Links, References & Insights
HCPC G2211 Longitudinal Care in Podiatry
Many medical providers are undercoding evaluation & managment visits because they are creatures of habit. Are you still coding and documenting the same way you have been for years? If you answer yes to that question, you could be leaving money on the table.
The coding and documentation rules for E&M coding changed significantly in 2021 with some additional revisions in 2023. As a specialist, it is now much easier (and appropriate) to code a higher level E&M!
The new rules are based on medical decision making (MDM) or time spent. With MDM, coding is based on problems and data or risk. With time, it is based on not only time spent with the patient, but also time spent reviewing records, educating caregivers, and documentation!
Avoid These 5 Common Coding Mistakes
ABIs When are They Covered?
Non-invasive areterial studies can be performed on the following:
Adults over 65 years of age
Adults over 50 years of age and over with a history of tobacco use and/or diabetes and/or coronary artery disease
Adults with abnormal lower extremity vascular PE
Adults with leg symptoms consistent with lower extremity PAD
Adults with chronic lower extremity ulcer
Must document an order AND a hard copy of the study results with interpretation of the findings.
What are the Signature Requirements for Documents?
Medicare providers must comply with documentation requirements including timeliness of provider signature. Without a signed document, a claim cannot be submitted to the payer. With that in mind, this is real incentive to complete your documentation in a timely manner.
What is "timely"? Medicare is vague, they say "during or as soon as practicable after it is provided in order to maintain an accurate medical record". What?! So just what does that mean? What is practicable to one is different to another. This is where your power of reason comes in. Some publications say 72 hours, is this reasonable? Would you want your claim being held any longer than that? These are up for your consideration.
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/signature_requirements_fact_sheet_icn905364.pdf
New CPT and ICd10 codes
Z79.85 inj long term use antidiabetic drug
Use with E08, E09, E11, E13 codes as 2nd dx. Use more than one if appropriate. There are other Z codes in the family. They tell the payer how the patient's diabetes is being managed.
Z59.82, 86, 87 social determinants, these can be used for e&m coding, to tell the payer about risk factors.
15853 & 4, removal of sutures and/or staples.
Use for 0 day global procedures such as amputations and 28001-3. Bill with appropriate e&m because these are add on codes
76882 has had it's definition clarified to include the term focal evaluation, 76883 has been added for comprehensive ultrasound of an entire structure
Coding has nothing to do with $$ or RVU’s.
Jeffrey Lehrman DPM FASPS MAPWCA CPC• 1st
Coding has nothing to do with $$ or RVU’s.
Coding education should only be about following the rules and getting it right.
There is no such thing as “strategic coding.”
Chapter IV, Section A of the 2023 NCCI Policy Manual states:
"A provider/supplier shall not report multiple HCPCS/CPT codes if a
single HCPCS/CPT code exists that describes the services.” For example, if a transmetatarsal amputation is performed, the CPT® code whose descriptor is ““Amputation, foot; transmetatarsal” should be selected. Breaking down the procedure into a bunch of other codes because it pays more is the definition of unbundling….and is a bad thing to do.
59/XS & 25 modifier denials
2023 brings on a new challenge with many MA and commercial payers denying claims that are properly coded with 59, XS or 25 modifiers. The payer wants to see your documentation, appeal the claim. If you believe your documentation properly supports the use of the modifiers, APMA wants to see that documentation and the denial so they can fight these system edits. Redact all HIPAA information and email the information to healthpolicy.hpp@apma.org
If we do not do our part by appealing these claims, APMA and other Podiatric Associations at the state level have nothing to bring to the powers that be to make changes.
New Modifier Requirement for Skin Substitutes and Grafts
Beginning July 1 2023 CMS requires the use of JZ modifier when there is no waste. The rule for the JW modifier has not changed, still code the wasted units on a separage line with a JW modifier, no JZ required in this scenario.
www.cms.gov/files/document/mm13056-new-jz-claims-modifier-certain-medicare-part-b-drugs.pdf
