CDI 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 Related Posts:2 Tips for Billing a Physician Assistant as Assistant…

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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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Using Modifier 95 for Telehealth Makes Cents

Capture full payment for remote visits during the PHE for COVID-19. An interim final rule published in the April 6, 2020, Federal Register explains how to bill telehealth services during the COVID-19 public health emergency (PHE). The final rule goes … For more, read here: AAPC Blog Related Posts:Medicare Telehealth Coding as of April 30Modifier 59 Is Over-Used and Abused, MAC Says

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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:Prevent Medicare Claims Denials in 2020CMS Proposes Payment Changes to Endoscopic Sinus Codes

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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:MDM – New Problem to Examiner or Patient?Prevent Medicare Claims Denials in 2020

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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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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:CDI Tips for Diagnostic EndoscopiesBilling 95165 Is Nothing to Sneeze At2021 Physician Fee Schedule Final Rule – Prolonged ServicesMichigan Surgeon Accused of $60M Billing FraudIncident-to Billing May Be Eliminated

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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:2 Tips for Billing a Physician Assistant as Assistant…Differentiate Separate Procedures with Modifiers 59 and…

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