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Tag Archives: Services

More Changes Ahead for Evaluation and Management Services

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Changes to payment, coding, and documentation policies for evaluation and management (E/M) services finalized in the 2019 Physician Fee Schedule (PFS) final rule are necessary to align with the American Medical Association’s (AMA) revisions to the 2021 CPT code set for office/outpatient E/M visits, according to the Centers for Medicare & Medicaid Services (CMS). The proposed policy changes for E/M […]

The post More Changes Ahead for Evaluation and Management Services appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Reporting Bilateral Services: Conflicting Information Causes Confusion

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Payer-specific rules — especially rules that vary for every claim — not only make collecting revenue difficult, but also add to the cost of collection of monies earned by the physicians. A blog clarifies Novitas’ instructions for reporting modifier 50 when bilateral procedures are performed. The instructions from Novitas state that bilateral services should be […]

The post Reporting Bilateral Services: Conflicting Information Causes Confusion appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Medicare Diabetes Prevention Program: Coding Pre-Diabetes Services

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A new Medicare program aims to reduce the risk of type 2 diabetes (T2DM) in patients 60 and older by 71 percent. The goal of the Medicare Diabetes Prevention Program (MDPP), rolled out last year by the Centers for Medicare & Medicaid Services (CMS), is to help patients achieve at least 5 percent weight loss. Obesity […]

The post Medicare Diabetes Prevention Program: Coding Pre-Diabetes Services appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Preventing denials of RPM and related services

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First Coast Service Options Inc. (First Coast) wants to ensure you avoid common denials related to “Remote physiologic monitoring (RPM)”, RPM treatment management and digitally stored data services. 

These services are relatively new and have specific coding requirements that must be strictly followed to prevent denials and reduce appeal delays.

Let’s look at each type of service.

RPM services:

Report these services using the following Current Procedural Terminology (CPT®) codes,
  • CPT code 99453 — Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; setup and patient education on use of equipment
    • Used to report the setup and education of the device
  • CPT code 99454 — Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
    • Used to report supplying the device for the monitoring

Collection and interpretation of the remotely captured data only (without treatment or management) is reported with CPT code 99091

For RPM treatment and management services, use CPT code 99457

RPM limitations:

  • Do not report these codes in conjunction with codes for more specific physiologic parameters [e.g., CPT code 93296 (implantable, insertable, and wearable cardiac device evaluations), CPT code 94760 (measure blood oxygen level)]
  • May not be reported when provided with other monitoring services (e.g., CPT 95250 for continuous glucose monitoring)

Additional points of consideration:

  • Do not report CPT codes 94002-94004 (ventilator management codes) in conjunction with these services

For More Information: Click Here 


Coding Ahead

Connecticut Diagnostic Services Provider Settles Case Involving False Claims

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On November 19, 2018, Southern Connecticut Vascular Center, LLC (SCVC), Stratford, Connecticut, entered into a $ 792,076.76 settlement agreement with OIG. The settlement agreement resolves allegations that SCVC submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which SCVS submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the submission of claims for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.

The post Connecticut Diagnostic Services Provider Settles Case Involving False Claims appeared first on The Coding Network.

The Coding Network

Addiction Services Billing

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We are looking for some coding guidance for addiction services in Kentucky. If an MD is providing services of H0038 or 90832, Kentucky MCO’s are denying as non covered. Wouldn’t an MD be allowed to provide the behavioral health services?

We also have E&M levels (med checks) denying as bundled because of individual therapy and/or case management. Should we bill E&M with Z79.891 as diagnosis to unbundle?

How does a group becoming a BHSO affect billing?

Thanks for any help!

Medical Billing and Coding Forum

Telephone services

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My provider is constantly doing phone consults for new issues for established patients over the phone. He spends anywhere from 10-30 mins usually on the phone with patients talking them through their issues. THEY’VE NEVER SEEN US IN THE OFFICE FOR THIS PROBLEM! I believe he should be reimbursed for these phone visits. Is there any way to bill for these?????

Medical Billing and Coding Forum

Telehealth, Other Services Changed in Medicare Advantage

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Medicare Advantage (Part D) enrollees  have additional telehealth benefits thanks a final rule released by the the Centers for Medicare & Medicaid Services (CMS). Telehealth Expanded Under New Rule Starting in 2020, Medicare Advantage enrollees will be able to access providers through electronic devices, such as their computers, computer pads, and smart phones from their […]

The post Telehealth, Other Services Changed in Medicare Advantage appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Excluded services and discounts

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Looking for some guidance on this scenario:

We bill $ 528.00 on a certain procedure code to every insurance company (commercial or Medicare). Based on our individual agreement with those insurances, we write off the difference to get down to our contracted amount (when it is a covered service). However, there are some commercial companies that consider the procedure investigational and/or not a covered benefit, and deem it "non-covered" and patient responsibility.

Can we offer a discounted price to those patients whose insurance does not cover that procedure, as long as the discounted price is the same for un-insured patients?

My physician has concerns about us having "different fee schedules", however the way I see it, we have *one* fee schedule ($ 528.00 billed to all carriers), and we simply offer our own discount when it is non covered, rather than the contracted amount (or making the patient pay the entire amount).

I have tried looking for this on the OIG website, but so far all I have been able to find is reference to un-insured patients.

Any thoughts are appreciated, as well as any links to specific sites (including the OIG).

Medical Billing and Coding Forum