In CMS
Jul 14th, 2017
Among the many provisions detailed within the 2018 Physician Fee Schedule Proposed Rule, released July 13, the Centers for Medicare & Medicaid Services (CMS) acknowledges that the current evaluation and management documentation guidelines create an administrative burden and increased audit risk for providers: Stakeholders have long maintained that both the 1995 and 1997 guidelines are ...
Healthcare expenditures account for an estimated 18 percent of the United States’ gross domestic product. A 2014 BMC Health Services Research study (“Billing and Insurance-related Administrative Costs in United States’ Health Care”) found that in 2012 billing and insurance-related administrative costs alone totaled $471 billion — nearly one-fifth of all healthcare costs. While I celebrate ...
In Coding
Dec 12th, 2016
Question: Can a physicians code separately for reading X-rays or imaging studies taken elsewhere? For instance, could we report the appropriate X-ray CPT® code with modifier 26 Professional component attached? Answer: If another provider (e.g., hospital radiologist) previously read/interpreted the image, and has issued a report, your physician cannot separately code or be paid for ...
In Coding
Oct 17th, 2016
Minor procedures (including colonoscopy and endoscopy) have a zero- or 10-day global period and no pre-operative period (other than the day of the procedure). As such, the initial office consultation with the provider to determine the indications and need for an endoscopy, potential risks, type of sedation, preparation, etc., is a billable service, when medically ...
In Audit
Jul 5th, 2016
Whether you may assign credit in the data review section of medical decision-making (MDM) if the provider separately bills for the professional component of a test is a matter of payer interpretation and policy, as explained by the American College of Emergency Physicians (ACEP): If I bill for an ECG or X-ray interpretation, can I ...