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Pay for chronic care management easier in proposed fee schedule, part 2

September 11, 2014 - By Roy Edroso
More good news for practices who offer transitional care management (TCM) services: CMS proposed similarly amending the direct-supervision requirements for those codes (99495-99496). But the E/M service that goes with TCM must be done by the doctor or under his or her direct supervision.The hoops yo... Read More

Read payer policies closely when doing radiofrequency for knee OA

September 11, 2014 - By Laura Evans
Question: One of our doctors is looking into performing minimally invasive genicular nerve ablation procedures and wants me to research the CPT codes and Medicare reimbursement. The procedure uses a cooled radiofrequency procedure to treat osteoarthritis-related knee pain. What CPT code would we use... Read More

CMS sketches out ICD-10 testing schedule, finalizes Oct. 1, 2015 start date, part 2

September 11, 2014 - By Laura Evans
Timely, detailed test results are keyEnd-to-end testing is where providers will find out whether their claims will be paid or denied with ICD-10 codes, says consultant and former CMS official Stanley Nachimson of Nachimson Advisors in Reisterstown, Md.CMS plans to do that for a vastly smaller pool o... Read More

Pay for chronic care management easier in proposed fee schedule

September 03, 2014 - By Roy Edroso
A program to pay for chronic care management (CCM) that CMS proposed last year has undergone changes in the proposed 2015 Medicare physician fee schedule: While the new rules make it easier to fulfill the service with non-physician clinical staff, you'll have to jump through some hoops to earn the $... Read More

Make sure PCI is documented during myocardial infarction to report 92941

September 03, 2014 - By Laura Evans
Question: If a patient is admitted for ST segment elevation myocardial infarction (STEMI), do we report only 92941 for the percutaneous transluminal revascularization if the procedure is done on the date of admission when the STEMI occurred? I have a patient that had a percutaneous coronary int... Read More

CMS sketches out ICD-10 testing schedule, finalizes Oct. 1, 2015 start date

September 03, 2014 - By Laura Evans
Practices will have expanded access to ICD-10 testing next year, including three opportunities each for acknowledgement and end-to-end testing, CMS said.You'll be able to test whether a claim with ICD-10 codes was successfully transmitted and accepted by your Medicare administrative contractor (MAC)... Read More

No new conversion factor and PQRS requirements addressed in proposed fee schedule

August 21, 2014 - By DecisionHealth Staff
Payments set until AprilThe "doc fix" implemented April 1 had a 0% update through March 31, 2015, leaving the conversion factor at $35.8228.CMS didn't include a new conversion factor in the proposed fee schedule, saying that it will submit an estimate of the sustainable growth rate (SGR) and convers... Read More

Watch for new bundles for imaging

August 21, 2014 - By Laura Evans
On the imaging front, your spinal mylography procedures (72240-72270) are bundled components of CT neck chest and lumbar studies (72125-72133), though the code pairs have a "1" modifier indicator, meaning you can unbundle them with the appropriate modifier when wanted.Fluoroscopy codes 76000&nb... Read More

Case study: How to code hypertensive heart, kidney disease in ICD-10, part 2

August 21, 2014 - By Laura Evans
Code diabetes based on type, conditionWhen coding diabetes in ICD-10, you will no longer be concerned about whether the patient has controlled or uncontrolled diabetes, as you are in ICD-9. Instead, you'll select from five diabetes categories, explains Deb Grider, CCS-P, CDIP, CPC, CPMA, CPC-H, seni... Read More

New chronic care payments, changes to global periods in proposed fee schedule

August 14, 2014 - By DecisionHealth Staff
Your practice could earn almost $42 per patient every 30 days for chronic care management (CCM) as long as your clinical staff jump through the proper hoops to bill a new G-code, including being available 24/7.The CCM fee and one G-code, GXXX1, were announced in the 609-page proposed 2015 Medicare p... Read More


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