Billing & Coding

Back in August of 2018, as part of the Medicare Shared Savings Program (Shared Savings Program), CMS proposed some sweeping changes for Accountable Care Organizations (ACOs). There has been some controversy over these changes which require ACOs to move to two-sided models. In this Final Rule which was scheduled to be published in the Federal Register on December 31, 2018, they address the comments and concerns submitted during the comment period.

Welcome 2019 CPT Codes!

The AMA has released the New, Revised and Deleted CPT codes these are currently available on Find-A-Code. View the entire list of changes on the CODE tab and select CPT. Be sure to review all of the changes effective January 01, 2019.  

  • 168 New Codes
  • 72   Deleted Code
  • 51   Revised Codes

Here are a few important changes to watch for:

Importance of Depression Screenings

Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition.

Quality Measures Finalized for 2019

CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are:

  • Physical therapists
  • Occupational therapists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Clinical psychologists
  • Registered dietitian or nutrition professionals

The following are changes to Electronic Clinical Quality Measures (eCQMs) available for eligible professionals and eligible clinicians for 2019 reporting:

Center for Medicare and Medicaid Innovation (CMMI) models are created by CMS to test innovative payment techniques and service delivery models. As of November 2018, here are some CMMI models:

  • Medicare Diabetes Prevention Program
  • ACO Models (e.g., Pioneer ACO, Next Generation ACOs)
  • Independence at Home Model
  • Comprehensive Primary Care Plus
  • Oncology Care Model
  • Joint Replacement Model

See the References to be linked to Medicare's page listing all Innovation Models.

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Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?

The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...

Q/A: What Codes do I use for CLIA-Waived Tests?

Question:

I am a certified DOT medical examiner and have applied to get my CLIA lab (waiver) for urinalysis, finger prick blood tests for A1c, cholesterol and glucose. I realize I cannot diagnose patients with these tests, but I am using them to make decisions in the DOT process and with nutritional counseling. What codes do I use for these tests?

Answer:

Question:

We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as TMJ related so they can be more widely covered?

Answer

The list of settings where a physician’s services are paid at the facility rate include:
  • Telehealth (POS 02);
  • Outpatient Hospital-Off campus (POS code 19);
  • Inpatient Hospital (POS code 21);
  • Outpatient Hospital-On campus (POS code 22);
  • Emergency Room-Hospital (POS code 23);
Physicians’ services are paid at nonfacility rates for procedures furnished in the following
settings:
 
  • Pharmacy (POS code 01);
  • School (POS code 03);
  • Homeless Shelter (POS code 04);

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