E/M Changes On The Horizon For 2021?

By:Jacqueline Thelian, CPC, CPC-I, CHCA

Significant changes to the E/M Documentation Guidelines for “outpatient visits” will an important change in 2021.

CMS, the AMA and most physicians agree the cognitive work of physicians and qualified healthcare professionals for E/M office visits is best determined by the time and the level of medical decision making. Therefore, the proposed guidelines for 2021 allow the physician/QHP to select the level of service based upon time or the level of medical decision making.

The AMA has updated the Table of Risk (download below) to include clearer definitions relating to the Number and Complexity of Problems Addressed, the inclusion of Categories regarding Options for the Amount and/or Complexity of Data to be Reviewed and Analyzed as well as straightforward definitions of Risk on the Risk of Complications and/or Morbidity or Mortality of Patient Management.

2021 will also include the deletion of CPT code 99201 Outpatient Office Visit for a New Patient at the lowest level, and a new HCPCS Level II code GPC1X Visit complexity inherit to evaluation and management associated with primary medical care would be added to established office/outpatient CPT® codes. This new add on code will reimburse $15.00.

---

 Source:

• https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf

Are Your Orders Validated?

By:Jacqueline Thelian, CPC, CPC-I, CHCA

Whether you are a Diagnostic Testing Facility, an Independent Laboratory or a Physician who received referrals, you need to make sure your orders are valid and validated.

Valid orders include at minimum, the patient’s name, test(s) ordered, indication for the test(s), a clear and legible name of the ordering physician, the ordering physician’s signature and date of the signature. Remember signature stamps are not valid.

However, on many occasions the order is incomplete and/or illegible.

CMS as well as many other insurers are now asking the “rendering” provider to validate the order.

As per CMS, “The physician who treats a beneficiary must order all diagnostic x‐ray tests, diagnostic

laboratory tests, and other diagnostic tests for a specific medical problem. Documentation in the patient’s medical record must support the medical necessity for ordering the service(s)”

CMS goes on to say, “However, it remains the responsibility of the individual or entity upon whom/which the request has been made to provide documentation.”

Therefore, in order to validate the request for the test, it is the responsibility of the rendering/servicing provider to produce the patient’s medical progress note from the ordering physician which documents the test(s) ordered as well and the medical necessity and indication for the test.

---

2020 CPT Changes New and Noteworthy

By:Jacqueline Thelian, CPC, CPC-I, CHCA

2020 CPT includes 384 changes, including 248 new codes, 71 deletions and 75 revisions. Are you ready?

E/M codes for online digital E/M services.

99421 – On-line digital E/M service for an established patient for up to 7 days, cumulative time during the 7 days; 5-10 minutes, 99422 11-20 minutes and 99423 21 or more minutes.

These services are reported through HIPAA Compliant secure platforms, such as an electronic health record portal, secure email, and other secure digital applications.

Time reported is cumulative during a seven-day period and physicians and QHPs in the same group practice contribute to the total service time.

Dry Needling

These long-awaited CPT codes are finally here. 20560 Needle insertion(s) without injection(s) 1 or 2 muscle(s) and 20561 for 3 or more muscle(s).

Long Term EEG Setup & Monitoring

This section underwent a complete overhaul.

• Codes 95950, 95951, 95953, 95956 are being deleted.

• 23 codes (95700 – 95705-95726) are being established to replace the deleted codes - 13 Technical Component only

For a comprehensive listing and review of all the new and revised CPT codes come and join us at the 2020 CPT Workshop offered for the first time in New York. The course includes the 2020 CPT Manual (Professional Edition) and its companion CPT Changes An Insiders View.

---

What CPT code replaced 10022?

By:Jacqueline Thelian, CPC, CPC-I, CHCA

CPT code 10022 Fine needle aspiration; with imaging guidance was replaced in 2019 with the following range of CPT codes 10005-10012.

CPT 2019 includes a new subsection of CPT codes for Fine Needle Aspiration (FNA) Biopsy as these codes now include imaging guidance as part of the procedure. The subsection includes the following codes, including the nine new codes, all of which are reported by type of imaging modality and per lesion.  

• 10021 Fine needle aspiration biopsy, without imaging guidance; first lesion (not a new code)
  

• +10004 each additional lesion (List separately in addition to code for primary procedure)
  

• 10005 Fine needle aspiration biopsy, including ultrasound guidance; first lesion
  

• +10006 each additional lesion (List separately in addition to code for primary procedure)
  

• 10007 Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
  

• +10008 each additional lesion (List separately in addition to code for primary procedure)
  

• 10009 Fine needle aspiration biopsy, including CT guidance; first lesion
  

• +10010 each additional lesion (List separately in addition to code for primary procedure)
  

• 10011 Fine needle aspiration biopsy, including MR guidance; first lesion
  

• +10012 each additional lesion (List separately in addition to code for primary procedure)

When more than one FNA biopsy is performed on separate lesions at the same session, same day, same imaging modality, use the appropriate imaging modality add on code for the second and any subsequent lesions. For example: 

10005 Fine needle aspiration biopsy, including ultrasound guidance; first lesion

+10006 each additional lesion (List separately in addition to code for primary procedure)

When FNA biopsies are performed on separate lesions, same session, same day, using different imaging modalities 

Report the corresponding primary code with modifier 59 for each additional imaging modality and the  corresponding add on codes for subsequent lesions sampled. Regardless  if the lesions are ipsilateral or contralateral to each other, and/or whether they are in the same or different organ/structures. For example:

10007 Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion

10005 -59 Fine needle aspiration biopsy, including ultrasound guidance; first lesion

+10006 each additional lesion (List separately in addition to code for primary procedure)

In this example three lesions are biopsied, one by fluoroscopy and two by ultrasound. Modifier 59 is appended to the second fine needle aspiration code (10005)  by ultrasound and  CPT code 10006 is reported to capture the second fine needle aspiration  by ultrasound.

---

 Source:

• 2019 Current Procedural Terminology (CPT) 

Do I Still Need Progress Reports?

By:Jacqueline Thelian, CPC, CPC-I, CHCA

As per the Centers for Medicare and Medicaid Services (CMS) effective for dates of service on and after January 1, 2019 the reporting of HCPCS G Codes for Functional reporting and the severity modifiers are no longer required. 

This change had no impact on the requirement to document Progress Reports.  The CMS Local Coverage Determinations (LCD) state “Progress reports shall be written by a clinician at least once every 10 treatment days. A progress report is not a separately billable service.” 

It is important to keep in mind progress reports are oftentimes the  key document in physical therapy audits to provide the medical necessity for the services rendered. 

For further information  please go to the following CMS sites:  CMS All Fee For Services Providers Page https://www.cms.gov/Center/Provider-Type/all-fee-for-service-providers-center.html

---

 Source:

• CMS Functional reporting: https://www.cms.gov/Medicare/Billing/TherapyServices/Functional-Reporting.html 

The Clock is Ticking for Quality Payment Program (QPP) Data Submission

By:Jacqueline Thelian, CPC, CPC-I, CHCA

It’s that time again. The QPP data submission site is open now until April 2, 2019, 8pm.

If you are part of an Accountable Care Organization (ACO) or Alternative Payment Model (APM) who will submit quality measures on your behalf remember you are most likely  responsible to report your Promoting Interoperability.  It is advised to check with you ACO/APM, many of which encourage the providers/group to report this on their own.

For an eligible clinicians or groups reporting on their own or to report their Promoting Interoperability, go to the QPP Data Submission System https://qpp.cms.gov/login and you can login using either your Enterprise Identity Management (EIDM) credentials or the new HCQIS Authorization Roles and Profile (HARP).

It is recommended you sign in during the submission period which will allow you to review the entered data before the final submission.

If you are an EC reporting via administrative claims, your reporting was included in all your claims.

---

 Source:

• QPP Data Submission System: https://qpp.cms.gov/ 

Home Visits, Now on Cruise Ships and Campgrounds!

By:Jacqueline Thelian, CPC, CPC-I, CHCA

(99347 – 99350)

Yes, it is true CMS  updated the definition of home to include, temporary lodging and short term accommodations. The change includes places such as, hotels, hostels, campgrounds, and cruise ships.

Other changes to the home visit include:

• Only requiring documentation of an interval history since the previous visit
  

• Eliminating requirements to re-document information from practice staff or patient
  

• Removing the need to justify home visits in place of office visits

---

 Source:

• Source: MLN Matters MM11063: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11063.pdf