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Evaluation and Management (E/M) Services - Domiciliary or Rest Home Environment

Domiciliary, Rest Home, or Custodial Care Services CPT codes 99324 - 99337 Domiciliary, Rest Home (e.g. Boarding Home), or Custodial Care Services, are used to report E/M services to individuals residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis.  These codes are also used to report E/M services in an assisted living facility. The facility’s services do not include a medical component. A home or domiciliary visit includes a patient History, Physical Examination and Medical Decision Making in various levels depending upon a patient’s needs and diagnosis.  The visits may also be performed as counseling and/or coordination of car, when medically necessary outside the office environment and are an integral part of a continuous of the patient's care.  The patients seen may have chronic conditions, may be disabled, either physically or mentally, making access to a traditional office visit very difficult, or may have l

Home Health (HH) Billing Updates'2022

Correction to Home Health (HH) Billing for Denial Notices The implementation of the one-time home health Notice of Admission (NOA) in calendar year 2022, every claim for a home health period of care first required the submission of a Request for Anticipated Payment (RAP). Correction to the Calculation of 60-Day Gaps in Home Health Services A sequence of related home health periods of care is defined beginning with an admission to home health services and ending when there is a 60-day gap in home health services. This 60-day gap is used by Medicare systems for two purposes. It is used to validate whether a home health period of care is correctly coded as an early or later period. It is also used to identify early periods that should pay a Low Utilization Payment Adjustment (LUPA) add-on amount. Medicare administrative contractors recently identified a minor variance between the way the 60-day gap is counted and used for these two purposes. The requirements below revise the counting meth

Diagnostic Angiography and Revascularization of Lower Extremity

The Catheterization is divided into two types and there are,  Non Selective Catheter Placement Selective Catheter Placement Non Selective Catheter Placement The non selective catheter placement is not to be coded with selective catheter placement together.  And the following to be considered as non selective catheter placement, puncture of catheter, Insertion, and placement of catheter into the aorta.  Also, if the catheter does not have any further movement it should be considered as non selective catheter placement. E.g., When the documentation shows that the catheter placement was only in the aorta, the non-selective catheter placement CPT code 36200 is to be coded. Selective Catheter Placement The selective catheter placement is advanced from the original vessel of puncture sites to another vessels and it should be considered as selective catheter placement. When the catheter is advanced and/or crossed from the aorta and it should be considered as selective catheter placement. E.g.

Pneumococcal Vaccine Claims Processing Updates April 2022

The Pneumococcal Vaccine CPT codes will be payable by Medicare. The new codes will be in the 2021 Medicare Physician Fee Schedule Database file update and the annual HCPCS update.  90677-  Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use. Which is effective for Dates of Service (DOS) on or after July 1, 2021 90671 - Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use Which is effective for DOS on or after July 16, 2021  The CPT 90677 does not apply for Coinsurance and deductible. A Medicare Administrative Contractor (MAC) will pay institutional providers for these codes based on the Type of Bill (TOB) used. The two payment methods are,        1. The Medicare Administrative Contractor (MAC) will pay these institutional providers using reasonable cost if you use the following, Hospitals (TOBs 12X and 13X) Skilled Nursing Facilities (TOBs 22X and 23X) Home Health Agencies (TOB 34X) Hospital-based Renal Dialysis Facilities (RDFS) (TOB 72X) Crit

CPT Changes in April 2022 & July 2022

New CPT Codes Included Effective From April 1st, 2022 CPT Description 0306U Oncology (minimal residual disease [MRD]), next-generation targeted sequencing analysis, cell-free DNA, initial (baseline) assessment to determine a patient specific panel for future comparisons to evaluate for MRD 0307U Oncology (minimal residual disease [MRD]), next-generation targeted sequencing analysis of a patient-specific panel, cell-free DNA, subsequent assessment with comparison to previously analyzed patient specimens to evaluate for MRD 0308U Cardiology (coronary artery disease [CAD]), analysis of 3 proteins (high sensitivity [hs] troponin, adiponectin, and kidney injury molecule-1 [KIM-1]), plasma, algorithm reported as a risk score for obstructive CAD 0309U Cardiology (cardiovascular disease), analysis of 4 proteins (NT-proBNP, osteopontin, tissue inhibitor of metalloproteinase-1 [TIMP-1], and kidney injury molecule-1 [KIM-1]), plasma, algorithm reported as a risk score for majo

COVID-19 vaccine and Monoclonal Antibody Billing for Part B Providers

Guidelines for COVID-19 vaccines and monoclonal antibodies Billing The patient can get the vaccines including of booster dose and or additional doses. The patient administered the vaccine with no out of pocket cost for both vaccines and administration of the vaccines. Vaccinate everyone, including the uninsured, regardless of coverage or network status. When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Don't include the vaccine codes on the claim when the vaccines are free. If the patient is enrolled in a Medicare Advantage (MA) plan, submit your COVID-19 vaccine and monoclonal antibody infusion claims to Original Medicare in 2020 and 2021. On or after January 1, 2022, claims for vaccine or mAb administrations for Medicare Advantage enrollees should be submitted to the Medicare Advantage plan.  For services provided to Medicare Advantage enrollees on or after January 1, 2022, contact the Medi

Fee Schedule Updates - 2022

The fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. The CMS develops a fee schedules for following services, Physicians Services, Ambulance services, Clinical laboratory services,  Durable Medical Equipment Services, Prosthetics Services, Orthotics Services, Supplies Services. The Overall, neurosurgery will receive a 3.2% payment cut in 2022. The cut stems from a lower conversion factor from $34.89 in 2021 to $33.58 in 2022.  In the final rule CMS lowered the conversion factor (CF) from $34.89 in calendar year of 2021 to $33.59 for CY 2022, a decrease of $1.30 (-3.7%).  This is due in part to the expiration of the 3.75% payment increase provided for in Year of 2021 by the Consolidated Appropriations Act of 2021 With the 2% Medicare sequester set to resume next year and additional Medicare payment cuts of up to 4% possible under pay-as-you-go rules to pay for the American Rescue Plan, providers could be facing up to 9% in payment