What to do when the pathology doesn’t correlate to the service provided. The rules for cutaneous (skin) excision coding are straightforward: When the pathology for a lesion is benign, code for excision of benign lesion, 11400-11446; and when the patho… For more, read here: AAPC Blog
Continue ReadingInterview on Podcast – Life as a Coder ~ Breaking down the Global Package for ENT Services and More
Jennifer McNamara interviews Barbara Cobuzzi on Life as a Coder. They talk about the global package as it applies to ENT services. Also reviewed is the new encoder, Coding Advisor by Barbara Cobuzzi and what Barbara has been doing lately as she consults and provides expert witness services in the coding, billing, revenue cycle and compliance space…
Continue ReadingCDI Tips for Diagnostic Endoscopies
CPT® guidelines offer clues for what payers and auditors are looking for in op notes. When reading notes or auditing documentation associated with the performance of diagnostic endoscopies performed by otolaryngologists (e.g., 31231, 31575, 31525, … For more, read here: AAPC Blog
Continue Reading2021 Physician Fee Schedule Final Rule – Prolonged Services
by Barbara J Cobuzzi The 2021 Physician Fee Schedule Final Rule was published by CMS on Tuesday December 1, 2020. (https://www.cms.gov/files/document/12120-pfs-final-rule.pdf) There were not many surprises since we had the Proposed Rule to review during the late summer/early fall. But one new item was introduced as part of the 2021 Outpatient E&M Documentation changes that was not expected and that was the introduction of CMS code G2212, “Prolonged office or other outpatient evaluation and management service(s) beyond maximum required time of the primary procedure which as 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 or 99215 for office or other outpatient evaluation and management services)”. G2212 replaces AMA CPT code 99417 for Medicare Part B patients. The AMA description of 99417, “Prolonged office or other outpatient evaluation and management service(s) beyond minimum required time of the primary procedure which as been selected using total time requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each additional 15 minutes of total time (list separately in addition to CPT codes 99205 or 99215 for office or other outpatient evaluation and management services)” Comparing the definitions of G2212 and 99417 it appears at first blush, that they are they are the same. But in reality, one word difference in the two definitions is what sets them apart and… Read More
Continue ReadingModifier 59 Is Over-Used and Abused, MAC Says
Failure to adopt the X[ESPU] modifiers may be putting your practice at risk for Medicare fraud. Modifier 59 Distinct procedural service continues to be the most-used modifier among Medicare Part B providers, according to Novitas, and it is sending up … For more, read here: AAPC Blog
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