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Level of Concern Rises as RACs are Back

Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2,…

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August 5, 2019
CPT 2011 / Hot Coding Topics / Provider News

Look Up New Observation Codes When Reporting ‘Middle Days’

2011 brings a new coding option when reporting the middle day of observations that last longer than two days. Check out this expert advice on how CPT additions will affect your FP’s observation care services coding starting on Jan. 1, 2011.

Until this point, coding for the “middle days” of an observation service caused problems. Although not the norm, there are times when a physician admits a patient to observation and she remains in that status for three or more days. CPT 2011 addresses these middle days between admission and discharge by introducing three new E/M codes. The additions parallel the hospital subsequent care series in terms of component requirements and time frames:

  • 99224 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99225 — … an expanded problem focused interval history; an expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/ or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99226 — … a detailed interval history; a detailed examination; Medical decision making of high complexity. Counseling and/or

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February 6, 2011
Coder's Cranium

Here’s How You Can Bill The Correct New G Code

If you find choosing the right G code for your claims difficult, help is at hand.

Starting Jan. 1, CMS is requiring eight new billing codes in addition to the existing six codes for home health agency services. Those include new nursing codes for RN management and evaluation of the plan of care (G0162), LPN or RN observation and assessment (G0163), and LPN or RN training and education (G0164). CMS is revising G0154 to cover only direct skilled care by an RN or LPN, CMS notes in Dec. 17 Transmittal No. 824 (CR 7182).

“We recognize that, in the course of a visit, a nurse or qualified therapist could likely provide more than one of the nursing or therapy services reflected in the new and revised codes,” CMS says.

But “HHAs must not report more than one G-code for the nursing visit regardless of the variety of nursing services provided during the visit.” The same goes for therapy.

“In cases where more than one nursing or therapy service is provided in a visit, the HHA must report the G-code which reflects the service for which the clinician spent most of his/her time,” CMS instructs. Hopefully this will ease providers’ concerns, voiced at the most recent home health Open Door Forum, about how to choose the right code.

“If direct skilled nursing services are provided, and the nurse also provides training/education of a patient or family member during that same visit, we would expect the HHA to report the G-code which reflects the service for which most of the time was spent during that visit,” CMS says in the transmittal. “Similarly, if a qualified therapist is performing a therapy service and also establishes a maintenance program during the same visit, the HHA should report the G-code which reflects...

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January 3, 2011
Coding Challenge / Hot Coding Topics / modifier 25

Is 99211 + 95115 OK?

Question: If a nurse has to check vitals to make sure an allergy injection is the correct quantity or if she has to educate the patient about the administration or side effects of the injections, we’ve been billing 99211 with 95115 or 95117. There is...

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December 6, 2010
CPT / CPT 2011 / Hot Coding Topics

Hip Arthroscopy, Observation Receive CPT 2011 Coding Updates

2991x, 9922x medical procedure CPT 2011 codes added.

If you’ve been frustrated about the lack of arthroscopic hip surgery codes that CPT offers, CPT 2011 will change that, with three new codes that debut on Jan. 1.

In fact, CPT will introduce over 200 new codes in 2011 to help keep your coding more specific than ever, spanning several categories, from dermatology to orthopedics to cardiology, and beyond.

In orthopedics, you’ll benefit from the following three hip arthroscopy codes, which will be excellent additions to CPT.

  • 29914 – Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
  • 29915 – Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
  • 29916 – Arthroscopy, hip, surgical; with labral repair

Check out New Observation Codes

CPT adds to your E/M coding options with the introduction of three new observation codes, as follows:

  • 99224 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99225 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or

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September 30, 2010