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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Modifier 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 Related Posts:Using Modifier 95 for Telehealth Makes Cents

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Check Your FESS Claims for Improper Payment Adjustments

MACs may be applying the multiple endoscopy rule incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endosco… For more, read here: AAPC Blog Related Posts:CMS Proposes Payment Changes to Endoscopic Sinus CodesPrevent Medicare Claims Denials in 2020

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New Medicare Cards Initiate Phishing Scam

Medicare patients are receiving calls from telephone solicitors who are phishing for private identification information for nefarious purposes. The ruse is facilitated by the issuance of new Medicare cards. Here’s How the Scam Goes Down The callers c… For more, read here: AAPC Blog Related Posts:OIG Uncovers Medicare Overpayments for Chronic Care…Medicare Telehealth Coding as of April 30CMS Goes After Medicare Advantage OverpaymentsPrevent Medicare Claims Denials in 2020

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New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in t… For more, read here: AAPC Blog Related Posts:Prevent Medicare Claims Denials in 2020MDM – New Problem to Examiner or Patient?

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Multiple Endoscopy Rule Examples

In my last blog “Special Rules Apply to Endoscopic Sinus Surgeries,” I discussed the change to the Multiple Endoscopy Rule for multiple surgeries when performed within the family of endoscopic sinus codes. How Does the Multiple Endoscopy Rule Affect … For more, read here: AAPC Blog Related Posts:2021 Physician Fee Schedule Final Rule – Prolonged Services

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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 Fraud

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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:Is Direct Primary Care the Answer?New Medicare Cards Initiate Phishing Scam2021 Physician Fee Schedule Final Rule – Prolonged ServicesMedicare Telehealth Coding as of April 30Reporting Bilateral Services: Conflicting Information Causes…Prevent Medicare Claims Denials in 2020

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