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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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:2021 Physician Fee Schedule Final Rule – Prolonged ServicesHMA Pays $260 M for False Billing and KickbacksMichigan Surgeon Accused of $60M Billing FraudE/M: 2019 Proposed Physician Fee Schedule – Next StepsAssistant at Surgery Modifiers Require Specific…Billing 95165 Is Nothing to Sneeze At

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Assistant at Surgery Modifiers Require Specific Documentation

Over my almost 30-year surgical coding career, the documentation for assistant surgeons consisted of only the name of the assistant surgeon in the operative note header. Most often there was no mention of the role of the assistant surgeon in the body … For more, read here: AAPC Blog Related Posts:Final PFS Rule: Documentation2 Tips for Billing a Physician Assistant as…New Rules Issued for Modifiers 59, XE, XS, XP, and XUDifferentiate Separate Procedures with Modifiers 59…E/M Documentation for Teaching Docs Changes July 1, 2019

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E/M Documentation for Teaching Docs Changes July 1, 2019

There is a change in Medicare policy forthcoming regarding evaluation and management (E/M) services documentation requirements for teaching physicians. It is important to train teaching physicians, residents, and nurses who document E/M services of a… For more, read here: AAPC Blog Related Posts:Technology Outlook in Health: 2019Assistant at Surgery Modifiers Require Specific…E/M: 2019 Proposed Physician Fee Schedule – Next StepsFinal PFS Rule: Documentation3 Issues in 2019 Virtual CareE/M Changes May Hit Podiatry and Teaching Attestation

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Technology Outlook in Health: 2019

A lot of things are happening on the technology front in healthcare. These changes will impact medical coding and billing, compliance, and practice management. Health Technology – Amazon It starts with Amazon’s announcement that they are going to join… For more, read here: AAPC Blog Related Posts:E/M: 2019 Proposed Physician Fee Schedule – Next Steps3 Issues in 2019 Virtual CareE/M Documentation for Teaching Docs Changes July 1, 2019

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No Changes to E/M Payment Until at Least 2021

The 2019 Physician Fee Schedule and Quality Payment Program final rule has come out. The Centers for Medicare & Medicaid Services (CMS) announced they are not going to make changes to payment for E/M until at least 2021. CMS Administrator Seema V… For more, read here: AAPC Blog Related Posts:2021 Physician Fee Schedule Final Rule – Prolonged ServicesCMS Proposes a Single E/M Payment, Streamlined Doc…CMS Proposes Payment Changes to Endoscopic Sinus Codes

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ICD-11 Includes New Sections, Benefits

As we all just implemented ICD-10 changes for 2019, ICD-11 is being worked on. Don’t worry, it is not going to be implemented next year, but it is being planned for some time after 2022, which is actually not very far away. We will have just gotten us… For more, read here: AAPC Blog Related Posts:Telemedicine Offers Benefits to Providers

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Telemedicine Offers Benefits to Providers

Deloitte did a 2018 survey of U.S. healthcare consumers and physicians, and found: 90 percent of physicians see the benefits of telemedicine technology but only 14 percent have the ability to perform video telemedicine visit capabilities right now. Of… For more, read here: AAPC Blog Related Posts:ICD-11 Includes New Sections, BenefitsHelping Substance Abusers Via Telemedicine10 Reasons to Refuse Job Counter Offers

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