what you document.nn Welter Healthcare Partners provides robust coding and documentation training for these updates, as well as other topics. Please contact cwhitworth@rtwelter.com to book your training now.n
— CLICK TO VIEW THE COMPLETE LIST OF 30 FAQ’s TO START YOUR 2021 REPORTING OFF RIGHT —
nReferences:nAMA CPT® E/M Code and Guideline Changes for 2021nAma-assn.orgnNovitas E/M Documentation RequirementsnNoridian E/M Documentation Requirements
Dec 21, 2020 | Uncategorized
From our Welter Healthcare Partners family to yours, we hope you all have a merry holiday season and a safe, healthy, and happy New Year! We are grateful for the support and appreciation for the work that we do and are excited to continue in 2021!nnIn observance of the holidays, Welter Healthcare Partners will be closing at noon on December 24th and will be closed all day on December 25th and January 1st to spend time with our loved ones. Once again, happy holidays to you all and we hope you all have a great and prosperous New Year!nn
Dec 18, 2020 | Uncategorized
CMS updated payment information for Covid-19 treatments. This new update includes the reimbursement of monoclonal antibody treatments authorized by the FDA. Continue reading below to learn more.nnMonoclonal antibody products are paid under the Medicare Part B COVID-19 vaccine benefit and therefore are not eligible for a New COVID-19 Treatments Add-on Payment. CMS released new and updated FAQs on Medicare Part B billing and reimbursement for COVID-19 treatments and vaccines. The information updated December 9 is included in Section BB, Drugs and Vaccines under Part B of CMS’ COVID-19 billing FAQs.nnFor the duration of the public health emergency, CMS will pay for monoclonal antibody treatments authorized or approved by the FDA. For payment purposes, CMS is treating these products as vaccines covered under Medicare Part B. If the product is acquired for free, CMS will only pay for the administration. If the provider or supplier purchases the product, CMS will pay for the product and the administration separately. Monoclonal antibody products are paid under the Medicare Part B COVID-19 vaccine benefit and therefore are not eligible for a New COVID-19 Treatments Add-on Payment.nnPayment for administration of an infusion of bamlanivimab or an infusion of casirivimab and imdevimad is approximately $310. The payment rate is based on one hour of infusion and post-infusion monitoring in the hospital outpatient setting. CMS may change the payment rate based on additional information from providers and suppliers. When organizations begin purchasing monoclonal antibody products, CMS plans to set the payment rate in the same way it will set the payment rate for COVID-19 vaccines. The payment rate will be reasonable cost or 95% of the average wholesale price. A chart on p. 123 of the FAQ document shows payments rates by setting.nnCurrently, there is no separate payment for preparation of monoclonal antibodies, even if prepared for another provider or supplier. Monoclonal antibody products administered at a nonexcepted off-campus, provider-based department (PBD) will be paid at the full Outpatient Prospective Payment System (OPPS) rate. They will not be subject to the reduced rate (40% of the OPPS) that applies to other services provided at these facilities.nnDocumentation must support the medical necessity of the treatment as well as demonstrate that the terms of the applicable FDA emergency use authorization are met. The documentation must include the name of the practitioner who ordered the infusion.nnOther new and updated FAQs in Section BB include payment for monoclonal antibody treatment provided:n
n
- By skilled nursing facilities, mass immunizers, and home health agencies
n
- On the same day as evaluation and management services
n
- To beneficiaries dually eligible for Medicare and Medicaid
n
nOriginal article published on healthleadersmedia.com
Dec 18, 2020 | Uncategorized
The report below describes a patient undergoing a right inguinal hernia operation. The entire procedure has been documented in detail, describing the step by step process used by doctors to carry out the surgery. Keep reading for more on how this procedure was performed.nnDo you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. nn– Click Here to Submit Redacted Surgery Case Study –nnPATIENT NAME: D., M.nnMR#: XXXXXnnSURGEON: T. G., M.D.nnDATE: 09/XX/2020nnPREOPERATIVE DIAGNOSES: Right inguinal hernia (direct), obesity.nnPOSTOPERATIVE DIAGNOSES: Right inguinal hernia (direct), obesity.nnOPERATIONS: Right inguinal hernia repair with mesh, excision of round ligamentnnSURGICAL ASSISTANT: J. D., SA-C.nnANESTHESIA: General endotracheal.nnESTIMATED BLOOD LOSS: Minimal.nnSPECIMEN REMOVED: Round ligament.n
INDICATION FOR SURGERY:
nThis is a 65-year-old female with a history of obesity, who has pain and bulge in the right groin consistent with inguinal hernia. The need for surgery and all the possible risks and complications were discussed at length with the patient with the help of the daughter, who helped with the translation. the patient understood, all the questions were answered, and she wanted to proceed with surgery.n
DESCRIPTION OF PROCEDURE:
nThe patient was brought in the operating room and placed on the table in supine position. After the general anesthesia was administered, the right groin and abdomen were prepped and draped in the usual sterile fashion.nnA slightly oblique incision was done in the right groin and deepened through the subcutaneous tissue. In the lower part of the inguinal area, the bulge of the inguinal hernia was identified. 11ie skin flaps were dissected. Good exposure of the fascia of external oblique muscle was obtained. 111e fascia was opened, and the inguinal canal was entered. 11ie patient had a quite very large bulging of the posterior wall of the inguinal cru1al consistent with a direct hernia. The round ligament was carefully divided between ligatures ru1d excised. A purse-string was placed in the fascia of the transversalis around the neck of the hernia and the bulging direct hernia was invaginated and the purse-string was tied. This repair was done with a O silk. At this point, the posterior wall of the inguinal canal was reinforced with a 2 x 4 Marlex mesh. The mesh was secured in place with 2 rows of continuous running 0 Prolene, suturing 1 margin of the mesh to the inguinal canal and the other margin of the mesh to the conjoint tendon and lateral margin of the rectus abdominis muscle fascia. 11ie fascia of the external oblique muscle was closed on top of the mesh with continuous running 0 Vicryl. The wound was irrigated with antibiotic solution. Perfect hemostasis was noted. Local anesthesia was injected. The wound was closed with continuous running 2-0 Vicryl in 2 layers for the subcutaneous tissue and continuous running 4-0 Monocryl subcuticular closure for the skin. Steri-Strips and sterile dressing were applied. The patient tolerated the procedure well and left the operating room in stable condition.
Dec 8, 2020 | Uncategorized
Medicare released a physician fee schedule on December 1st that is set to take effect on January 1st, 2020. The release of the Final Rule delivers a 10.2% drop in the Conversion Factor. Most other E/M revisions remain on track with the AMA. Continue reading below to learn more.nnby: Ginger Avery, CPC, CPMA, CRC 12/2/2020nAccording to the 2021 Medicare physician fee schedule released on December 1st , starting Jan. 1, 2021, clinicians are facing a 10.2% drop in the Medicare conversion factor, finalized at $32.41. This CF decrease will result in an up-and-down projection in 2021 for medical specialties. CMS states the cut is needed as a counterweight to the increased fees for E/M officenvisit codes (99202-99215), which account for 20% of fee schedule spending.n
Source: Final 2021 Medicare physician fee schedule, released Dec. 1
nThe final rule confirms that CMS has adopted relative value units (RVU) approved by the AMA. The new valuations boost total RVUs for nearly all of the office visit codes and elevate RVUs for established office codes 99212-99215 by an average of 28%.nnDue to the CF reduction, office visit codes will see a diminished payment increase in 2021. For example, reimbursement for new patient E/M codes 99202-99204 will be reduced. Established office visit codes will see an increase in the range of 11% to 15%. Coding patterns are expected to shift to higher levels of service based on the new guidelines.n
Source: Final 2021 Medicare physician fee schedule
nAccording to data contained in the final fee schedule, specialties that will see a positive outcome with the new CF includes: endocrinology (+16%), rheumatology (+15%), hematology/oncology (+14%) and family practice (+13%). Specialties that are on pace for pay cuts include radiology (-10%), chiropractor (-10%), nurse anesthetist (-10%) and physical and occupational therapy (-9%).nnIn 2021, either medical decision-making (MDM) or time will drive code selection for E/M office visit codes. Medically appropriate history and/or exam will be the new accepted practice. CMS states. “We continue to believe these policies will further our ongoing effort to reduce administrative burden, improve payment accuracy, and update the O/O E/M visit code set to better reflect the current practice of medicine.”nnCMS Replaces Prolonged Service Code 99417 with HCPCS Code G2212nCMS made the decision to issue a new HCPCS code, G2212, instead of 99417, for prolonged services when reporting based on time. As expected, CMS did not agree with the AMA’s final descriptor for 99417, and is requiring the visit to exceed the maximum time for 99205 and 99215 to be met before capturing G2212 , unlike AMA’s guidance to meet the minimum time before capturing prolonged service time.nnThe descriptor for Medicare’s new prolonged services code G2212: “Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services) (Do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (Do not report G2212 for any time unit less than 15 minutes).”nnCheck with your commercial/private payers that may prefer the G code. Reach out to your software vendors to assure your systems are ready to capture these new codes. If your organization has not received training on the upcoming changes for E/M office visits services, now is the time, contact WHP for details.nnVisit Complexity Add-on HCPCS Code G2211 Enters the Coding ArenanAlthough it is not yet clear as to appropriate application, CMS will roll out add on code +G2211 (Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. CMS stated in the final rule that the new add-on code will be appropriate for 90% of E/M office visit encounters and is appropriate for both new and established patients.nnTelehealth Rule Changes During/After COVIDnCMS finalized 114 Category 2 codes for telehealth – i.e., codes cleared for use outside of the restrictive distant-and-originating-site requirements and eligible for other flexibilities under the public health emergency (PHE). The agency also added a new “Category 3” of codes that “will remain on the list through the calendar year in which the PHE ends.” The bad news is these codes will eventually go back to the old telehealth rules if Congress does not change the law.nnCMS states it will conduct “a commissioned study, analysis of Medicare claims data or another assessment mechanism, to further study the impacts of this limited permanent expansion of the virtual presence policy to inform potential future rulemaking, and in an effort to prevent possible fraud, waste and abuse.”nnTelephone Visits New G codenCMS finalized its decision to cease separate payment for CPT telephone E/M codes 99441-99443 once the PHE ends. For the remainder of 2021, CMS created an interim code, G2252, for a “brief communication technology-based service (e.g., virtual check-in)” for established patients only. The code is priced at the same amount as CPT telephone visit code 99442 and covers 11-20-minute “medical discussion,”.nnCMS states that the G2252 service applies when a patient reports an exacerbation of an ongoing problem and wants to know whether a face-to-face office visit is warranted. CMS does not consider a telephone visit to be a substitute for an E/M service but instead “an assessment to determine the need for one.”nnCode G2252 will therefore be considered a communications technology-based service (CTBS) similar to a virtual check-in, not a telehealth service. Like the CPT phone codes, it will not be separately reported if the call occurs within seven days after a previous in-person visit or within 24 hours “or soonest available appointment.”nnRemote Patient MonitoringnCMS also finalized PHE flexibilities in remote patient monitoring codes: For example, while “only physicians and NPPs [non-physician providers] who are eligible to furnish E/M services may bill RPM services,” auxiliary personnel, including contract employees, may provide RPM services incident to under codes 99453 and 99454. Once the PHE ends, many of the current flexibilities will, too: For example, established patient-physician relationship will once again be required to initiate RPM services.nnThe waiver for direct supervision of NPPs by a physician using real-time, interactive audio and video technology is cleared through “the latter of the end of the calendar year in which the PHE ends or December 31, 2021.”nnCMS added some new virtual services that NPPs will be eligible to provide G2250 (Remote assessment of recorded video and/or images submitted by an established patient) and G2251 (Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional) for providers that cannot bill E/M services.nnTransitional Care ManagementnAs part of its ongoing quest to boost utilization of transitional care services (99495-99496), CMS is unbundling 14 end-stage renal disease (ESRD) codes and chronic care management (CCM) code G2058 – which will be replaced with 99439 next year – from the service.nnThis is a breaking news story. Please check CMS for additional updatesnnSee DecisionHealth’s Blog for more details.
Dec 8, 2020 | Uncategorized
On December 1st there was an announcement made regarding Medicare Telehealth services. The Trump Administration finalized the permanent expansion of Medicare Telehealth services and improved payment for the time doctors spend with patients. Continue reading below to learn more. nnOn December 1st, the Centers for Medicare & Medicaid Services (CMS) released the annual Physician Fee Schedule (PFS) final rule, prioritizing CMS’ investment in primary care and chronic disease management by increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions. The rule allows non-physician practitioners to provide the care they were trained and licensed to give, cutting red tape so healthcare professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. This final rule takes steps to further implement President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors including prioritizing the expansion of proven alternatives like telehealth.nn“During the COVID-19 pandemic, actions by the Trump Administration have unleashed an explosion in telehealth innovation, and we’re now moving to make many of these changes permanent,” said HHS Secretary Alex Azar. “Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to healthcare in the setting that they and their doctor decide makes sense for them.”nn“Telehealth has long been a priority for the Trump Administration, which is why we started paying for short virtual visits in rural areas long before the pandemic struck,” said CMS Administrator Seema Verma. “But the pandemic accentuated just how transformative it could be, and several months in, it’s clear that the healthcare system has adapted seamlessly to a historic telehealth expansion that inaugurates a new era in healthcare delivery.”nnFinalizing Telehealth Expansion and Improving Rural HealthnnBefore the COVID-19 public health emergency (PHE), only 15,000 fee-for-service beneficiaries each week received a Medicare telemedicine service. Since the beginning of the PHE, CMS has added 144 telehealth services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that are covered by Medicare through the end of the PHE. These services were added to allow for safe access to important health care services during the PHE. As a result, preliminary data show that between mid-March and mid-October 2020, over 24.5 million out of 63 million beneficiaries and enrollees have received a Medicare telemedicine service during the PHE.nnThis final rule delivers on the President’s recent Executive Order on Improving Rural Health and Telehealth Access by adding more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the PHE, and we will continue to gather more data and evaluate whether more services should be added in the future. These additions allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services. Medicare does not have the statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their home. However, this is an important step, and as a result, Medicare beneficiaries in rural areas will have more convenient access to healthcare.nnAdditionally, CMS is announcing a commissioned study of its telehealth flexibilities provided during the COVID-19 PHE. The study will explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.nnPayment for Office/Outpatient Evaluation and Management (E/M) and Comparable VisitsnnLast year, CMS finalized a historic increase in payment rates for office/outpatient face-to-face evaluation and management (E/M) visits that goes into effect in 2021. The Medicare population is increasing, with over 10,000 beneficiaries joining the program every day. Along with this growth in enrollment is increasing complexity of beneficiary healthcare needs, with more than two-thirds of Medicare beneficiaries having two or more chronic conditions. Increasing the payment rate of E/M office visits recognizes this demand and ensures clinicians are paid appropriately for the time they spend on coordinating care for patients, especially those with chronic conditions. These payment increases, informed by recommendations from the American Medical Association (AMA), support clinicians who provide crucial care for patients with dementia or manage transitions between the hospital, nursing facilities, and home.nnUnder today’s final rule, CMS continues to prioritize this investment in primary care and chronic disease management by similarly increasing the value of many services that are similar to E/M office visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, and physical and occupational therapy evaluation services. These adjustments ensure CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients.nn“This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care,” Administrator Verma added. “In the past, the system has rewarded interventions and procedures over time spent with patients – time taken preventing disease and managing chronic illnesses.”nnIn addition to the increase in payment for E/M office visits, simplified coding and documentation changes for Medicare billing for these visits will go into effect beginning January 1, 2021. The changes modernize documentation and coding guidelines developed in the 1990s, and come after extensive stakeholder collaboration with the AMA and others. These changes will significantly reduce the burden of documentation for all clinicians, giving them greater discretion to choose the visit level based on either guidelines for medical decision-making (the process by which a clinician formulates a course of treatment based on a patient’s information, i.e., through performing a physical exam, reviewing history, conducting tests, etc.) or time dedicated with patients. These changes are expected to save clinicians 2.3 million hours per year in administrative burden so that clinicians can spend more time with their patients.nnProfessional Scope of Practice and SupervisionnnAs part of the Patients Over Paperwork Initiative, the Trump Administration is cutting red tape so that healthcare professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. The PFS final rule makes permanent several workforce flexibilities provided during the COVID-19 PHE that allow non-physician practitioners to provide the care they were trained and licensed to give, without imposing additional restrictions by the Medicare program.nnSpecifically, CMS is finalizing the following changes:nnCertain non-physician practitioners such as nurse practitioners and physician assistants can supervise the performance of diagnostic tests within their scope of practice and state law, as they maintain required statutory relationships with supervising or collaborating physicians.nPhysical and occupational therapists will be able to delegate “maintenance therapy” – the ongoing care after a therapy program is established – to a therapy assistant.nPhysical and occupational therapists, speech-language pathologists, and other clinicians who directly bill Medicare can review and verify, rather than re-document, information already entered by other members of the clinical team into a patient’s medical record. As a result, practitioners have the flexibility to delegate certain types of care, reduce duplicative documentation, and supervise certain services they could not before, increasing access to care for Medicare beneficiaries.nFor a fact sheet on the CY 2021 Physician Fee Schedule Final rule, please visit click here.nnFor a fact sheet Medicare Diabetes Prevention Program, please click here.nn2021 Physician Fee Schedule and Quality Payment Program final rule, please click here.nnOriginal article published on cms.gov
Dec 2, 2020 | Uncategorized
Medicare payment for COVID-19 vaccines is underway and CMS is currently working to make sure the vaccine is available to all Medicare beneficiaries. Continue reading below to learn more.nnQ: How much will Medicare pay for FDA-approved or emergency use authorized COVID-19 vaccines?nnA: CMS will pay $28.39 to administer a single dose vaccine.nnFor vaccines requiring two or more doses, the agency will pay $16.94 for the first dose and $28.39 for the last dose, according to the CMS toolkit.nnCMS said it hopes to enroll new Medicare providers, including pharmacies and other “mass immunizers” to help bring the vaccine to all Medicare beneficiaries.nnFor more information, see “Note from the instructor: Good news regarding COVID-19 vaccines and treatments,” by Valerie A. Rinkle, MPA, CHRI.nnRevenue Cycle Advisor combines all of HCPro’s Medicare regulatory and reimbursement resources into one handy and easy-to-access portal. News is not just repeated from other sources. It is analyzed by our Medicare experts so professionals can comprehend any new rule and regulatory updates thoroughly.nnComplete and original article published on healthleadersmedia.com
Dec 2, 2020 | Uncategorized
nnStress in the era of covid may be unavoidable. It is important to be able to recognize the different symptoms and the potential health problems that can arise if stress levels are left unmanaged. Continue reading below to learn about the symptoms of stress and different ways to mitigate it.nnIn this time of Covid, many of us are experiencing remote work and a different kind of celebration fornthe holidays., These challenges may trigger a particular biological stress response that causesnchemicals and hormones to surge throughout our bodies.nnSome of the most common physical symptoms are aches and pains, diarrhea or constipation,nnausea, dizziness, chest pain, rapid heart rate, loss of sex drive, and frequent colds or flu. Emotionalnsymptoms include depression, unhappiness, anxiety and agitation, moodiness, and irritability ornanger.nnBeing able to recognize common stress symptoms can help you manage them. Stress that is leftnunchecked can contribute to many health problems such as heart disease, high blood pressure,nobesity and diabetes.nnSo how can we relieve the stress and anxiety that we are all facing in our daily lives? Considernexercise, taking slow even deep breaths, and my favorite soak in a warm bath while listening tonsoothing music. Reducing your caffeine intake and writing down what has you most concerned cannalso reduce anxiety These are simple, easy steps that can brighten your outlook and help younimprove your health.nnDifferent people may feel stress in different ways. But remember, you are important, you matter, younare valued and most importantly, you are unique and special! We will survive Covid, and in thenprocess maybe learn how to improve our mental and physical health.
Nov 25, 2020 | Uncategorized
As we get closer to Thanksgiving, all of us at Welter Healthcare Partners are reminded of what we are thankful for. We would like to wish all of our clients, business partners, families, and friends a happy, healthy, and safe Thanksgiving! We are grateful for each of you and appreciate your support immensely.nnIn observance of the holiday, we will be closed on Thursday, November 26nd to give our employees time to enjoy the day with their loved ones. From the Welter Healthcare Partners family to yours, have a great Thanksgiving!
Nov 20, 2020 | Uncategorized
You may have questions about billing procedures after administering care via telehealth. It is important to review all information specific to your own situation before deciding on a code assignment. Continue reading below to learn more about code assignments when using telehealth.nnQ: What place of service (POS) codes and modifiers should be reported on physician claims for wound care services performed via telehealth during the novel coronavirus (COVID-19) public health emergency (PHE)?nnA: POS codes are two-digit codes that delineate the location in which services were rendered by a provider.nnWhen billing for outpatient telehealth services during the COVID-19 PHE, providers should use the POS code that they would have otherwise used had the service been provided in person.nnThe following POS codes may be reported on physician and non-physician practitioner claims for wound care services:n
n
- 11 (physician office): The wound clinic is designated as part of the physician’s office.
n
- 19 (outpatient hospital off campus): The wound clinic is hospital based but not on campus.
n
- 22 (outpatient hospital on campus): The wound clinic is designated as hospital based.
n
- Physicians billing under Medicare should use modifier -GT (via interactive audio and video telecommunication systems) to indicate that the services were rendered via synchronous telecommunication.
n
nEditor’s note: This question was answered by Gloria Miller, CPC, CPMA, CPPM, vice president of Revenue Cycle Management at Comprehensive Healthcare Solutions Inc. in Tacoma, Washington, during the HCPro webinar “Revitalize ICD-10-CM and CPT Coding for Wound Care.”nnThis answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.nn nnOriginal article published on revenuecycleadvisor.com
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
n
- 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.
n
- PLA code 0202U, effective May 20, 2020, is used to report the BioFire® Respiratory Panel 2.1 (RP2.1) test.
n
- Code 87426 is used to report infectious agent antigen detection by immunoassay technique of SARS‐CoV and SARS‐CoV‐2.
n
- 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.
n
- 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.
n
- Code, 86413, was created for reporting quantitative antibody detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).
n
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
n
- 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.
n
- 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.
n
- 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.
n
- 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
n
- Coronavirus (SARS‐CoV‐2): Long descriptors (PDF)
n
- Coronavirus (SARS‐CoV‐2): Medium descriptors (PDF)
n
- Coronavirus (SARS‐CoV‐2): Short descriptors (PDF)
n
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
n
- Codes, descriptors and purpose
n
- Clinical examples
n
- Description of the procedures
n
- FAQs
n
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.
