Question: What level of risk is assigned when a practitioner refers a patient to a physician in another specialty? Does the complexity of the problem … [Read more...]
OIG report on telehealth during the PHE
What? An OIG report without doom and gloom? Fire and brimstone? https://youtu.be/EPJHOABNNxM Slides In February, 2024 the OIG released an … [Read more...]
Interprofessional Internet Consultations
CMS recognizes and pays for six codes for interprofessional consults codes 99446–99449, 99451, 99452 These codes were updated in 2023. Codes 99446, … [Read more...]
CPT® codes (99421-99423) – and payment for – online digital evaluation and management (E/M) services
Or, as I call them: message, manage, message. There are CPT codes for online digital E/M services. CPT developed a set of CPT® codes for use … [Read more...]
E/M frequency data for hospitalists
Hospitalists became a recognized specialty by CMS starting in 2017, and we now have frequency E/M data for the specialty. There are probably still … [Read more...]
2024 RVU table with national fee amounts
Looking for 2024 work RVUs? Wondering how much a new code pays? Look no farther. You can download the 2024 CMS national RVU table below. It does … [Read more...]
HCC coding: V24 versus V28
Medical practices are assessing the impact of the change in the HCC model from V24 to V28, a phased in change that begins in 2024. CMS pays … [Read more...]
CMS’s 2024 shared or split services policy: document and report them correctly
In 2024, CPT expanded its definition of split/shared services, CMS updated their requirements. CPT expanded its definition of split/shared … [Read more...]
Facility versus Non-Facility in the Physician Fee Schedule
Understanding facility versus non-facility in the physician fee schedule explains the RVU and payment differences that practices receive when … [Read more...]
CMS will implement G2211 in 2024
CMS will pay for add-on code G2211 in 2024 (effective date 1-1-2024) Table of Contents Not all visits Clinician’s relationship with the … [Read more...]
HCPCS Code G0136 for Assessment Social Determinants of Health (SDoH)
This is information from the 2024 Physician Fee Schedule Final Rule, released Nov. 2, 2023. New CPT and HCPCS codes, and CMS policy changes are … [Read more...]
CMS Adopts HCPCS codes for Community Health Integration (CHI) services
This is information from the 2024 Physician Fee Schedule Final Rule https://public-inspection.federalregister.gov/2023-14624.pdf The effective … [Read more...]
Medicare Advantage Plan Network Issues
Question: My sister is thinking of enrolling in a Medicare Advantage plan. In our practice, we have issues with pre-authorizations and denials. I’ve … [Read more...]
How do we code for “meet and greet” visits?
Question: What code can I use when a patient presents to establish care, and doesn’t have any symptoms or problems? Answer: First, code or … [Read more...]
Is ChatGPT Coming to Coding?
Question: What’s all this I hear about ChatGPT? Is it coming to coding? Answer: All right, I wrote that question myself. I’ve been thinking … [Read more...]
Coding Mattersâ„¢
Health care coding news matters to coders, billers administrators and practitioners in medical practices. Often, there’s new beyond new codes or new … [Read more...]
CMS Finalizing Principal Illness Navigation (PIN) Services
This is information from the 2024 Physician Fee Schedule Final Rule https://public-inspection.federalregister.gov/2023-24184.pdf CMS developed … [Read more...]
CMS Adopts Codes for Caregiver Training Services (CTS)
This is information from the 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023. You can read it for yourself by downloading the pdf … [Read more...]
RHC and FQHC Update
Background Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) have specific rules related to coding for service in their … [Read more...]
Medicare Coverage for Marriage and Family Therapists and Mental Health Counselors
In the Consolidated Appropriations Act, 2023 Congress mandated that Medicare provide coverage and payment for the services of health professionals who … [Read more...]
Coding for telehealth – Overview
Update: Medicare telehealth payment policies The public health emergency federal designation expired March 11, 2023 However, the end of the … [Read more...]
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