There are over 300 changes you need to know. KEY TAKEAWAYS Knowledge of coding updates is essential for everyone from the biller to the revenue cycle leader. The 2024 CPT…
Using time to determine evaluation and management code levels THE AMERICAN MEDICAL ASSOCIATION (they own the CPT code set) in January of 2021 changed the criteria for determining the proper…
Refinements continue for the evaluation and management (E/M) office-visit and outpatient documentation and coding reforms that took effect this year, and these include technical corrections updates to the Current Procedural…
Merriam-Webster, which tracks changes to the evolution of the English language, added 535 new words and terms to its dictionary this year, such as “COVID-19,” “physical distancing” and “self-isolate.” E/M…
Modifier 25 is a particularly meaningful coding tool for physicians who bill for evaluation and management (E/M) services. CPT guidelines define the 25 modifier as “Modifier 25 is defined as…
While many people make plans for a new year, it's also time to prepare for the new 2020 Current Procedural Terminology (CPT) codes. That means reviewing CPT coding changes, learning…
Too little attention is paid to documentation, coding, and billing in many medical practices. For patients, documentation simply means that your doctor is providing an account of your visit in…
The "early release" of the Category I vaccine product codes prior to publication of CPT® 2006 was approved by the CPT Editorial Panel. In recognition of the public health interest in…
According to report published by Grand View Research, Rising importance of evidence-based medicine, pharmacoeconomic risk benefit analysis of different drugs and medical devices, and insurance settlements are major factors driving…
The American Medical Association revealed the 2019 Current Procedural Terminology code set, which includes significant changes to CPT codes and descriptors. Here's what you should know: 1. The AMA changed…
Change is never-ending for ambulatory surgery centers (ASC's). ASCs need to always stay on top of the seemingly nonstop influx of contractual and coding changes, which can have a direct…
Healthcare organizations are constantly producing and collecting medical data to help treat patients more effectively, and are also using the data for analytics purposes such as population health. Organizations need…
Keys to the Right Diagnosis Coding Diagnosis coding is the forgotten stepchild in medical practices. Physician coding has focused on Current Procedural Terminology codes, which drives revenue when services are…
The Centers for Medicare and Medicaid Services has just released a fact sheet on preparing for ICD-10. This latest message offers suggestions for providers whose information systems may not be…
Take a hint from a CPT®’s global period when choosing between modifiers 25 or 57
Contrary to popular thinking, modifier 57 does not apply exclusively for consultation codes only. Medicare may have stopped paying for consult codes, but this doesn’t mean you have to stop using modifier 57. Here are two tips on how you can use this modifier to suit your practice’s needs.
Background: Starting January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) eliminated consult codes from the Medicare fee schedule.
Non-Consult Inpatient Codes Keep Modifier 57 Alive
With CMS eliminated consult codes (99241-99245, 99251- 99255) for Medicare patients, you might have wondered if modifier 57 (Decision for surgery) would remain useful. The answer? You can still use this modifier for a non-consult inpatient E/M code, so long as your documentation supports it. This is because any major procedure includes E/M services the day before and the day of the procedure in the global period, says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “The only way you can be paid properly for an E/M performed the day before the major surgery or the day of the surgery is to indicate that it was a decision for surgery (modifier 57), which also indicates to the payer that the major procedure was not a pre-scheduled service,” she explains.
Past: Say the pulmonologist carries out a level four inpatient consult in which she figures out the patient requires thoracoscopy with pleurodesis for his recurring, persistent pleural effusion (511.9). The physician decides to perform thoracoscopy with pleurodesis the day after the consult. In this case, appending modifier 57 to the E/M code (99254, Inpatient consultation for a new or established patient, which requires these 3...
Boost co-surgery, multiple surgery, and bilateral surgery pay for these select procedures
You’ll no longer have to eat the cost of your services if your physician acts as co-surgeon on spine revisions. Thanks to several Fee Schedule changes that CMS recently enacted. CMS had good news in MLN Matters article MM7430, which had an effective date of Jan. 1, 2011 and an implementation date of July 5, 2011.
Look for Potential Co-Surgery Payment for These Codes:
CMS will change the co-surgery indicator for spine revision codes 22212 and 22222 from “0” to “1”. Keep in mind that supporting documentation is required when billing for a co-surgeon with these procedures, so don’t forget to submit that with your claim or you’ll be looking at bad news.
Remember: If you’re billing for co-surgery, append modifier 62 (Two surgeons) to your procedure code. For modifier 62 claims, most payers pay an additional fee (generally 125 percent of the “usual” fee for the procedure, split evenly between the two surgeons). Avoid reimbursement problems by checking these claims carefully. To claim co-surgeons, each surgeon must perform a distinct portion of a single CPT procedure, and each surgeon must dictate and submit his own operative report for his portion of the surgery.
Benefit From Surgical Assist Changes:
Practices that perform sinus endoscopies will also get a potential boost from the fee schedule changes, now that you’ll see the assistant at surgery indicator change for codes 31233 and 31235 from “1” (Assistant at surgery may not be paid) to “0” (Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity).
You’ll append modifier 80 to the assistant’s surgical codes if the assisting surgeon is a physician. In cases when a non-physician assists at surgery on Medicare patients, append...