Tag: medical coding

EHRmedical billingMedical Billing and CodingRevenue Cycle ManagementTelehealth

Understand How To Code Telehealth, Telemedicine

Hint: The terms aren’t interchangeable.

Providers are increasing patients’ access to healthcare services through virtual communications. If providing services to patients without an in-person, face-to-face interaction makes sense for your practice, it’s important for you to know how to code the services correctly.

TelehealthWhile you may hear telehealth and telemedicine used interchangeably, from a coding perspective, the words refer to different services and situations.

Definitions:  A good place to start is by outlining the difference between telehealth (defined as any health service provided by telecommunications) and telemedicine (defined as any clinical service provided by telecommunications). Additionally, you’ll want to consider the array of nuanced guidelines and constantly changing code sets.

Have a look at three key areas to cover some of your most pressing telemedicine and telehealth services’ coding needs:

 

  1. Keep an Eye on Changes

“One of the greatest challenges facing telemedicine coding is that changes in technology typically occur faster than changes in coding,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

“CPT® code change proposals are often generated and acted upon more than a year before the changes/new codes appear in CPT®, and CPT®itself is only published once a year. So, it’s easy to see how technology moves faster, leaving coders to wonder if a new telemedicine service fits an existing code or needs to be reported using an unlisted code,” Moore adds.

As an example of this rapid change, theCenters for Medicare and Medicaid Services(CMS) introduced two new HCPCS codes for 2019: G2012 (Brief communication technology-based service, e.g. virtual check-in…) and G2010 (Remote evaluation of recorded video and/or images submitted by an established patient…), which you can use when a provider is evaluating information to determine if a patient needs to be seen in the office.

Additionally, CMS added two prolonged service codes, G0513 (Prolonged preventive service(s) … first 30 minutes…) and G0514 (…each additional 30 minutes…), to the telehealth services’ list.

One means of staying current with telemedicine codes is consulting Appendix P in your CPT® manual. Documenting any service listed there when provided via telemedicine is as easy as appending modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system). You will also need to add place of service (POS) code 02 (Telehealth) to your claim to indicate that the provider is at the distant site (as opposed to the originating site where the patient is located).

GT no longer needed: Unless you are billing claims from a critical access hospital (CAH) under method II for institutional claims, you no longer need to apply modifier GT (Via interactive audio and video telecommunication systems) to a Medicare telehealth claim. But modifier GQ (Via asynchronous telecommunications system) is still required for asynchronous communication when appropriate, says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

2. Know What Qualifies as Telemedicine

While telemedicine can involve the use of telephone communication, two groups of telephone evaluation and management (E/M) codes are not regarded as telemedicine.

Codes 99441 through 99443 (Telephone evaluation and management service by a physician or other qualified healthcare professional … provided to an established patient, parent, or guardian …) and 98966 through 98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian …) are not regarded as telemedicine because CPT®does not regard them as being “face-to-face” services.

Medicare Advantage Now Features Telehealth Expansion

In the past, telehealth was only an option offered through Medicare Advantage beneficiaries’ supplemental benefits, but the Centers for Medicare and Medicaid Services (CMS) wants to change that.

Now: Bolstered by provisions outlined in the Bipartisan Budget Act of 2018 (BBA 2018), CMS updated telehealth services for Medicare Advantage (MA) plans starting in the contract year 2020, notes a two-part final rule, published in the Federal Register last month.

“Under this final rule, MA enrollees may have great opportunities to receive healthcare services from places like their homes, rather than being required to go to a healthcare facility,” CMS advises. “MA plans will now have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees.”

The final rule allows MA plans the option to offer telehealth benefits to MA patients beyond their supplemental benefits in both rural and urban environments, aligning with BBA 2018 legislation, indicate attorneys Matthew M. Shatzkes and Susan Ingargiola of the national law firm Sheppard, Mullin, Richter & Hampton LLP, in the Sheppard Mullin Healthcare Law Blog.

However, “MA Plans will continue to be able to offer MA supplemental benefits (that is, benefits not covered by fee-for-service Medicare) via remote access technologies and/or telemonitoring for those services that do not meet the requirements for coverage under fee-for-service Medicare or the requirements for MA additional telehealth benefits (such as the requirement of being covered by Medicare Part B when provided in-person),” Shatzkes and Ingargiola explain.

The same is true for 99444 (Online evaluation and management service provided by a physician or other qualified healthcare professional … using the Internet or similar electronic communications network), which is also regarded as non-face-to-face and would also not be defined as telemedicine by virtue of its asynchronous nature.

3. Don’t Forget Difference Between State and Federal Rules

Depending on the nature of the telehealth service and the clinical care administered telemedically, CMS may not cover the outcomes.

“The key to compliance with Medicare rules is to evaluate the Medicare billing requirements for a bona fide telehealth encounter with the proposed arrangement from the telehealth company,” says John E. Morrone, a partner at Frier Levitt Attorneys at Law in New York City. “It is very common for healthcare services to comport with applicable state law but not be reimbursable by Medicare.”

He adds, “A telehealth encounter may be perfectly acceptable under state law, and even billable to commercial carriers, but not be billable to Medicare.”

Resource: For a more in-depth look at CMS’s telehealth services, visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf?utm_campaign=2a178f351b-EMAIL_CAMPAIGN_2019_04_19_08_59&utm_term=0_ae00b0e89a-2a178f351b-353229765&utm_content=90024810&utm_medium=social&utm_source=facebook&hss_channel=fbp-372451882894317.

 

Originally published Published on Thu Jun 06, 2019, TCI

Revenue Cycle Management

Reporting Cardiac Stress Tests

Interpretation only, or supervision, too? The answer affects your coding.

If coding for cardiac stress tests makes you want to pull your hair out, you are not alone. Understanding the nuances of the appropriate stress test codes can be tricky. Here’s how to avoid the confusion so you can seamlessly report stress tests.

Notice What Happens During Stress Tests

Cardiologists use stress tests, also known as treadmill or exercise tests, to see how well a patient’s heart deals with work.

When a patient takes a stress test, the cardiologist (or tech) hooks up the patient to heart monitoring equipment, and the patient walks slowly on a treadmill. Next, the treadmill’s speed increases and tilts to simulate the patient going up a small hill. During the test, the cardiologist monitors the patient’s heart rate, breathing, blood pressure, and level of tiredness.

Stress tests allow the cardiologist to diagnose coronary artery disease, determine a safe level of exercise for the patient, and diagnose a possible heart-related cause of symptoms such as chest pain, shortness of breath, or light-headedness.

stress test

Grasp 93015 — Several Codes in One

When it comes to reporting stress tests, the CPT® manual gives you the following options:

  • 93015, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharma­cological stress; with supervision, interpretation and report
  • 93016, … supervision only, without interpretation and report
  • 93017, … tracing only, without interpretation and report
  • 93018, … interpretation and report only.

Problem: The way that the CPT® manual lists the above codes could suggest that they work together. This interpretation isn’t correct, but the manual does not offer any extra explanation beyond the descriptor language for the codes’ appropriate usage.

Solution: You can look to an article in the January 2010 CPT® Assistant to see the close connection between the stress test codes.

According to CPT® Assistant, 93015 represents a complete cardiac stress test procedure, which includes the technical and professional components of the service — 93016, 93017, and 93018. To correctly report 93015, one cardiologist must perform all three components in a nonfacility setting like an office, clinic, or diagnostic testing center.

If the cardiologist does not perform a complete 93015, he should report just the code or codes that best represent the service he did perform (93016-93018).

Reporting stress tests in the hospital: If the cardiologist reports stress tests in a facility setting like the hospital, the facility would report the technical component (93017), and the cardiologist would report the service he performed (93016, 93018, or both).

Bonus tip: The PC/TC indicators for these codes in the Medicare Physician Fee Schedule also can help you use these codes correctly:

  • Code 93015 has indicator 4, meaning it’s a global test code that describes selected diagnostic tests where there are associated codes that indicate (a) the professional component only and (b) the technical component only.
  • Codes 93016 and 93018 have indicator 2, meaning they are professional components only. Codes 93016 and 93018 describe the physician work portion of selected diagnostic tests where there is an associated code that describes the global test.
  • Code 93017 has indicator 3, meaning it is the technical component only. Code 93017 indicates the staff and equipment costs of selected diagnostic tests where there is an associated code that describes the professional component of the diagnostic test only.

Understand the Individual Component Codes of 93015

Let’s dig deeper into each component of 93015 — 93016, 93017, and 93018 — to see what it means when a cardiologist reports these codes.

1. Code 93016 is a professional component you report for the physician’s supervision only, without the interpretation and report. Medicare’s diagnostic test supervision guidelines require this component.

Expert tip: Report 93016 only if the physician provides direct supervision of the stress test. Physicians should document they supervised in order to use this code.

2. Code 93017 represents the service’s technical component such as technicians, providing the equipment, paying for rental space, utilities, supplies, etc. You use 93017 for tracing only, without the interpretation and report.

Expert tip: For tests performed in a facility setting, only the facility reports 93017.

3. Code 93018 is a professional component.

Expert tip: Report 93018 if the provider provides an interpretation and a written report.

Learn more-

Cardiac Stress Test 

Cardiac Health

~Excerpt taken from the 2018 Cardiovascular Survival Guide

electronic patient recordICD-10MACRAmedical billingMedical Billing and Coding

New PT CPT Codes for 2017

pt-with-patient

CPT® 2017 has a few expanded codes for physical therapy evaluations and follow-up exams.  These codes are in effect for dates of service starting January 1, 2017.

97001 to be replaced by three codes in 2017:

These new codes will add more specificity and details regarding the scope of the evaluation and states that it involves clinical decision-making of low/moderate/high complexity. The evaluation includes history to identify any factors that impact the plan of care; using standardized tests and measures to assess body structures and functions that may limit activity or restrict participation; and evaluation of the patient’s current status on presentation. The evaluation typically includes face-to-face time with the patient and/or family.

97161 Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
97162 Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
97163 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.

CPT® 2017 adds 97164 to replace 97002 (Physical therapy re-evaluation).

The new code adds more specificity and details regarding the scope of the evaluation, which includes history review and standardized tests (criteria established and agreed upon by a group of experts) and measures to assess body structure and function; a revised plan of care using standardized instrument and measurable functional outcome assessment tool; and typically involves 20 minutes of face-to-face time with patient and/or family.

Consider these to be the equivalent of E&M codes (99000) for Physical Therapy.  You should now consider these elements when coding for services:

  • Patient’s history
  • Examination results
  • Clinical decision-making
  • Development of the care plan

The level of the PT evaluation performed depends on the clinical decision-making and the patient’s severity, according to CPT® instruction. For reporting, PTs must demonstrate review of these body regions and body systems:

  • Defined body regions such as the head, neck, back, lower extremities, upper extremities, and trunk
  • Musculoskeletal systems, which include gross symmetry, range of motion, strength, height, and weight
  • Neuromuscular systems, which includes gross coordinated movement and motor function
  • Cardiovascular and pulmonary systems, which include heart and respiratory rates, blood pressure, and edema
  • Integumentary system, which means assessing the pliability, scar formation, color, and integrity of the skin

One other thing-make sure to sequence these codes before your modality CPT codes (those starting at 97010).

OT and AT have similar changes.  Look for those in a future post.

References:
CPT® 2017 Professional Edition, American Medical Association, pages 664-668
Federal Register, Vol. 81, No. 136, Pat. 46162, July 15, 2016, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other revisions to Part B for CY 2017; Medicare Advantage Pricing Data Release: Medicare Advantage and Part D Medicare Advantage Provider Network Requirements’; Expansion of Medicare Diabetes Prevention Program Model”
AAPC Healthcare Business Monthly, November 2016

 

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It’s the holiday season….time to spread the Flu!

santa-hat

With all the weather changes we have experienced in the south over the past few months, getting the flu has been the last thing on anyone’s mind.  80 degree temps here in Kentucky in November is unheard of!  We’ve all been taking advantage of getting out in the fresh air (flu?  what flu?).

Well, now we are experiencing our first “Arctic Blast” and my first trip to Kroger this week resulted in witnessing probably the most embarrassing thing we as parents experience….projectile vomiting from a child in the grocery store.  Okay, maybe not the most embarrassing thing in the world but one that certainly had me running for the hand sanitizer and masks (no-I didn’t stick around to help).

And yes, remembering that in fact, the flu season is upon us.

Guidelines for Billing Influenza Vaccines

Medicare pays for one seasonal influenza virus vaccination per influenza season (12 months do not have to pass). Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.

Medicare will pay both administration fees when a beneficiary receives both the seasonal influenza virus and the pneumococcal vaccines on the same day. Report ICD-10-CM diagnosis code Z23 Encounter for immunization when an individual receives both vaccines, but report separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines.

Medicare Payment Allowances for this flu season (8/1/2016-7/31/2017)

CPT® Code Payment Allowance
90630 Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use $20.343
90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use $37.383
90654 Influenza virus vaccine, split virus, preservative-free, for intradermal use Pending
90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use Pending
90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use $17.717
90657 Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6–35 months of age, for intramuscular use Pending
90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use Pending
90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use $42.722
90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use $26.876
90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use $40.613
90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use

*NOTE-Claims for this code must be held until 1/1/17

$22.936
90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use $26.268
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use $19.032
90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6–35 months of age, for intramuscular use $9.403
90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use $17.835

 

HCPCS Level II Code Payment Allowance
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria) $16.284
Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval) $16.284
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin) Pending
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) Pending
Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) Flu Vaccine Adult – Not Otherwise Classified: Payment allowance is to be determined by the local claims processing contractor.

The payment allowance for some codes is still pending. Check the CMS website periodically for updates.

Resources:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html

https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2016-12-08-eNews.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending#_Toc468862699

 

 

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CMS Announces July 2015 Transition from IACS to EIDM

CMS 

The Centers for Medicare & Medicaid Services (CMS) would like to inform Physician Quality Reporting System (PQRS) participants and their staff to an important system update scheduled to be in place on July 13, 2015.


The Individuals Authorized Access to CMS Computer Services (IACS) system will be retired, but current IACS user accounts will transition to an existing CMS system called Enterprise Identity Management (EIDM). The EIDM system provides a way for business partners to apply for, obtain approval, and receive a single user ID for accessing multiple CMS applications.


Existing PQRS IACS users, their data, and roles will be moved to EIDM and will be accessible from the ‘PQRS Portal’ portion of the CMS Enterprise Portal at  http://portal.cms.gov. Users will then access the PQRS Portal to submit data, retrieve submission reports, view feedback reports, or conduct various administrative and maintenance activities. New PQRS users will need to register for an EIDM account.


Stay tuned for more information and resources in the coming weeks and months! In the meantime, please ensure that your IACS account is active, current, and you’re able to log in. This will help ensure a smoother transition to EIDM.


For additional assistance regarding IACS or EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday, or via email at qnetsupport@hcqis.org. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in email inquiries to the QualityNet Help Desk.

Integrated Cloud Based Solutions

ICD-10 Walking Through the Workflow

With less than a year to go until the ICD-10 code set implementation deadline, physician practices should be pursuing a comprehensive plan designed to ensure a smooth coding transition with minimal cash flow disruption.

A key step in any ICD-10-CM transition strategy is to conduct a detailed assessment of existing workflows and processes to determine which elements will require modification, according to Bess Ann Bredemeyer, a consulting director with McKesson Business Performance Services (BPS).

By identifying each point in the claims lifecycle that ICD-10- CM will touch, appropriate adjustments can be made and simulations conducted to test the new processes against real-world conditions.

“The best way to proceed with an assessment is to begin at the patient encounter and then move through to the claim drop and denial management,” Bredemeyer said. “That way you won’t miss anything.”

Clinical Documentation  Whether the clinical documentation is sent directly to a coder or to data entry personnel, it is also important to ensure that any changes in National Coverage Determinations (NCDs) and payer’s Local Carrier Determinations (LCDs) are incorporated and reflected in the claim. A good approach includes:

  • Identifying the top 50 most utilized diagnoses codes
  • Evaluating where additional documentation will be required
  • Mapping out modifications to support appropriate reimbursement
  • Updating charge tickets, super-bills and other revenue cycle tools

This is a Test  With all the elements theoretically in place, it is critical to begin testing your new workflow to determine if it can handle ICD-10-CM. Code audits can assess both clinical documentation and coding to determine whether the claims should come through clean or not. A real-world testing process may also reveal previously unknown problems that would otherwise remain hidden until the ICD-10 go-live.

Don’t Be Denied  Because of the complexity of ICD-10-CM and the sheer magnitude of the change, it’s reasonable to assume that even the best-laid plans may encounter some unexpected problems. For that reason, it makes sense to be prepared for a rise in denials. For physician practices, that means ensuring that staffing is adequate to manage an increase in volume, and that problems will be quickly identified and remediated.

“There is no denying that the transition to the new code set will require planning and resources to mitigate the burden of change,” Bredemeyer said. “That’s why you should get started now on developing a workflow analysis impact assessment that will help you develop a detailed ICD-10 timeline and budget.”

Article Resource:

ReveNEWS, Industry Spotlight, “Walking Through the Workflow- An Important First Step,” November 2013 edition located on the McKesson ReveNEWS website

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