Revenue Cycle and Coding

MLN Matters Articles

ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2023 Update

• New codes
• Recent changes
• How to find NCD coding information

ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2023 Update

HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing: April 2023 Update

Learn about codes excluded from skilled nursing facility consolidating billing, including:

• HCPCS Codes
• Codes for blood clotting factors

COVID Updates

Reference below links for available COVID vaccine and immunization codes

AMA – COVID-19 CPT vaccine and immunization codes

CDC – COVID-19 Vaccine Codes

CMS – COVID-19 Vaccines and Monoclonal Antibodies

Split-Shared Visit

Updates postponed to 2024

Public Health Emergency

The Biden Administration announced its intent to end the COVID-19 national emergency and public health emergency (PHE) declarations on May 11, 2023. These emergency declarations have given the federal government the authority to waive or modify regulatory and other requirements during the PHE. The Table below provides an overview of some of the flexibilities and waivers impacting teaching hospitals and physicians during the PHE, and their status after the PHE ends. As noted, some of these waivers and flexibilities will expire on May 11, 2023, some will be in effect until December 31, 2023, some will be in effect until December 31, 2024, and others were made permanent. The Table indicates whether legislative or regulatory action would be needed to change these policies. A comprehensive list of all the waivers and flexibilities is available on CMS Website.

Telemedicine

Reference the below link for general Medicare Telehealth guidelines and coding information.

CMS – Medicare Telemedicine Health Care Provider Fact Sheet

Shoulder Arthroscopy 2023 NCCI Changes

Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure.

With 3 exceptions:

1. Shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure.
2. CPT codes 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure))
3. 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), and 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.

Medicare NCCI 2023 Coding Policy Manual

Hernia 2023 CPT Changes

Many codes have been deleted and or revised.

Codes 49591-49618 will be reported only once, based on the total defect size for one or more anterior abdominal hernia(s), measured as the maximal craniocaudal or transverse distance between the outer margins of all defects repaired. The hernia defect size should be measured prior to opening the hernia defect(s) as during the repair the fascia will typically retract creating a falsely elevated measurement.

When both reducible and incarcerated or strangulated anterior abdominal hernias are repaired at the same operative session, all hernias are reported as incarcerated or strangulated.

For example, one 2 cm reducible initial incisional hernia and one 4 cm incarcerated initial incisional hernia separated by 2 cm would be reported as an initial incarcerated hernia repair with a maximum craniocaudal distance of 8 cm (49594).

Inguinal, femoral, lumbar, omphalocele and/or parastomal hernia repair may be separately reported when performed at the same operative session as anterior abdominal hernia repair by appending modifier 59 as appropriate.

Implantation of mesh or other prosthesis, when performed, is included in 49591-49622 and may not be separately reported. For total or near total removal of non-infected mesh when performed use 49623 in conjunction with 49591-49622.

For removal of infected mesh use 11008.

AMA 2023 CPT Code Book

Final Rule

2023 CMS Final Rule changes effective January 1st, 2023

CY 2023 CMS is taking a similar approach to the CY 2021 PFS final rule for office/outpatient Evaluation and Management (E/M) visit coding and documentation.  CMS has finalized and adopted most of the AMA CPT changes in coding and documentation for Other E/M visits which includes hospital inpatient and observation services effective January 1, 2023.

CPT code definition changes include:

• New descriptor times (where applicable)
• Revised interpretive guidelines for levels of medical decision making
• Choice of medical decision-making or time to select code level for timed services
• Elimination of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam)
• The amount and/or complexity of data to be reviewed and analyzed will now include interprofessional communications (typically called curbside consults) as part of the medical decision-making when not reported separately
• Observation care CPT codes are being combined with other hospital services
  • Observation Care Discharge 99217 is deleted and to be reported with 99238 and 99239 (Hospital Inpatient or Observation Discharge Services)
  • Initial Observation Care New or Established 99218, 99219, 99220 have been deleted and to be reported with 99221, 99222, 99223 (Initial Hospital Inpatient or Observation Care)
  • Subsequent Observation Care 99224, 99225, 99226 have been deleted and to be reported with 99231, 99232, 99233 (Subsequent Hospital Inpatient or Observation Care)
  • 99234-99236 Hospital Inpatient or Observation care (including Admission and Discharge) change in descriptor
• Deletion of Level One Consultation services 99241/99251
• Creation of Medicare-specific G-codes for payment of Other E/M prolonged services, similar to what CMS adopted in CY 2021 for payment of Office/Outpatient prolonged services.
• Extension of Medicare telehealth services temporarily available through CY2023
• Eliminated barriers to allow for greater use of services provided by behavioral health professionals (LPCs/LMFTs), adding an exception to the direct supervision requirement.
• Updated opioid treatment payment rates

2023 CMS Final Rule

Critical Care Services 2022

Critical Care Services (CPT codes 99291-99292) CMS finalized the adoption of the CPT prefatory language for critical care services as currently described in the CPT Guidelines. CMS prohibits a practitioner that reports critical care services furnished to a patient from also reporting any other E/M visit for the same patient on the same calendar day that the critical care services are furnished to that patient and vice versa. Additionally, CMS would prohibit billing critical care visits during the same time as a procedure with a global surgical period.

2022 Medicare Physician Fee Schedule and QPP Final Rule Summary | AMA