CMS recently released a transmittal regarding the quarterly updates to the OPPS. The transmittal, which was originally published internally, was republished for the public regarding updates that went into effect on October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Practices that treat conditions such as carpal tunnel syndrome and osteoarthritis of the knee must review a new uniform policy that covers a variety of painful chronic conditions. Start now by training staff and reaching out to patients who are no longer covered.
Laboratory services are often overlooked as potential suspects for fraud because they are typically not considered high-cost services. But the sheer volume of laboratory services billed more than compensates for their low cost. These charges represent hundreds of millions in healthcare spending.
The AMA recently announced that the 2027 CPT code set includes 299 new codes, 74 revisions, and 80 deletions coming to a variety of services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Practices that perform allergy testing take note: A uniform allergy diagnostic testing policy for Medicare Part B patients will go into effect in 38 states as soon as September 27.
Less than one-half of adults discharged from emergency departments for diabetes-related encounters obtain outpatient follow-up care within 30 days, according to a recent study published in the Journal of General Internal Medicine.
Q: When coding endoscopic procedures, some CPT codes have multiple procedures bundled in a single code. How do coders report when one of the procedures isn’t done?
Next year’s CPT manual will include new surgical implants to address knee pain and heart failure, repair diaphragm hernias, and excise pharyngeal neoplasms.
The range of evaluation and management services and ways to bill them continues to expand. But with more billing opportunities comes more confusion about work that can and cannot be billed.
Beginning in 2027, services for antepartum care, labor management, delivery, and postpartum care will be coded separately. The old global approach to billing obstetric care was intended to simplify billing, but it no longer reflects the variation and complexity of care across the phases of pregnancy.
CMS intends to introduce multiple new codes next year, according to the proposed 2027 Medicare Physician Fee Schedule. The agency is considering codes for advance care planning services by clinical staff, assessment and treatment of patients who have a reaction to a vaccination, and speech-language services for pediatric patients.
Q: What are some red flags associated with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) that might trigger payer audits?
Beginning January 1, 2027, services for antepartum care, labor management, delivery and postpartum will be coded separately. The old global approach to billing obstetric care was intended to simplify billing, but it no longer reflects the variation and complexity of care across the phases of pregnancy.
Hospitals are mandated to separately bill HCPCS Level II codes. This longstanding guidance was recently reiterated by two Medicare Administrative Contractors who have published articles on their websites about this specific instruction.
You’ll select a modifier and receive a pay boost, one that’s amplified for eligible accountable care organization participants, if CMS goes through its plan to replace patient trust code G2211 with two modifiers.
Train your coding and clinical teams to think like an auditor before you report modifier -25. Improper payments associated with the modifier have triggered more audits and a variety of attempts to detect and recoup improper payments or stop payments from being issued in the first place.
