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Radiology Updates, Reminders, and Tips for MIPS

The rules and requirements for success in the Medicare Quality Payment Program (QPP) are ever-changing, and it seems like each year brings a new challenge for practices to avoid a payment penalty or, hopefully, to earn a payment bonus. Most recently, CMS announced that the 2023 data submission deadline would be extended to April 15, 2024, due to the cyberattack at Change Healthcare in February, and that practices affected by the cyberattack could apply for an Extreme and Uncontrollable Circumstances (EUC) Exception. The EUC exception allows the applicant to request reweighting of any or all of the performance categories under the Merit-Based Incentive Payment System (MIPS).

While CMS has not specified the Change Healthcare cyberattack as a circumstance that would be acceptable for an EUC exception, some experts, like McDermott+Consulting, are reporting that it will qualify if it negatively impacted a provider's ability to participate in MIPS in 2024 by preventing them “from collecting MIPS data for an extended period of time.” Practices affected may consider completing the EUC application and choosing “Ransom/Malware” as the “Event Type” and confirming in the application that the ransom/malware event pertained to the Change Healthcare cyberattack. The EUC Exception application can be filed at any time during the year, until 8pm ET on December 31, 2024.

Alternatives to Traditional MIPS Reporting

Practices reporting in 2024 must obtain a score of at least 75 points to avoid a payment penalty in 2026; scores between 75 and 100 points will earn a positive payment adjustment in 2026. For the 2022 performance year, the mean score nationwide was 82.9 points, according to the CMS 2022 Quality Payment Program Experience Report. Unfortunately, radiology clinicians have a limited number of measures to choose from, which interferes with their ability to obtain a high score. One way to improve the pool of measures is to use a Qualified Clinical Data Registry (QCDR). A QCDR is operated by a vendor approved by CMS, often sponsored by specialty societies, such as the American College of Radiology (ACR). QCDR submission differs from the usual MIPS qualified registry submission in that QCDRs can submit non-MIPS measures, called QCDR measures, as well as MIPS quality measures.

Advantages for Small Practices

Because QCDRs charge a fee, they might be more suited to larger practices. Small practices, defined as those having 15 or fewer eligible clinicians billing under the same Taxpayer ID Number (TIN), have special advantages under the MIPS framework that can help them achieve a bonus without using a QCDR. The advantages for small practices include:

The ability to submit MIPS Quality Measures through claims reporting.
Three points are awarded for submitting:
• Quality measures without an available benchmark.
• Quality measures that do not meet case minimum or data completeness requirements.
Six (6) bonus points added to the quality performance category score for clinicians who submit at least one measure, either individually or as a group or virtual group.
Automatic reweighting of the Promoting Interoperability performance category to 0%, without the need to apply for a hardship exception.
Full credit in the Improvement Activities performance category for performing and attesting to either one high-weighted activity or two medium-weighted activities.

Possible New Quality Measures

CMS began a testing stage, in February 2024, for mammography measures that were created by Acumen, a policy research company with a focus on healthcare. The testing stage signifies an important first step toward official inclusion into the MIPS Quality Measures available for practices to report. In MIPS performance year 2024, there are no traditional MIPS measures for mammography. While the ACR-supported measure QMM18 (Use of Breast Cancer Risk Score on Mammography) is available for practices, it has no current benchmark.

The ACR reported that the following three outcome-related quality measures may become available for radiology groups to report on in the future:

Breast Cancer Screening Recall Rate Quality Measure (Outcome)
Breast Cancer Screening with an Eventual Breast Cancer Diagnosis: Positive Predictive Value 1 (PPV1) Quality Measure (Outcome)
Use of Biopsy After Diagnostic Follow-up with Eventual Breast Cancer Diagnosis: Positive Predictive Value 3 (PPV3) Quality Measure (Outcome)

According to the Quality and Safety Department of the ACR, the earliest that these proposed mammography measures will be finalized into MIPS and available for usage would be the 2026 performance year. We will not know until late 2024 whether or not the new measures were submitted to CMS.

Conclusion

With the Medicare Physician Fee Schedule constantly under the threat of annual reductions or small increases that do not keep up with inflation, avoiding a payment penalty for not fulfilling the minimum MIPS requirements is crucial. Practices must annually review the changes to the program and take advantage of any opportunity to improve their score.

Erin Stephens, CPC, CIRCC, is Sr. Client Manager of Education at Healthcare Administrative Partners.

www.hapusa.com

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ICD-10-PCS Official Guidelines for Coding and Reporting 2025

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8 Medical Coding Mistakes That Could Cost You

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The Difference Between Autonomous Coding and Computer-Assisted Coding

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8 Common Medical Coding Errors That Could Impact Your Practice

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The New ICD-10-PCS Codes for the 2025 Fiscal Year (FY):The 2025 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2025. These 2025 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2024 through September 30, 2025.

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Hospital Outpatient Prospective Payment System:Here's a summary of the main points covered:

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Understanding the Intricacies of RAF Coding: A Comprehensive Guide:In the complex ecosystem of healthcare, Risk Adjustment Factor (RAF) coding stands as a crucial methodology, particularly within the Medicare Advantage (Part C) framework. This article offers a deep-dive exploration into RAF coding, examining its historical origins, the intricacies of the risk adjustment model it employs, the application of the RAF score, and the profound influence of chronic versus acute conditions on these scores and reimbursement rates.

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Analyzing the Auditing of Psychotherapy:Psychotherapy is the treatment of mental illness and behavioral disturbances in which the physician or other qualified healthcare professional, through therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.

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Navigating the Maze of ASC Claim Denials: Proven Strategies for a Seamless Process:As ambulatory surgical centers (ASCs) experience a surge in case volume due to a growing recognition of the efficiency, cost-effectiveness, and patient convenience they offer, the potential for revenue growth is matched by the heightened risk of billing and coding errors, making the fight against denials more daunting than ever.

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How Lab Benefits Management Can Smooth the Transition to Value-Based Care:Switching the U.S. healthcare system from the traditional fee-for-service model to value-based care is an enormous undertaking. It requires no less than changing how healthcare is thought of, delivered, measured, and paid for.

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Understanding the Changes in the CMS-HCC Model V28:The New Year brought with it a long-overdue overhaul of the Centers for Medicare and Medicaid Services (CMS) hierarchical condition categories (HCC), ushering in the 28th version of the model used to assign risk adjustment factor (RAF) scores and estimate future healthcare costs for Medicare Advantage patients.

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Coding for Zika: Unraveling the Threat of a Silent Predator:When we consider treacherous animals, our thoughts may drift to lions, bears, and sharks. Yet, the true menace is a far less conspicuous creature: the mosquito. This seemingly harmless insect can spread many deadly diseases, including Zika, dengue fever, yellow fever, and West Nile virus. In this article, our focus is on the Zika virus, exploring its means of transmission, presenting symptoms, diagnostic methods, and available treatments. Furthermore, we shed light on medical coding for Zika, providing nine detailed examples to simplify the accurate assignment of ICD-10-CM codes in accordance with established guidelines and conventions.

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How Are Radiology Practices Impacted by Annual Changes to the Medicare Physician Fee Schedule?:With passage of the Consolidated Appropriations Act, 2024 (CAA 24), we finally learned the rates that physicians will be paid for Medicare services during the remainder of 2024. Effective when it was signed by the president on March 9, 2024, the CAA 24 contained several provisions that benefitted physician reimbursement:

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Coding Changes That Will Impact Radiology Practices in 2024:The annual update to the Current Procedural Terminology (CPT)® for 2024 has 230 new codes, 70 revised codes, and 49 deleted codes. In addition, there are 395 new diagnosis codes contained in the ICD-10-CM update, about one-third of them describing new ways to capture accidents and injuries. Although relatively few of these changes will impact radiology practices, it's essential to know what they are and adjust your practice systems accordingly.

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Breaking Down Misconceptions: Understanding Thyroid Diseases:Imagine a tiny butterfly-shaped gland quietly regulating your body's energy levels and overall health. Your thyroid, which uses iodine to make thyroid hormones, helps control blood pressure, body temperature, heart rate, metabolism, and the reaction of your body to other hormones. Thyroid disorders occur when the gland becomes overactive (hyperthyroidism) or underactive (hypothyroidism). When the thyroid is not working as it should, it can result in serious health problems.

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ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD):Chronic Obstructive Pulmonary Disease (COPD) is a progressive and persistent inflammatory lung disease resulting in limited airflow. Primary causes of COPD are long-term exposure to irritating gases or particulate matter, most commonly from cigarette smoke. There are multiple factors that can contribute to the development of COPD, such as:

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Demystifying EKG and Telemetry for the Non-Clinician:Electrocardiograms (EKG or ECG) and telemetry are indispensable tools in the field of cardiac health. They have revolutionized how healthcare professionals diagnose and monitor various heart conditions, from arrhythmias to heart attacks. EKGs record the heart's electrical activity, while telemetry involves wireless data transmission from a patient's heart to a healthcare provider.

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Valentine's Day - From Romance to Responsibility: STD Awareness:>Love is in the air, and hearts are excited as we celebrate Valentine's Day. Yet, amidst the whispered promises and tender embraces, we need to remember that pure love is about caring for each other's well-being. Regular testing is essential for anyone who is sexually active to avoid STIs 365 days a year. Getting tested is necessary to give love and maintain your sexual well-being. More than flowers, chocolates, or champagne, knowing the facts about STDs and taking the necessary precautions are the best ways to celebrate love responsibly, passionately, and to its fullest.

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Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing:Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing: In the complex world of healthcare, accurate reporting of services is crucial for ensuring quality patient care and fair compensation for medical providers. One significant aspect of this process involves purchased diagnostic testing, where medical tests are conducted outside the healthcare organization. In this tip, we'll delve into the essentials of healthcare claim reporting and the auditing process related to purchased diagnostic testing.

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Fathom Announces Partnership with Google Cloud, Adding its Autonomous Medical Coding Solution to Google Cloud Marketplace :This collaboration will boost access and integration with best-in-class autonomous medical coding for healthcare providers.

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Modifier -25: Interpretation Is In The Eye of the Beholder :Fresh insights from the American Medical Association (AMA) are always welcome when it comes to medical coding policy. Although they have provided previous guidance on the appropriate use of modifier -25, the AMA's

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Should I Report the Symptom or Confirmed Diagnoses for Testing?:Coders frequently ask questions about the guidelines surrounding coding symptoms vs. confirmed diagnoses, especially when tests are ordered during an encounter to rule out a condition, illness, or disease.

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Optimizing HCC Coding for Accurate Reimbursement:Hierarchical Condition Category (HCC) codes are an integral aspect of healthcare’s ongoing transition from fee-for-service to a value-based care model of reimbursement—a transition that requires providers to better manage patient costs based on a clear, concise, and comprehensive picture of patients’ health and medical conditions.

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Understanding CPT Code Range 92920-93793 in Cardiology Billing :The realm of cardiology encompasses a vast array of specialized services and procedures, demanding precise documentation and accurate coding for proper reimbursement. Understanding the specific CPT codes within the range of 92920-93793 is crucial for healthcare providers navigating this complex landscape. This article serves as a detailed guide, unpacking the details of this CPT code range 92920-93793 and its applications within cardiology billing.

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Missing HCC Codes Leave Money on the Table:Improper clinical documentation of one patient can mean a difference of more than $10,000 in yearly estimated healthcare costs. How much money are you potentially leaving on the table?

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Big Changes Will Streamline CPT Coding for Immunization :Significant changes in the Current Procedural Terminology (CPT ® ) code set for immunizations reflect the changing nature of how COVID-19 is being addressed as actions transition from a public health emergency response to combatting emerging variants much like the flu.

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Time Changes for 2024:Beginning January 1, 2024, providers utilizing time for leveling an office and/or outpatient Evaluation and Management (E/M) service must meet or exceed the minimum threshold total service time. This change for 2024 better aligns with time changes that were already made in 2023 for inpatient settings.

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The Impact and Challenges of Sequencing Z Codes for Reimbursement :Every year, we get updates to the Official Guidelines for Coding and Reporting, and this year, for reporting year 2024, we received an update regarding Chapter 21 for follow-up codes Z08 and Z09. The accurate sequencing of these Z codes was emphasized in the guideline update by reminding us that they can be used for both medical and surgical treatment.

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Updated ICD-10-CM Codes for Appendicitis :According to JAMA, there are approximately 250,000 cases of appendicitis diagnosed annually in the United States. Appendicitis can quickly spiral out of control when a perforation of the appendix occurs, and a patient becomes septic. Understanding the language used in medical documentation helps with the proper assignment of ICD-10-CM codes and supports testing and treatment.

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Update on Policy for Using Modifiers JW and JZ:JW has been a requirement since 2017; however, Medicare is using the JW modifier and JZ modifier to calculate discarded drug refunds, effective January 1, 2023.

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Capturing HCCs in a Changing World:On March 31, 2023, the Centers for Medicare and Medicaid Services (CMS) released the CY 2024 Medicare Advantage (MA) Capitation Rates along with Part C and Part D payment policies. The largest key decision in the release was the finalized proposal to revise the Medicare Advantage Risk Adjustment model.

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Aetna Reimbursement Policy: Radiology Modifiers:According to provider October updates: Aetna will reduce the reimbursement rate for HCPCS radiology codes when modifiers FX and FY are appended.

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Reviewing the Guidelines for Reporting ICD-10-CM Aftercare Codes:Aftercare codes are assigned to explain encounters where the initial treatment of a disease has been completed and the patient encounter is now focused on aftercare for healing and recovery. These codes may also be reported to explain long-term consequences of the disease.

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COVID Vaccine Coding Changes as of November 1, 2023:Correctly coding the administration of COVID-19 vaccines had become such a huge burden for providers.

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2024 ICD-10-CM Code Changes:It's that time of the year again. The new ICD-10-CM code books are out, and the changes are now active. There are 395 new diagnosis codes, 25 deleted codes, and 12 revised codes for 2024. As a healthcare professional, the ability to understand and navigate the updated ICD-10-CM codes is integral. Mistakes or misunderstandings can lead to claim denials, inaccurate data collection, and potential patient harm. It is vital to engage in continued education to understand these changes fully. This article will provide an overview of the new codes for ICD-10-CM for 2024.

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Truly Autonomous Coding Requires a Multifaceted Solution:Coding technology has come a long way since the days when Computer-Assisted Coding (CAC) was a bleeding edge feature of the more advanced encoder solutions. Today's CAC solutions are often integrated with Clinical Documentation Integrity (CDI) tools and have automated much of the coding process.

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Why Support for H.R. 2474 Is Important to Your Radiology Practice:The Strengthening Medicare for Patients and Providers Act (H.R. 2474) would modify the way the Medicare Physician Fee Schedule (MPFS) is calculated and adjusted each year. The basic system of determining Relative Value Units (RVU) would not change, but the annual adjustment of the Conversion Factor (CF) would more closely reflect the actual economic factors that affect physicians' practices.

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Pediatric Craniosynostosis Coding in ICD-10-CM:Craniosynostosis, a complex craniofacial condition, impacts approximately one in every 2,500 babies in the United States. This article delves into the complexity of this congenital disability, shedding light on its various forms, categorized broadly by either an unknown cause or an underlying condition. Moreover, we explore ICD-10-CM coding for these diagnoses, including the recent updates as of October 1 of this year, designed to reflect the diverse types of craniosynostosis.

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Radiology Practices Struggle to Avoid Penalties in the Medicare Quality Payment Program:For many radiology practices, the idea of a positive payment adjustment for participation in the Medicare Quality Payment Program (QPP) has been lost. Several factors have combined over the past few years to change the goal for radiology practices - it is now "penalty avoidance" rather than a reward for reporting quality metrics. As outlined in Healthcare Administrative Partners' recent review of the Medicare 2024 Physician Fee Schedule Proposed Rule, the QPP requirements for successful participation are going to become even stricter.

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The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance:The ICD-10-CM annual updates scheduled for implementation on October 1, 2023, include 395 new codes, 25 deleted codes, and a total of 13 revised codes. Among the newly added codes are codes that better define metabolic disorders, such as metabolic syndrome, also known as insulin resistance syndrome, dysmetabolic syndrome, hypertriglyceridemic waist, obesity syndrome, and Syndrome X.

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Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding:GERD stands for Gastroesophageal Reflux Disease, a chronic condition where stomach acid flows back into the esophagus, causing a range of symptoms, such as heartburn, regurgitation, chest pain, difficulty swallowing, and a chronic cough.

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ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2023 Update:CR 13166 is a maintenance update of ICD-10 conversions and other coding updates specific to NCDs.

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E/M Scoring Questions:Evaluation and Management visits are often the "bread and butter" of an organization. Thus, correctly scoring encounters is essential to ensuring proper reimbursement. The element of "Risk" is only one of the three elements of Medical Decision Making (MDM) but understanding what is meant by all the definitions within each element is critical.

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Medical Necessity and Data Under the E/M Documentation Guidelines:Whenever I audit charts under the 2021 E/M Documentation Guidelines, which now apply in all places of service, I like to start by reviewing the first and third columns. The first column is Number and Complexity of the Presenting Problem, and the third column is Risk of Complications and/or Morbidity or Mortality of Patient Management.

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Coding Critical Care Services in 2023:Critical care services refer to the delivery of medical care to the critically ill or injured patient by a qualified physician or other qualified healthcare professional (QHP). Current Procedural Terminology (CPT) defines a critical illness or injury as one that "acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition."

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PSQIA, PSWP, and HIPAA Compliance:This article addresses patient confidentiality and security related to patient safety evaluation systems, investigations, root cause analyses, and compliance to rules and regulations. It is a basic introduction to help understand the importance of appropriately managing this type of privileged information.

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ICD-10 Codes to Report Cataracts:Cataracts, a leading cause of vision loss in the United States, occur when the normally clear lens of the eye becomes clouded. This clouding obstructs or alters the passage of light into the eye, resulting in impaired vision. Ophthalmic surgeons perform safe and effective surgery to treat cataracts. Professional medical billing and coding companies can assist physicians with coding and claims submission tasks.

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Understanding Skin Biopsy CPT Codes: A Comprehensive Guide:Skin biopsy plays a crucial role in the diagnosis and management of various dermatological conditions. To accurately report and bill for these procedures, healthcare providers rely on Current Procedural Terminology (CPT) codes. CPT codes are standardized numerical codes used to describe medical procedures and services. In this article, we will delve into the world of skin biopsy CPT codes. Understanding these codes can help family physicians code and bill skin biopsy procedures correctly, ensuring optimal reimbursement and proper documentation.

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The Transition to ICD-11: A Major Step Forward for Global Health:During the late 1800s, a physician from France named Jacques Bertillon was developing a method to create a consistent way of categorizing diseases. His goal was to simplify the process of monitoring and comparing mortality rates across various nations. In 1893, he released the inaugural version of the International Statistical Classification of Diseases, which is currently recognized as the International Classification of Diseases - ICD.

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Overcoding: Putting a Strategic Stop to a Silent Revenue Killer:Overcoding is in the crosshairs as the Centers for Medicare and Medicaid Services (CMS) continues its quest to ferret out fraud and abuse and recoup improper reimbursements-a focus that returns $8 for every $1 spent on audits. There are no signs that they are letting up any time in the future, as the federal government has increased funding for audits and fraud investigations.

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Identifying the Admitting, Principal, Primary, and Secondary Diagnoses:Knowing how to differentiate the admitting, principal, primary, and secondary diagnoses for reporting and sequencing purposes can be intimidating and confusing. The following are some commonly asked questions related to reporting diagnoses in the facility setting.

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Combination Codes Provide Greater Detail for Complicated Conditions:When ICD-10-CM was initially implemented, it was like watching the Discovery Channel, where new codes and guidelines seemed to appear, along with new guidelines for how to report them.

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Identifying the Components of a High-Risk Evaluation and Management Service:Since 2021, when the Office and Other Outpatient Evaluation and Management (E/M) services coding guidelines changed to require only scoring by time or medical decision making (MDM), coders, providers, and facilities have worked hard to implement changes that would facilitate correct coding through clear documentation and well-formatted templates.

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Defining Modifier 25:Yes! Considering the recent uproar caused by one payer's plan to implement a policy requiring prepayment review of documentation for all visits billed with 99212-99215, modifier 25, and a minor procedure, it is clear there is still a need to discuss this often-misused modifier.

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Are You Properly Reporting Radiology Services?:It's probably not surprising that the most commonly billed imaging services are radiologic examinations of the humerus, spine, fingers, and abdomen (codes 72070, 73060, 73140, and 74019).

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If a Procedure Was Not Documented, Was It Performed?:Most of us, if not all of us, have heard the statement, "If it isn't documented, then it wasn't performed." While I know this is often the perspective of payers, I cringe when I hear this, thinking about all the providers that I work with and the fact that it may not be a true statement that the procedure was not done.

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How Can Radiology Networking Improve Your Practice?:A large metropolitan-area radiology group covers several departments within a hospital system. They have on-site staff daily at each location to handle all modalities, including sub-specialists to be sure pediatric, neuro, and body imaging are handled with the right expertise.

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May Is Clean Air Month: Spread the Word About Air Pollution and Health:Summary: Clean Air Month in May is a nationwide campaign to encourage people to preserve the environment and make the world a more sustainable, healthy planet.

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Let's Talk Prolonged Services! Did you report all of your time?:Prolonged preventive services are provided in outpatient settings and can be provided via telehealth. Annual wellness visits and the Welcome to Medicare visit include a thorough review of the patient's health and medical history. The physician performs an exam that consists of a blood pressure check, height and weight assessment, and a vision screen. Depending on the medical history information provided by the patient and the results of the physical examination, the physician orders or performs additional tests as medically necessary.

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New ICD-10-PCS procedure codes - Effective April 1, 2023:To download all of the new files, go to this CMS website: https://www.cms.gov/medicare/icd-10/2023-icd-10-pcs or see below.

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2023 release of ICD-10-CM - Effective April 1, 2023:The FY2023 ICD-10-CM codes are to be used from April 1, 2023 through September 30, 2023.

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Keys to Correct Embolization Coding: CPT® Codes 37241-37244:It is no secret that interventional radiology is one of the most difficult specialties for coders and auditors to master. In particular, coding correctly for embolization procedures can be tricky due to the multiple coding considerations involved. This article provides tips that will have you coding and auditing some of the most common embolization procedures like a pro!

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What's Going on With the COVID Vaccines Now?:Keeping up with the changes to the COVID vaccines has certainly been a rollercoaster ride, and we now have two new twists to this exciting ride. Twist one comes from the FDA who recently pulled the emergency use authorization (EUA) for the monovalent Moderna and Pfizer-BioNTech mRNA vaccines, and instead authorized the bivalent boosters for all doses starting at age 6 months. Twist two is found in the changes taking place as part of the official end to the COVID Public Health Emergency (PHE), beginning May 11, 2023. Buckle up, and let's look at how this changes things.

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Men's Health Awareness Month: Catch Prostate Cancer Early with Routine Screening:Summary: Men's Health Awareness Month is the ideal time to spread information about preventable health problems and encourage early detection and treatment of diseases such as prostate cancer.

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What Is the Impact of the 2023 Medicare Fee Schedule on Your Radiology Practice?:The Medicare Physician Fee Schedule (MPFS) was lowered for 2023 due to a cut of 2.08% in the Conversion Factor (CF) used to determine payment rates. We reported that the CF could have been reduced as much as 4.47% had Congress not intervened at the last minute to adjust it, along with waiving the 4% PAYGO reduction that was supposed to occur in 2023.

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Second Quarter 2023 Updates Are Different This Year:The second quarter of 2023 is not business as usual, so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023).

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Dermatology CPT® Codes and Tips for 2023:Your dermatology practice performs medical and surgical services for your clients; as such, your medical billing strategy needs an understanding of both medical and surgical dermatology CPT codes.

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How to Bill Mental Health Telehealth:Billing for mental health telehealth services can be challenging due to various factors. Mental health providers must navigate different payer coverage and reimbursement policies, choose the correct CPT codes and modifiers, document telehealth services properly, comply with regulations related to telehealth, and educate patients about insurance coverage.

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2023 Emergency Care Physician Changes:Welcome to 2023 - so far, an interesting year. This year, CPT made many changes to Evaluation and Management (E/M) services, including emergency care physician changes. Emergency care CPT codes are simply a different form of E/M CPT codes.

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Facility Outpatient E/M Coding:Reporting outpatient E/M services in a facility setting is a little different than other outpatient services. It is important to follow payer guidance. Novitas has provided some guidance on which codes to report based on the type of service provided. They have an FAQ page that covers both emergency department (99281-99285, G0380-G0384) and clinic visits, which states the following:

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Cervical Dysplasia: Risk Factors, Diagnosis, and Treatment:Summary: Mild cervical dysplasia usually resolves on its own but should be monitored as it can progress to moderate or severe dysplasia, which, if not treated, could become cancerous.

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Overcoming Code Denials in Healthcare:Denial rates are rising because of numerous factors, including the increasing complexity of coding guidelines, increased workloads and staff shortage, adoption of AI and automation in payor claim reviews, increasingly sophisticated remittance processes, and more. However, taking a more granular review of your claims may help avoid significant revenue hurdles or other more serious headaches, like audits.

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Gastroenterology CPT Codes and Tips for 2023:Since gastroenterology practices can perform both medical and surgical services, your gastroenterology medical billing strategy has to take this into account. Billing for this specialty can be challenging, but the friendly experts at NCG want to make it simple for you to boost your healthcare revenue cycle.

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Dawning of a New Era: The Sun Rises on New E/M Standards in 2023 and Beyond:Well, the time is finally here! 2023 has ushered in a new standard for how we look at evaluation and management (E/M) services. Physicians, providers, coders, auditors, educators, and compliance professionals alike are finally able to utilize much more than the "bean-counting" methods set forth by the Centers for Medicare and Medicaid Services' (CMS) 1995 and 1997 ("95" and "97") E/M guidelines.

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Is the End Really Near?:What is going on? We hear rumors that the end is near; well, that depends on what you are talking about - the end of what? The pandemic is not over; we are just making a transition.

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New Modifier Required on all Single Use Drugs:Attention providers and suppliers, there is a new modifier in town! Starting July 1, 2023, Modifier JZ - Zero drug wasted, will be required on all claims to attest there is no drug left over, if applicable. Meaning there is zero drug amount discarded, and there was no leftover drug administered to any patient.

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2023 Coding Conundrums:We have our first bit of 2023 behind us, which means the first of the claims for the new year have been submitted. Here's the $100,000 question: Are your claims paying appropriately with the 2023 Evaluation and Management (E/M) changes that have occurred?

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Top 5 Takeaways From the CMS 2023 Final Rule: Conversion Factor, MIPS, Telehealth, E/M, and Refunds for Discarded Drugs:As we walk into 2023 (or run depending on your enthusiasm for leaving 2022 behind), we are presented with the rules that will govern much of the healthcare industry's regulatory compliance standards and reimbursement guidelines. These rules are published in the Center for Medicare and Medicaid (CMS) Annual Final Rule, which was released on November 18, 2022 for the 2023 calendar year.

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Clean Claims: A New Year's Resolution You Can Keep:Considering that coding errors can cost upwards of $20 billion per year in either delayed or permanently lost reimbursement,² clean claims are essential to the health of any medical organization's bottom line.

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World Cancer Day: Challenges of Working Toward a World Without Cancer:World Cancer Day, started on February 4, 2000 at the World Summit Against Cancer (held in Paris), is an initiative of the Union for International Cancer Control (UICC). This international observance aims to ease the global burden of cancer by raising awareness and education about cancer and promoting more equitable access to care.

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Medicare Fee Schedule Changes In 2023:The internet is ringing with the news of the CMS Updates Final rule for the 2023 Medicare Physician Fee Schedule. The finalized 2023 Medicare Physician Fee Schedule was announced by the Centers for Medicare & Medicaid Services (CMS) on November 1, 2022.

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Evaluation and Management 2023 Updates:Changes to 2023 Evaluation and Management (E/M) coding will impact CDM files, coding, documentation, charge capture processes, and various information systems.

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A Long Time Coming: 2023 Changes to Inpatient Prolonged Service:It's been two years since CMS collaborated with the AMA to revamp Evaluation and Management (E/M) coding guidelines, including a rework of prolonged service codes in the office/outpatient setting.

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How Does the Definition of "Problem Assessed" Change in the 2023 E/M Guideline Updates?:In 2021, the AMA defined certain terms to facilitate better understanding and scoring for MDM. For the purposes of this article, we will focus more specifically on what is meant by "problems addressed" and what that means when scoring E/M services in the hospital inpatient and observation setting.

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Lichen Sclerosus and Vaginal Lichen Planus:Lichen planus and lichen sclerosus are both idiopathic conditions that affect your skin, especially mucus membranes. The difference between lichen planus and lichen sclerosus is that lichen sclerosus rarely affects the mucous membranes in your mouth.

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The Medicare Final Rule Confirms Big Payment Reduction for 2023:When the 2023 Medicare Physician Fee Schedule (MPFS) was proposed in early 2022, it projected a 4.42% cut to the conversion factor (CF), with radiology facing cuts between 3-4% depending on subspecialty. The final rule moves the cut even deeper, with the 2023 CF set 4.47% lower than the 2022 CF.

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2023 E/M Changes: What’s Coming?:When the American Medical Association (AMA) revised the Office/Other Outpatient Services codes in 2021, it was the largest change to E/M codes in decades. The AMA has now turned its attention to the rest of the section, with massive changes coming January 1, 2023.

Coding

2023 Procedure Coding Updates Are Just Weeks Away:Changes to the 2023 CPT code set include 102 new codes, 68 deleted codes, and 87 codes with revised long descriptions, as well as 36 new parent codes.

Coding

Last Minute Congressional Action Reduces Medicare Fee Cuts For 2023:In response to concern expressed across the spectrum of physicians and their representative organizations, the omnibus spending bill, titled the Consolidated Appropriations Act, 2023 (CAA23), passed by Congress on December 23, rolled back a Medicare payment cut of 8.5%. As a result, it is estimated that the conversion factor will still be cut 2.08% for 2023. However, as reported previously, many practices will feel a larger reimbursement reduction due to the annual valuation adjustments within the fee schedule.

Coding

The Role of the History and Examination in 2023 Evaluation and Management Services:While listening to the virtual AMA CPT/RBRVS Annual Symposium lecture by Gift Tee, BS, MPH, Director of the Division of Practitioner Services in the Hospital and Ambulatory Policy Group (HAPG) of CMS on the Update from Centers for Medicare and Medicaid Services (CMS), I was struck by something he said about the revisions to the coding and documentation framework for Evaluation and Management (E/M) Services for the 2023 CPT code descriptors.

Coding

A Long Time Coming: 2023 Changes to Inpatient Prolonged Services:It's been two years since CMS collaborated with the AMA to revamp Evaluation and Management (E/M) coding guidelines, including a rework of prolonged services codes in the office/outpatient setting.

Coding

The Pain of Lichen Planus:This article is written for all those people Joanne knows who are suffering from this autoimmune disease. It is painful and life altering in many ways. After research, we found that many practitioners, coders, and billers know little about this disease. We hope this article will help practitioners document and code this condition correctly, and direct patients with chronic LP for emotional support and refer appropriately to more experienced specialists for treatment.

Coding

Monkeypox: Coding and Documentation for U.S. Cases:Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.

Coding

Modifier FT:As of January 1, 2022, CMS created a new modifier for an unrelated E/M visit during a postoperative period. It was revised as of April 1, 2022, quite possibly due to some questions on usage. Modifier FT is described as follows.

Coding

The No Surprises Act Final Rule Changes the IDR Process:The Final Rule related to the No Surprises Act (NSA), issued August 26, 2022, clarifies and modifies the Independent Dispute Resolution (IDR) process but makes no changes to the patient protections and other provider obligations of the NSA, such as notifications and cost estimates for uninsured patients.

Coding

Coding and Documentation for Arterial Embolization:Arterial catheter embolization is an interventional radiology procedure that requires detailed documentation of the steps performed by the physician to maximize coding and reimbursement. The procedure places medications, embolic agents, or a radiopharmaceutical into a blood vessel to prevent abnormal bleeding, close off vessels, eliminate abnormal connections between arteries and veins, or to treat aneurysms or tumors.

Coding

Identifying Common Coding Errors for Lower Extremity Arterial Interventions:Each day, thousands of patients are undergoing one or more therapeutic interventions, the most common ones being angioplasty, stent, and atherectomy of the lower extremity arteries to treat various forms of peripheral vascular disease. This article will highlight the most common coding errors to be on the lookout for when auditing these procedures.

Coding

Chutes and Ladders E/M Style:We are all excited about the upcoming 2023 E/M changes, aren't we? Well, I can say, as a coder and auditor, I am! I've been in this E/M world for about 35 years.

Coding

2023 ICD-10-CM Code Changes:In 2022, there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes - a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from October 1, 2022 through September 30, 2023.