This report includes a collection of topics. Compliance, CPT® Panel Meeting, and new CPT codes for respiratory syncytial virus (RSV) vaccine administration are included in this report.
On the Centers for Medicare and Medicaid Services (CMS) website, there is an education tool to assist with the billing for assorted services ranging from venipunctures to supplies. The tool is named “Medicare Provider Compliance Tips” and can be found at MLN 4824456.
The American Medical Association (AMA) CPT Editorial Panel met in San Diego, CA on Feb. 1 and 2 last week to discuss applications for new CPT codes. There were 31 topics on the agenda including code set maintenance, Category III sundown, terminology standardization, hearing device services, coronary therapeutic services and procedures, prostate biopsy services, and online digital evaluation and maintenance (E&M).
Code set maintenance involved the removal of lowly utilized CPT codes. Category III codes are established for a period then converted to a regular CPT code. A number of specific Category III codes were discussed with proposed CPT options. The panel discussed the inconsistent use of the phrase, “qualified non-physician health care professional” throughout CPT. The prostate biopsy services topic was a discussion for reporting prostate biopsies and the radiology procedures which may also be performed. A topic which may be of interest to physician office staff is online digital E/M visits. There is a proposal to create a new section with CPT codes to capture these services/visits. I listened to the coronary therapeutic services and procedures presentation. This update will include changes to explanations, definitions, and CPT codes.
The MLN Connects Newsletter for Feb. 1, 2024, stated that CMS retroactively added two new CPT codes for RSV vaccine administration to the Medicare Physician Fee Schedule effective Oct. 6, 2023. The CPT codes are the following:
It is important to review various sources of new codes including AMA’s CPT Editorial Panel and CMS Coordination and Maintenance Committee Meetings. These meetings provide information on the “spirit” of the code or what drives the creation or deletion of a code. By participating in these meetings, the attendee has additional time to prepare for the implementation of codes as well as understand how the code changes will affect their organization.
Resources:
MLN Connects Newsletter, February 1, 2024
AMA CPT Panel February Agenda, https://www.ama-assn.org/practice-management/cpt
Continuing with our look at areas of coding confusion, let’s today examine pain. According to Medline Plus Magazine from the National Institutes of Health (NIH),
Today’s hot topic takes a look through the leadership lens of guiding your teams through a software transition. In my case currently, it is a
Please log in to your account to comment on this article.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
