Advantage Medical Billing Solutions

  • Home
  • About
    • Company Overview
    • Services
    • Another Satisfied Client
    • Resources
    • Cost Analysis Calculator
  • Tech
    • Practice Management Software
    • How it Works
    • Security / Privacy
  • EHR Software
    • Kareo EHR
  • Special Offers
  • Why Choose Us
  • News
  • Contact

January 5, 2021 By Linda J Sacco Leave a Comment

CMS Final Rule Changes E/M Reporting Guidelines for 2021

 

 

Prolonged Services Changes

Code 99417 is the new prolonged services code for office visits (99205, 99215). However, CMS will require using the following code INSTEAD of 99417:

G2212 “Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services)”

Even though this is for Medicare, there are some payers which state that they follow the Medicare guidelines. Therefore, you will need to check with individual payers and find out if they will be requiring 99417 or G2212 when billing prolonged E/M office services.

Visit Complexity Add-on

CMS has also created a visit complexity add-on code which may be reported, when applicable, with office visits. The new code is (emphasis added):

G2211 “Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)”

As you can see, this is aimed at providers managing more complex patient conditions, either a single serious condition or a complex condition. While CMS is not limiting this to certain specialties, they do anticipate that it will be most common in primary care. The following example was found in the final rule:

A 68 year-old woman with progressive congestive heart failure (CHF), diabetes, and gout, on multiple medications, who presents to her physician for an established patient visit. The clinician discusses the patient’s current health issues, which includes confirmation that her CHF symptoms have remained stable over the past 3 months. She also denies symptoms to suggest hyper- or hypoglycemia, but does note ongoing pain in her right wrist and knee. The clinician adjusts the dosage of some of the patient’s medications, instructs the patient to take acetaminophen for her joint pain, and orders laboratory tests to assess glycemic control, metabolic status, and kidney function. The practitioner also discusses age appropriate prevention with the patient and orders a pneumonia vaccination and screening colonoscopy.

It is clear that in the above example, the provider is providing longer-term care managing multiple organ systems.

NOTE: Do NOT report G2211 when reporting an office visit (99202–99215) with modifier 25.

Keep in mind that since this is related to E/M services, verify with individual payers if they will be following Medicare guidelines and if they will allow this code. Also, when reporting this code, be sure that the documentation clearly identifies how that the visit meets the code criteria.

 

References:

  • Medicare Physician Fee Schedule Final Rule

Filed Under: Uncategorized

December 31, 2020 By Linda J Sacco Leave a Comment

Happy New Year!

 

 

 

 

 

We want to thank all of our clients and business associates for your continued support, generosity, and trust in our company. Thank you for allowing us to serve you this most challenging year and we look forward to serving you in the years to come.

Despite the ups and downs of 2020, we all have pulled together, and gotten through it.  We move into 2021 with great aspirations and hopes for all of us.   We look forward to our continued relationships and wish you and your families a Very Happy New Year with good health, & much success and happiness.

       

      Happy New Year, Your partners and friends at Advantage Medical Billing Solutions!

                                                     Linda J Sacco, Founder & CEO

Filed Under: Uncategorized

December 30, 2020 By Linda J Sacco Leave a Comment

Medicare FFS 2% Payment Adjustment Suspended through March 31, 2021

CARES (The Coronavirus Aid, Relief, and Economic Security) (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.

Filed Under: Legislative News

December 26, 2020 By Linda J Sacco Leave a Comment

Highlights of the 2021 CPT/Documentation Changes Effective January 1, 2021

This year we have some rather important changes to be aware of. For some of you this will affect reimbursements and for all of you it will affect documentation. See below for the major changes:

Elimination of the History (H) and Physical Exam (PE) as elements (providers should perform a “medically appropriate history and/or examination” there will be NO required level of history or exam for 99202-99215.

Clinicians can now choose whether MDM or Time documentation can determine the appropriate E/M Code

MDM Modification 3 MDM subcomponents remain the same but there are extensive edits to elements for code selection.

Deletion of CPT Code 99201

Shorter Prolonged Service Codes, the definition of time is minimum time, not typical time and represents total physician/QHP time on the date of service (see below for what is included in time)

The care team may collect information and the patient or caregiver may supply information directly (by portal or questionnaire) that is reviewed by the reporting physician or other QHP

Time Documentation:

Physician or other QHP includes, preparing to see the patient including review of tests, obtaining/reviewing separately obtained history, performing medically appropriate exam/eval, counseling/education to patient/family/caregiver, ordering meds, tests, or procedures, referring and communicating with other health care professionals, documenting clinical info in EMR or other Health record, independent interpretation of results and communication of results to patient/family/caregiver, and care coordination.

Some new/revised key codes to add to your EMR and be aware of how to use them:

99415 Prolonged Clinical Staff Service direct patient contact with physician supervision. First Hour, note it doesn’t have to be continuous

99416 Prolonged Clinical Staff Service direct patient contact with physician supervision. Each Addl 30 minutes, it doesn’t have to be continuous

99417 Prolonged OV E/M service total time with or without direct patient contact each 15 minutes to be used ONLY with 99215 or 99205

99358 Prolonged Services Code w/o Direct Contact first hour regardless of POS

99359 Prolonged Services code w/o Direct contact first hour regardless of POS addl 30 mins

99354-99357 Prolonged Service Codes with Direct contact for physician or other QHP for Inpatient or Observation setting beyond the usual time.

We understand this may appear confusing; however, it’s extremely important that you understand how to use these codes in your practice; your revenue depends on it.

The most important thing to understand is documenting all of the pertinent medical information but now it’s also important to document start and stop times, time used consulting, time spent on the phone with family, caregivers and patients, time spend reviewing records etc.

You know the old saying “time is money”, well in this case it really is, so we are asking that you be mindful in your code selections.   You will be using a combination of codes you may not have used before and you will need to document why.

Sit down with your staff and office manager and determine how this can be done if you haven’t done so already.   For those of you who are clients feel free to reach out to us if you have any questions. As always we will be looking at your notes to insure that times are documented and code selection is correct based on the notes.

Have a Safe and Healthy 2021!     Wishing you the best, Linda

Filed Under: Uncategorized

February 10, 2017 By Linda J Sacco 1 Comment

Advanced Care Planning Billing and Reimbursement

Many providers are not familiar with these codes and are missing out on the
reimbursement for these services. Let me explain services provided in order
to bill for these codes. The provider discusses and shares planning for the
future health care needs of the patient including Advance Directives. Examples
of written Advance Directives would include but not limited to are Health Care
Proxy, Durable Power of Attorney for Health Care, Living Will, or Medical Orders
for Life-Sustaining Treatment (MOLST). This discussion is typically 30 minutes
with the patient, his family, or someone representing the patient. Advanced care
planning focuses on the patient and involves both the patient and the provider
responsible for their care. It empowers the patient to make an informative decision
about their future care including their advanced care decisions. This gives
the patient the opportunity to express their preference for care depending on their
current and future health status and treatment options available. The provider may
enter the actual plan on forms specifically designed for that purpose in the
patients record.

There are two CPT codes for Advanced Care Planning, 99497 which are used for up
to a 30 minute discussion, and 99498 which is an add on code for each additional
30 minutes of the discussion. These codes can be billed at the same time as other
medical services taking place at the same visit before or after the time spent
on advanced care planning. Don’t forget to add a 25 modifier to the office visit
code. The 2017 Medicare allowed reimbursement amounts are 99497 $88.15
and 99498 $76.60.

I am certain many of you have provided these services to your patients and just
bundled it into the office visit code and losing out on and additional
$88-$164.00 per encounter. Add these codes to your superbill and your EMR
templates so they are not forgotten!

As always, Take Advantage for all of your outsourced medical billing needs!

                                        

Filed Under: Medical Billing & Coding

  • 1
  • 2
  • 3
  • …
  • 9
  • Next Page »

Let's Connect

RSSTwitterFacebookLinkedin

Topics

  • Electronic Medical Records
  • Legislative News
  • Medical Billing & Coding
  • Practice Money Management & Tips
  • slider
  • Uncategorized

Latest News

CMS Final Rule Changes E/M Reporting Guidelines for 2021

    Prolonged Services Changes Code 99417 is the new prolonged services code for office visits (99205, 99215). However, CMS will require using the following code INSTEAD of 99417: G2212 “Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; […]

Happy New Year!

          We want to thank all of our clients and business associates for your continued support, generosity, and trust in our company. Thank you for allowing us to serve you this most challenging year and we look forward to serving you in the years to come. Despite the ups and downs […]

Partners

 

badge-regpartner copy

Connect with Us

RSSTwitterFacebookLinkedin

Log in

Hampton NH / Naples FL PHONE 877-666-5279 FAX 877-645-5855
Copyright © 2022 Advantage Medical Billing Solutions LLC. All Rights Reserved. Website By: A. Piper Creative