![]() When a patient has hypertension with chronic kidney disease, report I12. For example, when a patient has type 2 diabetes with chronic kidney disease, report E11.22. CMS also adopted new guidelines for musculoskeletal procedures, including nonmanipulative care, and continues to publish new vaccine codes for COVID-19.Īnother helpful pointer is to know when a singular combination code (rather than multiple diagnosis codes) is required, explains Sarah Ragan, CPC, certified coder in Daytona Beach, Florida. In addition, in 2022, Centers for Medicare & Medicaid Services (CMS) finalized the addition of proposed CPT code 99X21 as new CPT code 99437 (chronic care management services, each additional 30 minutes, by a physician or other qualified health care professional, per calendar month). She provides the example of G0297 for lung cancer screening this code was deleted in 2021 and replaced by 71271. ![]() Similarly, physicians who don’t stay on top of coding changes also run the risk of reporting invalid procedure codes, Huey explains. What are some recently updated diagnoses? Consider the following: “They file a claim on October 1, and the claim is denied because the code is invalid.” “So many practices don’t keep up with the coding changes,” she says. How to get paid: Stay abreast of annual coding changes, says Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, owner of KGG Coding and Reimbursement Consulting, LLC, in Alabaster, Alabama. See the chart below for more information.īe sure to document the total face-to-face or non–face-to-face time spent with the patient on the date of the encounter, as well as why additional time beyond the usual service was required, Elhoms explains.Ĭheck out the two guides on page 17 to help determine whether billing prolonged services may be warranted. Note minimum time thresholds for Medicare versus non-Medicare. Also be sure to append modifier -25 to the base E/M code. Physicians can only report G2212 or 99417 with 99205 or 99215 when the physician selects the E/M code based on total time (not medical decision-making). For Medicare, the prolonged services code is G2212. What do you need to know? Consider the following: However, in 2021, Medicare and current procedural terminology (CPT) rules and codes changed. In the past, physicians could report a prolonged services E/M code in addition to any other E/M office visit code. If a physician sees those same patients within three years, the patients are considered established, Elhoms explains.Ģ Incorrect application of prolonged services codes with office visit evaluation and management (E/M) codes ![]() “If taxonomy codes (aren’t) set up correctly, this will impact coding,” she says.īe mindful of non-physician providers who see new patients and bill under their own nation provider identifier. Was the patient who was seen within three years by another physician in the same clinic? If so, they’re also an established patient, according to Toni Elhoms, CCS, CPC, chief executive officer of Alpha Coding Experts, LLC, in Orlando, Florida. For example, did the patient have an audio-visual telehealth appointment within the past three years? If so, they’re considered an established patient even if they’ve never been seen in person, according to Victoria Moll, CPC, owner and founder of Contempo Coding, LLC, in Fleetwood, Pennsylvania. A patient who is new to you isn’t necessarily a new patient per official definitions. Listed below are eight of the most common reasons for denials and how to avoid them.ġ Incorrect patient status (i.e., new versus established) Experts say you can’t ever eliminate denials and post-payment recoupments entirely, but you can reduce them by focusing on coding and documentation compliance. Or in some cases, they pay you and then take the money back. Despite your best efforts to follow billing guidelines, payers still deny your claims.
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