Medical Coding Rights

The CMS released new updates in January 2023 for the medicare fee schedule summary for telehealth services.  The updates are effective from January 1, 2023 and the implemented date is January 3, 2023.  The major changes are Medicare Physician Fee Schedule and mentioned following four category and every providers, coders and billing staff knows this guidelines and changes. Telehealth originating site facility fee payment amount Expansion of coverage for colorectal cancer screening Coverage of Audiology services Other covered services The Medicare will continue to pay the telehealth service payment at same rate in person outpatient fee rate through out end of the 2023, And there is no changes and or decrease the fee rate.  And also, the Medicare will continuously paying the audio visit service CPT code 99441, 99442 & 99443 at the same rate of outpatient established office rate for the length of service/time spends with the patient. For Medicare patients, the provider would continue

CPT Code History & Guidelines There are three CPT codes are available, 90901 -  Biofeedback training by any modality 90912 - Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient +90913 - Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (List separately in addition to code for primary procedure) The CPT 90911 was deleted in 2022 and the CPT  90912 & +90913 was added in Jan'2020. The purpose of this codes added, The provider or other qualified healthcare professional will be trained the patients to control of involuntary bodily functions. There are, Altering brain activity, Blood pressure, Heart rate, and Othe

The Centers for Medicare and Medicaid services are allowed to submit claims with 12 diagnoses in CMS 1500 form. However, some of the practice management systems will limit the diagnoses to fewer than 12 diagnoses. If any practice management system limits the number of diagnoses to fewer than 12 and the supplemental claims can be submitted with E&M Codes with $ 0.01 or $0.00 based on whether the system allows it. Billing and Coding Guidelines The simple question is, how to capture all the diagnosis and billed it out to Florida Blue Insurance?.    Submit a second line item with CPT 99080 other than the first 12 diagnoses. Initially, the BCBS accepted only CPT 99080 for additional diagnoses but now, the BCBS insurance will allow to bill CPT 99499 as well for the additional diagnoses.  The BCBS can accept a zero-dollar charge ($0.00), or a penny charge ($0.01) if your system does not allow zero-dollar charges.    If the claim is electronic, use frequency code “0.” This code will deny a

Evaluation and Management 2021 Updates  The E&M 2021 changes primarily focused on the documentation and coding guidelines for office and outpatient visits (commonly referred to as E&M codes 99202-99215).  The main goals of these changes were to reduce administrative burden, simplify documentation, and recognize the value of cognitive work performed by healthcare professionals. Key aspects of the E&M 2021 changes included The Elimination of history and physical examination requirements as key components for code selection. The E&M guidelines now allow providers to choose the level of service based on either Medical Decision Making (MDM) or Total time spent on the encounter.  While the documentation of the history and physical examination is still important for patient care, it is not required to determine the appropriate code level but it should be documented in the medical records. A Revised guidelines for code selection based on medical decision-making (MDM. The MDM no

CPT Code Description: - 94760 - Noninvasive ear or pulse oximetry for oxygen saturation; single determination 94761 - Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise) The provider and or other qualified healthcare professional takes the oxygen  saturation using the a sensor on the ear or finger from the patients. To perform this service, the doctor places a sensor, such as one in the form of a clip, on the patient’s earlobe or fingertip. The sensor uses a light shining through the body part to measure the oxygen saturation, detecting the differences in the ways blood cells with and without oxygen reflect light.   The Oxygen saturation, is also called as O2 sat, and the percentage of hemoglobin carrying oxygen molecules.   Guidelines: - The CPT Codes ranges from 94010 to 94799 include laboratory procedure(s) and interpretation of test results. If a separate identifiable evaluation and management service is performed on the same day

The modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System). Modifier 93 is a new audio-only telemedicine code that is effective on Jan. 1, 2022. Modifier 93 describes services that are provided via telephone or other real-time interactive audio-only telecommunications systems. This modifier is appropriate only if the real-time interaction occurs between a physician/other qualified health care professional and a patient who is located at a distant site. When using this modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of face-to-face interaction. Addition of Appendix T This appendix is a listing of CPT codes that may be used for reporting audio-only services when appended with Modifier 93. Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at

Vaccine Name               CPT Code           Dosage                                                                 Age Range FluMist (LAIV4)         90672              0.2 mL (single-use nasal spray)              2 to 49 years Fluarix (IIV4)                     90686                0.5 mL (single-dose syringe)                          6 months & older FluLaval (IIV4)           90686                0.5 mL (single-dose syringe)                     6 months & older Flublok (RIV4)           90682                0.5 mL (single-dose syringe                          18 years & older Fluzone (IIV4)           90686                0.5 mL (single-dose syringe)                          6 months & older Fluzone (IIV4)           90686                0.5 mL (single-dose vial)                                    6 months & older Fluzone (IIV4)           90687                5.0 mL multi-dose vial (0.25 mL dose      6 to 35 months Fluzone