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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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 FraudHealthcare Job Growth Greatest in 2018Millennials and Their Healthcare Access

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OIG to Audit Risk Adjustment Coding

Consistent with previous reporting, the Office of Inspector General (OIG) has added to its 2020 Work Plan a targeted audit of Medicare Advantage (MA) programs for risk adjustment diagnosis codes. This is not the first time federal agency has targeted … For more, read here: AAPC Blog Related Posts:Will Computer-Assisted Coding Make Coders Obsolete?Coding News

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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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2 Tips for Billing a Physician Assistant as Assistant Surgeon

A physician assistant (PA) serves as an assistant surgeon only to suture and close an incision. There is no documentation that the PA performed any other function to assist the primary surgeon during the surgery performed on the Medicare patient, suc… For more, read here: AAPC Blog Related Posts:HMA Pays $260 M for False Billing and KickbacksE/M: 2019 Proposed Physician Fee Schedule – Next StepsIncident-to Billing May Be EliminatedCyber Threats to Physician Practices Are GrowingMichigan Surgeon Accused of $60M Billing FraudBilling 95165 Is Nothing to Sneeze At

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CMS Goes After Medicare Advantage Overpayments

The Centers for Medicare & Medicaid Services (CMS) knows that a significant amount of money is being overpaid to insurance companies in the Medicare Advantage program, but they have yet to recover these overpayments. That’s about to change. CMS sa… For more, read here: AAPC Blog Related Posts:Changing the Way Medicare Pays DoctorsMedicare Part D Prescription Drug Model to Change in 2020OIG Uncovers Medicare Overpayments for Chronic Care…Appeals Backlog Gone in 4 Years: MedicarePrevent Medicare Claims Denials in 2020

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CMS Proposes Payment Changes to Endoscopic Sinus Codes

The Centers for Medicare & Medicaid Services (CMS) is proposing major payment changes to sinus endoscopy services. The 2020 Physician Fee Schedule (PFS) proposed rule includes the following excerpt: We are proposing to apply the special rule for m… For more, read here: AAPC Blog Related Posts:CMS Proposes a Single E/M Payment, Streamlined Doc…Special Rules Apply to Endoscopic Sinus SurgeriesAuditing Postoperative Sinus DebridementsCMS Proposes Add-on Codes for E/M ServicesNo Changes to E/M Payment Until at Least 2021

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