2021 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

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Special Rules Apply to Endoscopic Sinus Surgeries

The multiple surgery calculation for nasal endoscopy codes is changed when multiple nasal endoscopies are performed in the same session on the same day. For Calendar Year 2020, instead of paying the multiple surgeries at 50 percent, surgeons will be … For more, read here: AAPC Blog Related Posts:New Rules Issued for Modifiers 59, XE, XS, XP, and XUAuditing Postoperative Sinus DebridementsCMS Proposes Payment Changes to Endoscopic Sinus CodesICD-10 Guidelines: Sometimes You Have to Break the Rules

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Helping Substance Abusers Via Telemedicine

The U.S. Drug Enforcement Administration (DEA) missed its deadline for creating regulations for a special registration process for prescribing controlled substances via telemedicine. What Is the Ryan Haight Online Pharmacy Consumer Protection Act? T… For more, read here: AAPC Blog Related Posts:Telemedicine Offers Benefits to Providers

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OIG Expects to Recover $5.9B in Healthcare Fraud

The Office of Inspector General (OIG) expects a banner year in recoveries stemming from fraud investigations and audits. According to the OIG semiannual report, released Dec. 2, the U.S. Department of Health and Human services (HHS) stands to recoup a… For more, read here: AAPC Blog Related Posts:Michigan Surgeon Accused of $60M Billing FraudAnthem Investigator Charged with FraudMillennials and Their Healthcare AccessHealthcare Job Growth Greatest in 2018

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Prevent Medicare Claims Denials in 2020

Medicare has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI) in place of Social Security Numbers (SSNs) for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s Socia… For more, read here: AAPC Blog Related Posts:Changing the Way Medicare Pays DoctorsCMS Goes After Medicare Advantage OverpaymentsOIG Uncovers Medicare Overpayments for Chronic Care…Medicare Part D Prescription Drug Model to Change in 2020Appeals Backlog Gone in 4 Years: Medicare

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Is Direct Primary Care the Answer?

Direct primary care (DPC) is one of the newer forms of plans offered by primary care providers to their patient populations. Some see DPC as an alternative to traditional third-party payment for care and other more recent models such as concierge med… For more, read here: AAPC Blog Related Posts:Bundled Payments Reduce Care CostOIG Uncovers Medicare Overpayments for Chronic Care…98point6 Wants to be Amazon Prime of Primary Care3 Issues in 2019 Virtual CareHow to Document E/M with Counseling and Coordinating Care

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OIG Uncovers Medicare Overpayments for Chronic Care Management Services

Chronic care management (CCM) services are services that do not involve face-to-face patient/provider contact. The Centers for Medicare & Medicaid Services (CMS) implemented Medicare coverage for CCM in Jan. 1, 2015. There are very specific guid… For more, read here: AAPC Blog Related Posts:2021 Physician Fee Schedule Final Rule – Prolonged ServicesBundled Payments Reduce Care CostAMA on Evaluation and Management Guidelines3 Issues in 2019 Virtual CareAppeals Backlog Gone in 4 Years: MedicareCMS Goes After Medicare Advantage Overpayments

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How Many Units of 95165 Can You Bill, Really?

Three credible sources give three different answers, and only one is right. The definition for billing units of allergy serum preparation for patients was recently challenged by a colleague of mine who works in the allergy space. Are there limitations… For more, read here: AAPC Blog Related Posts:Billing 95165 Is Nothing to Sneeze At

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Incident-to Billing May Be Eliminated

Incident-to billing for advanced practice providers (nurse practitioners, physician assistants, clinical nurse practitioners, nurse midwives, etc.) has been available to limited license practitioners s… For more, read here: AAPC Blog Related Posts:Billing 95165 Is Nothing to Sneeze AtHMA Pays $260 M for False Billing and KickbacksMichigan Surgeon Accused of $60M Billing Fraud2 Tips for Billing a Physician Assistant as…

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