Medical Coding Rights

 Modifier 25  Significant, separately identifiable evaluation and management [E/M] service by the same physician or Other Qualified Health Care Professional on the same day of the service  Modifier 25 is appended to an E&M service, when performed 0 days and or 10 days global period - (never to a procedure)  Example 1:   A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. The patient has a history of hypertension and high cholesterol. After the physician completes an office visit it is determined that the patient needs a cardiovascular stress test that is performed on same day by the same physician.  The physician codes an E/M visit (99201 – 99215) and he also codes for the cardiovascular stress test (93015). The modifier 25 is added to the E/M visit to indicate that there was a separately identifiable E/M on the same day of a procedure.  The modifier stops the bundling of the E/M visit into the procedure. When reviewing

The national public health emergency has been extended from April 20, 2021, to July 19, 2021. Below is an overview of how that extension affects temporary provisions for COVID-19 testing and testing-related services for major payers UHC Individual Exchange, Individual and Group Market health plans: From Feb. 4, 2020 through the national public health emergency period, UnitedHealthcare is waiving cost sharing for in-network and out-of-network COVID-19 tests and testing-related services, including testing-related telehealth visits. Medicare Advantage: From Feb. 4, 2020 through the national public health emergency period, UnitedHealthcare is waiving cost sharing for in-network and out-of-network tests for COVID-19. Medicaid : State-specific rules and other state regulations may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website, if applicable. Aetna Aetna’s liberalized coverage of Co

Prolonged Service Use 99417 & G2212 in conjunction with 99205, 99215 and do not report 99417 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416 Do not report 99417 for any time unit less than 15 minutes.  The payers will not reimburse you unless you report it with an appropriate primary code because this code is an add–on code,  Confirm payer coverage and requirements for this code. Medicare requires this code G2212 in place of +99417. Private payers require this code 99417 in place of G2212 As an example of proper use, when coding based on time, you report 99205 for a new patient visit lasting 60 to 74 minutes. Once the time reaches 89 minutes, you also may report +G2212 because 89 minutes is 15 minutes beyond the maximum required time of 74 minutes. When coding based on time, you report 99205 for a new patient visit lasting 60 to 74 minutes. Once the time reaches 75 minutes, you also may report +99417 because 75 minutes is 15 minutes beyond the minimum requir

 The AMA conducted a peer-reviewed study to determine the amount of time that could be saved after CMS’ changes for E/M encounters are fully implemented.  They found that the changes would bring a conservative reduction of 2.11 minutes per visit. Assuming a physician sees 20 patients per day, physicians would gain about 42 minutes a day to focus on patient care. Reduce administrative burden on documentation and coding Reduce the need for audits by adding and expanding key definitions and guidelines Reduce documentation in the medical record that is not needed for patient care Keep payment for E/M resource-based and eliminate the need to redistribute payments between specialties Deletion of level outpatient visit CPT code 99201 Summary of Revision E&M 2021 Eliminate documentation of the history and physical exam as components for E/M code selection, however, AMA asked the providers should continue the documentation part of the history and physical exam in order to evaluate the patie

All Medicare providers and suppliers who requested and received CAAPs that we began recovering those payments as early as March 30, 2021, depending upon the 1 year anniversary of when you received your first payment.  It also gives information on how to identify recovered payments.  Title V (Section 2501) of the Continuing Appropriations Act, 2021 and Other Extensions Act, enacted on October 1, 2020, amended the CAAP repayment terms for all providers and suppliers who requested and received CAAPs during the COVID-19 PHE and established a lower interest rate of 4% for any demanded overpayments to recover CAAP balances due.  The CAAP repayment terms provide as follows, Repayment begins 1 year starting from the date we issued your first CAAP. Beginning 1 year from the date we issued the CAAP and continuing for 11 months, we’ll recover the CAAP from Medicare payments due to providers and suppliers at a rate of 25%. After the end of this 11 month period, we’ll continue to recover the remain

The CPT Editorial Panel has released early an additional five new codes in the Medicine/Vaccine, Toxoids section of the AMA’s CPT Codes.  The following codes are effective from July 1, 2021, but won’t be published until CPT 2022, 90626 Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use 90627 Tick-borne encephalitis virus vaccine, inactivated; 0.5 mL dosage, for intramuscular use 90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use 90677 Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use 90758 Zaire ebolavirus vaccine, live, for intramuscular use These codes will be listed out of sequence. Medicare coverage will be determined by the Centers for Medicare & Medicaid Services in future rulemaking.

Reimbursement Guidelines for Depression Screening - CPT G0444 Depression screening CPT G0444 can't be coded with CPT G0402 & G0438 but you may report with CPT G0439. NCCI edits stated as "Code G0444 is a column 2 code for G0402. You may not override the edit". Details of the CPTs, G0444 - Annual depression screening, 15 minutes G0402 - Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment G0438 - Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit Nationally Covered Indications: CMS will cover annual screening up to 15 minutes for Medicare beneficiaries when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up.  At a minimum level, staff assisted supports consist of clinical staff (e.g., physician assistant, nurse) in the primary care setting who can advise the physicia