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The coding rulebook is always changing. Here are strategies from our two coding experts to help you stay compliant.
The coding rulebook is always changing, and for practices, compliance can be a tricky situation. One false move when you're coding can lead to payment delays and payer audits.
Luckily for you, our coding gurus, G. John Verhovshek, MA, CPC, managing editor for AAPC's publications, and Bill Dacey, principal in the Dacey Group, a consulting firm dedicated to coding, billing, and documentation, are on top of the most important changes to the rulebook. They also know the nooks and crannies that trip up seasoned coders.
We've got scoured their articles from this past year to glean some vital insights that you may have missed. Here are five.
Published: Jan. 31, 2017
"If there were to be one most important or significant change it would surely depend on your specialty. Even one small change in one code could alter a practice dramatically if that was your principle service. However, the most profound change is likely the elimination of the bullseye symbol throughout the manual. This means that 441 codes that used to include conscious sedation no longer do."
Bill Dacey, principal for the Dacey Group
Published: Feb. 15, 2017
"As of Jan. 1, 2017, CPT no longer defines moderate sedation as an inherent part of any procedure. Moderate sedation, when performed and properly documented, now may be reported separately. Per the 2017 Physician Fee Schedule Final Rule, 'This coding change [provides] for payment for moderate sedation services only in cases where it is furnished.'"
G. John Verhovshek, MA, CPC,managing editor for AAPC's publications.
Published: Feb. 28, 2017
"Although it has always been a mainstay of Medicare policy that a patient needs to be present in order to meet the definition of an 'encounter' - there are exceptions. Medicare, for example, departs from the CPT manual definition of counseling and coordination of care, which allows for patient/family and requires that the patient be present. But some codes by their nature of definition don't require patient presence. Depending on the patient's circumstances, the situation above might be covered by the care plan oversight codes 99340, 99375, 99378 or 99380."
Published: June 28, 2017
" Currently, CMS limits reimbursement for telehealth services to those represented by approximately 85 CPT and HCPCS Level II codes, including: psychiatric diagnostic procedures (90791-90792); select psychotherapy services (90832-90838); end-stage renal disease services (90951-90952, 90954-90956); outpatient evaluation & management (E/M) services (99201-99215); advanced care planning (99497-99498); annual depression screening (G0444), and more."
G. John Verhovshek
Published: July 28, 2017
"Per the CPT manual, you can use a [transitional care management] code for follow up related to an observation stay, just like you would for an inpatient stay. That is of course if you meet the requirements of the code, the 2-day contact, the timing of your visit, and the documented moderate level decision-making for the 99495. The global period only applies to the provider doing the scope. If your provider (or no member of your group of the same specialty) did not do the scope, then no global applies here."