This is the second CodingIntel post about CMS proposed changes to the 2019 Physician Fee Schedule rule. If you missed it, be sure to read the first post: CMS proposes significant changes to E/M requirements We are in the comment period, and the final rule will be released in early November. Just a reminder that all of the new HCPCS and CPT codes discussed in the rule are “dummy” codes, placeholders for the codes to be released. In … [Read more...]
Billing Guide – How Physician Services are Paid
Table of Contents CPT HCPCS Modifiers NCCI Multiple procedures Fee calculation Global surgical payment Diagnosis coding A physician sees a patient in the office or treats a patient with a fracture in the emergency department and wants to get paid for this service. That shouldn’t be too much to ask, should it? The coding and reimbursement system in the United States is anything but simple and easy. This billing … [Read more...]
Billing Guide – Medicare Incident-to and Shared Services
This in depth guide reviews the requirements for billing Medicare Incident-to and shared services including: -When/where these services can be billed -Which provider number to use -Documentation requirements The following NPP (non-physician practioner) designations are covered in this material: nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse midwives. Can an NPP see a new patient? What places of … [Read more...]
Billing Guide-Preventive Medicine Services
This is the resource guide from CodingIntel's one hour course on preventive medicine. Coding for preventive medicine services should be easy, but it's not. It's complicated by frequency issues, Medicare rules and the always difficult issue of when to bill a problem oriented E/M service on the same day. If you need more information, in July, 2018, we are posting detailed information about Medicare HCPCS screening and counseling codes, … [Read more...]
CMS proposes significant changes to E/M requirements
By now, you’ve read the headlines that CMS is proposing major changes to both the documentation requirements for new and established patient visits and the payment structure for the services. I’ll try to go beyond the headlines in this post, and tell you what CMS is proposing. Of course, we know that CMS puts together proposals every year for the payment policy for the coming year. Right now we are in a comment period for these policies. … [Read more...]
Screening for depression | HCPCS code G0444
Annual depression screening code G0444 Medicare pays primary care practices to screen all Medicare patients annually for depression. The service must be provided in a primary care setting, in place of service office, outpatient hospital, independent clinic or in a state or local health department. This service is paid using HCPCS code G0444, annual depression screening, 15 minutes. The reimbursement is relatively low, about $26 for the … [Read more...]
Behavioral counseling for obesity, HCPCS code G0447
Medicare pays for ongoing face-to-face behavioral counseling for patients with a BMI of ≥ 30, who are alert and able to participate in counseling. The service may be performed by physician or non-physician practitioner (NPP) , but is also allowed to be performed buy medical practice staff incident to the services of a physician or an NPP. The national Medicare fee schedule amount is about $26. G0447 face-to-face behavioral counseling for … [Read more...]
Two visits for the price of one? | Multiple medical visits on the same day
Patients often schedule two medical appointments on the same day with physicians of different specialties. It’s convenient for them. It saves travel time. It may mean the patient or a family member only needs to take one day off work. Can a multi-specialty practice be paid for two visits, when the physicians/non-physician practitioners (NPPs) practice in different specialties? The answer should be yes. Specialty designation When … [Read more...]
Preventive Medicine Services – Medicare
Medicare has very specific requirements for preventive services. What can you bill, what must you document? This article covers all the bases including tips for billing the Welcome to Medicare and Annual and Subsequent Wellness Visits. More tips for preventive medicine and split visits can be found here. Definition Traditional Medicare does not pay for routine services reported with codes 99381—99397. Preventive Codes Medicare Covers … [Read more...]
Shared Visits – Medicare
Medicare has specific rules for billing for Nurse Practitioners, Physician Assistants as shared services in the hospital. These rules are explained in this article. Definition Evaluation and Management services which are shared or split encounters between a physician and a qualified Non-Physician Practitioner (NPP.) Medicare rule Explanation A physician and an NPP can provide shared E/M services in the hospital (inpatient, ED or … [Read more...]
Are you missing the initial annual wellness visit? | G0438
After I gave a presentation at a family medicine conference a physician said to me, “What you just told me will pay for the entire cost of my coming to this conference.” I don’t always hear that after I give a presentation. Sometimes I hear the opposite. Incorrect coding equals lost revenue The mistake he was making that was costing him money is the same mistake I saw recently in a large primary care group. It was billing a subsequent annual … [Read more...]
Age and wellness visits | Eligibility for Welcome to Medicare
Question: Does the patient need to be 65 years old in order to bill the Welcome to Medicare Visit? Answer: No, there is no age restriction for billing Medicare for the Welcome to Medicare visit, the initial annual wellness visit or the subsequent annual wellness visit. Although we think of people being eligible for Medicare at age 65, there are many individuals who are eligible for Medicare at a younger age, because they have … [Read more...]
Billing physician services for hospice patients | Cheat sheet
Medical practices find the hospice modifiers confusing, and confusion leads to denials and payment delays. Use the decision trees below to help you determine if the service is separately billable once a patient has elected hospice and if so, how to bill it. There are two decision trees: one for the attending physician and one for other physicians, PAs and NPs. Walk through the decision tree to see which modifier to use, modifier … [Read more...]
Teaching physician rules | Bedside procedures
Question: Can an attending bill for a bedside procedure that a resident did without the attending being present? If so, is this billed at 85% like a PA or NP? If a PA or NP is overseeing a bedside procedure that a resident is preforming how is this billed (no attending is present at the bedside)? Is it billed under the supervising attending or under the PA/NP who is present or in a different way? Answer: Neither of these are billable … [Read more...]
Billing physician services for hospice patients
Overview of hospice care Medicare beneficiaries who have a terminal illness with a life expectancy of six months or less can elect to have their end-of-life care provided by a hospice organization. Medicare then pays the hospice to provide all of the care that the patient needs that is related to their terminal illness. According to Medicare, when the patient chooses to enter hospice they waive their rights to Medicare part B payments for … [Read more...]
Wellness visits and prolonged care | How to use G0513 & G0514
Medicare stunned us by creating two prolonged services HCPCS codes for use with Medicare covered preventive medicine services in 2018. They may be used only with Medicare covered preventive services when the typical intraservice time for the preventive service is met, and half of the prolonged care time. CMS then released the intraservice time for each code. See the cheat sheet including preventive services codes, intraservice time and the … [Read more...]
Medical necessity isn’t medical decision making
Have you heard of Talk Ten Tuesdays? It’s an internet radio program hosted by Chuck Buck and Dr. Erica Remer, and every week they discuss current coding issues. They started with the implementation of ICD-10 and just kept going. I was a guest recently and discussed one of my pet peeves: equating medical necessity with medical decision making, and payers requiring MDM to be one of the key components. I guess that’s two pet peeves. I know some … [Read more...]
Prolonged services codes for Medicare preventive medicine services: G0513, G0514
Update February 28, 2018 The first chart I posted with this article had an error. Thanks to the sharp eyed member who found my error and pointed it out. We've posted the corrected chart. Someone asked where to find the CMS chart with the intraservice guidelines. It is hidden deep on the CMS site! It is in the files that go with the 2018 Final Rule. Scroll down to about the 20th on the list and download 2018 List of Preventive Services Billed … [Read more...]
Let’s go to the source! Should this visit be downcoded?
A physician asked me this question: “As an interventionalist, a good part of my visit is spent not only explaining patients conditions to them but discussing various diagnostic/therapeutic procedures, the risks and benefits and whether to consider surgery. Recently I had a 99215 challenged. I documented >40min more than 50% in face-to-face counseling and detailed all of the matters discussed. I was told it should be down-coded to 99214 … [Read more...]
Screening pelvic/breast exam and pap smear denials | G0101 and Q0091
Lunch and Learn - June 2017 We received this question from one of our members: "We have a medicare patient for whom we provided a pelvic and a breast exam and a pap smear. We submitted it to Medicare and it got denied. Can you tell me why?" Medicare doesn't pay for "routine services", but they do pay for certain screening test. This short video reviews the Medicare requirements and coding for screening pelvic and breast exams and pap smears … [Read more...]