Tag: CPT Codes

Top-Challenges-for-Care-Management-Coding-in-2023

Top Challenges for Care Management Coding in 2023

Providing care management services, including chronic care management (CCM) and principal care management (PCM), is not easy. The first overarching challenge is that not enough patients actually participate in care management with a primary care physician. In fact, A recent report from the Primary Care Collaborative and the American Academy of Family Physicians’ more Americans […]
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AMA-Releases-2023-CPT-Errata

AMA Releases More 2023 CPT® Errata

E/M, Gastro, and Lab Coders, take note. The American Medical Association (AMA) announced some last-minute corrections to the CPT® code set effective Jan. 1, 2023. Add these to your code book, along with the previously released corrections, to ensure you start the year off right with accurate codes and guidelines. Evaluation and Management (E/M) In […]
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Policy-Changes-for-Medicare-Payments-Under-the-PFS

Policy Changes for Medicare Payments Under the PFS

On November 2, 2022, the Centers for Medicare & Medicaid Services (CMS) issued CY 2023 Physician Fee Schedule Final Rule (Final Rule), implementing certain updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS) and changes to the Medicare Shared Savings Program (MSSP), effective on or after January 1, 2023. The final […]
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Payers-Wrongly-Cutting-Payments-To-Physicians-For-EM-Services

Payers Wrongly Cutting Payments To Physicians For E/M Services

Payers have been wrongly cutting payments to physicians for evaluation-and-management (E/M) services—often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer downcoding. Downcoding happens when a payer changes a claim to a lower-cost service than what was submitted by the physician, leading the practice to get […]
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CPT®-and-HCPCS-Newly-Added-and-Revised-Codes

CPT® and HCPCS Newly Added and Revised Codes

CPT® codes are effective Jan. 1, 2023. The American Medical Association (AMA) released CPT 2023 on Sept. 12. There are 225 new codes, 75 deletions, and 93 revisions. Most of the changes fall in the Evaluation and Management (E&M) section. The 2023 CPT codes are effective Jan. 1, 2023. The October 2022 release of the […]
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Billing-for-Tetanus-Vaccine

Billing for Tetanus Vaccine? Check the Diagnosis

Did you know that tetanus vaccines are covered under Medicare Part B only when administered for treatment purposes? Preventive tetanus vaccinations do not fall under coverage. The Centers for Medicare & Medicaid Services Internet-Only Manuals Pub. 100-02, Chapter 15, Section 50.4.4.2 clarifies, “Vaccinations or inoculations are excluded as immunizations unless they are directly related to […]
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E-M Codes and Guidelines in 2023

Updates to the E&M Codes and Guidelines in 2023

The E&M categories that will undergo revision in 2023 encompass: Inpatient and observation care services. Consultations – both outpatient and inpatient Emergency department services Nursing facility services Home and residence services Prolonged services Throughout the upcoming months, a dedicated focus will be placed on each E&M category, delving into the revisions and changes in guidelines. […]
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Booster-Codes-for-COVID-19-Vaccine

Updated Booster Codes for COVID-19 Vaccine Released

Age determines who qualifies for the bivalent formulations from Pfizer and Moderna. On Aug. 31, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 vaccines to include updated booster bivalent formulations. These latest formulations include messenger RNA components to help build immunity against both […]
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Use-CPT-Modifiers-to-get-paid-correctly

CPT Modifiers for Physicians to Get Paid

During a typical office visit, physicians may provide evaluation and management (E/M) services, minor procedures and more. The question is: Can they bill for each one separately? In some cases, the answer is no. In others, though, the answer is yes — but they must know what current procedural terminology (CPT) modifier to append. Modifiers […]
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Get-Ready-for-EM-Coding-in 2023

Get Ready for E/M Coding in 2023

The reverberations of the 2021 evaluation and management (E/M) documentation guidelines have barely subsided, yet we are already on the verge of witnessing further changes in this segment of CPT® for 2023 – and this time, the implications stretch beyond mere office visits. If your healthcare institution conscientiously adopted the 2021 E/M guidelines, there’s no […]
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