Medicare
Jul 22, 2021
Helping practices thrive, not just survive.
.svg)
,
Medicare Part B Deductible is $226
Appropriate Use Criteria
Appropriate Use Criteria is when a physician orders (which includes performing in his office) an advanced diagnostic imaging study (PET, CT scan, MRI and nuclear) will not begin 01/01/2023, even if the PHE for COVID-19 ends in 2022. Until further notice, the educational and operations testing period will continue. CMS (Medicare) is unable to forecast when the payment penalty phase will begin.
Conversion Factor
The proposed 2023 conversion factor is $33.08, a decrease of $1.53 to the 2022 conversion factor ($34.61).
Evaluation and Management (E/M) Visits
Similar to the revised coding guidelines in 2021 for office and other outpatient visits, Medicare is proposing to adopt these changes in coding and documentation for other E/M visits (i.e., hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services and cognitive impairment assessment), effective 01/01/2023.
These revised coding and reimbursement guidelines will include:
· New descriptor times (where relevant)
· Revised interpretive guidelines for levels of medical decision making
· Choice of medical decision making or time to select level (except for a few families like emergency department visits and cognitive impairment assessment), which are not timed services
· Eliminate use of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam.
Telehealth Services
It appears that telehealth will potentially end 151 days following the end of the PHE. In addition, delaying the in-person visit requirement for mental health services furnished via telehealth until 152 days after the end of PHE. A new modifier (-93) will become available to indicate that a Medicare telehealth service was furnished via audio-only verses the use of Modifier -95.
Split (or Shared) E/M Visits
Medicare is proposing to delay the split (or shared) visits policy for the definition of substantive portion, as more than half of the total time, for one year with a few exceptions. The substantive portion of a visit may be met by any of the following elements:
· History
· Performing a physical exam
· Making a medical decision
· Spending time (more than half of the total time spent by the practitioners who bills the visit
Under the proposal, clinicians who furnish split (or shared) visits will continue to have a choice of history, physical exam or medical decision making, or more than half of the total practitioner time spent to define the substantive portion, instead using total time to determine the substantive portion, until 2024.
Chronic Pain Management
Medicare is proposing new codes for chronic pain management and treatment. The proposal includes:
· Diagnostic assessment and monitoring
· Administration of a validated pain rating scale or tool
· Development, implementation, revision and maintenance of a person-centered care plan
· Overall treatment management
· Facilitation and coordination of any necessary behavioral health treatment
· Mediation management
· Pain and health literacy counseling
· And more….
Audiology Services
Medicare is proposing to allow patients to have direct access, when appropriate, to an audiologist without a physician referral. A new code would indicate that the service is being furnished by the audiologist and would permit audiologists to bill the direct access (without referral) once every 12 months)
CODING CHANGES
· Observation codes (99217-99226) will be DELETED
· Nursing facility service 99318 (annual assessment) will be DELETED
· Domiciliary, rest home or home care plan oversight does 99339 and 99340 will be deleted
· Custodial care (99334-99337 for established patients and 99324-99326 for new patients will be DELETED
· New patient home visit (99343) will be DELETED
· Prolonged services (99354-99357) will be DELETED
· NEW coding for implantation of absorbable mesh and removal of sutures
· NEW code for total disc arthroplasty
· NEW codes for percutaneous pulmonary artery revascularization by stent placement and percutaneous arteriovenous fistula creation in the upper extremity
· Lots of new codes for the digestive system (esophaogastroduodenoscopy, repair of anterior abdominal hernias, repair of parasternal hernias and removal of total or near total non-infected mesh or other prosthesis)
· NEW code for laparoscopy, surgical prostatectomy, simple….
· NEW coding for the auditory system
· NEW code for diagnostic ultrasound of the nerves
AND MUCH MORE!!!!
STAY TURNED….as we will be proving webinars, seminars and on-on-one meetings to educate providers on these new changes !!!!
REVISION – prior list had a type on codes I71.4
Every year there are changes to the ICD-10 codes. Most often codes are raised to a higher level of specificity, meaning there are more digits added to particular ICD-10 codes. Below are the changes that I believe to be the most relevant. If you would like a complete list of all the changes, please let us know.
EFFECTIVE for dates of service on or after 10/01/2022
E87.20 see below for high specificity
E87.20 Acidosis, unspecified
E87.21 Acute metabolic acidosis
E87.22 Chronic metabolic acidosis
E87.29 Other acidosis
New
I25.112 Atherosclerotic heart disease of native coronary artery with refractory angina pectoris
I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
I25.792 Atherosclerosis of other coronary artery bypass grafts(s) with refractory angina pectoris
I31.3 see below for higher specificity
I31.31 Malignant pericardial effusion in diseases classified elsewhere
(Code first underlying neoplasm (C00-D49)
I31.39 Other pericardial effusion (noninflammatory)
I34.8 see below for higher specificity
I34.81 Nonrheumatic mitral (valve) annulus calcification
I34.89 Other nonrheumatic mitral valve disorders
I47.2 see below for higher specificity
I47.20 Ventricular tachycardia, unspecified
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I71.01 see below for higher specificity
I71.010 Dissection of ascending aorta
I71.011 Dissection of aortic arch
I71.012 Dissection of descending thoracic aorta
I71.019 Dissection of thoracic aorta, unspecified
I71.1 see below for higher specificity
I71.10 Thoracic aortic aneurysm, ruptured, unspecified
I71.11 Aneurysm of the ascending aorta, ruptured
I71.12 Aneurysm of the aortic arch, ruptured
I71.13 Aneurysm of the descending thoracic aorta, ruptured
I71.2 see below for higher specificity
I71.20 Thoracic aortic aneurysm, without rupture, unspecified
I71.21 Aneurysm of the ascending aorta, without rupture
I71.22 Aneurysm of the aortic arch, without rupture
I71.23 Aneurysm of the descending thoracic aorta, without rupture
I71.3 see below for higher specificity
I71.30 Abdominal aortic aneurysm, ruptured, unspecified
I71.31 Pararenal abdominal aortic aneurysm, ruptured
I71.32 Juxtarenal abdominal aortic aneurysm, ruptured
I71.33 Infrarenal abdominal aortic aneurysm, ruptured
I71.4 see below for higher specificity
I71.40 Abdominal aortic aneurysm, without rupture, unspecified
I71.41 Pararenal abdominal aortic aneurysm, without rupture
I71.42 Juxtarenal abdominal aortic aneurysm, without rupture
I71.43 Infrarenal abdominal aortic aneurysm, without rupture
I71.5 see below for higher specificity
I71.50 Thoracoabdominal aortic aneurysm, ruptured, unspecified
I71.51 Supraceliac aneurysm of the abdominal aorta, ruptured
I71.52 Paravisceral aneurysm of the abdominal aorta, ruptured
I71.6 see below for high specificity
I71.60 Thoracoabdominal aortic aneurysm, without rupture, unspecified
I71.61 Supraceliac aneurysm of the abdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the abdominal aorta, without rupture
N14.1 see below for high specificity
N14.11 Contrast-induced nephropathy
N14.14 Nephropathy induced by other drugs, medicaments and biological substances
NEW
Z79.85 Long-term (current) use of injectable non-insulin antidiabetic drugs
Initially, physician’s offices had a person in-house that handled everything having to do with billing for the practice. This person added to the overhead of the office – about 10 – 12% and handled everything from A-Z in the billing process. General knowledge of codes was all that was needed to ensure reimbursement from insurance companies as this was before managed care.
The beginning of managed care brought to the industry fee schedules, preferred provider contracts, the need for pre-authorizations and more. These changes meant a more intensive knowledge of medical codes was required as well as continuing to keep updated as codes were added and deleted. These changes increased cost and time required to handle billing.
Initially, physician’s offices had a person in-house that handled everything having to do with billing for the practice. This person added to the overhead of the office – about 10 – 12% and handled everything from A-Z in the billing process. General knowledge of codes was all that was needed to ensure reimbursement from insurance companies as this was before managed care.
The beginning of managed care brought to the industry fee schedules, preferred provider contracts, the need for pre-authorizations and more. These changes meant a more intensive knowledge of medical codes was required as well as continuing to keep updated as codes were added and deleted. These changes increased cost and time required to handle billing.
Our Complimentary Consultation is a discovery and feedback initiative built to help practices. You get one on one advice from our experts, plus a report for your practice to use, absolutely free for you.
.jpg)
After listening to what clients were asking for, a more robust system was created that covered more than just standard medical billing. This full-cycle revenue management system saved doctors time and money by eliminating the need to have different people handling all other aspects. Revenue Cycle Management includes: