Faculty Group Practice Newsletter

These codes are used for extensive time in addition to seeing the patient and must relate to a service for a patient where direct face-to-face patient care has occurred or will occur and be part of ongoing patient management. The time spent for prolonged non-face-to-face services does not need to be continuous but must be on the same calendar date.

Medicare has extended the Telehealth Flexibilities until Sept. 30, 2025. Other payers are starting to make decisions as to how they would like to handle telehealth. It is very important that when completing a telehealth visit, the TELEHEALTH NOTE is used. Using the telehealth note will bring up the proper documentation elements and add the appropriate telehealth modifier and place of service.

When co-surgeries and assistant surgeries are performed, it is very important that it is documented correctly so the appropriate modifiers can be added. Also, not all CPT codes can be billed as a co-surgery or an assistant surgery. Observing does not qualify as a co-surgery or an assistant surgery.

ICD-10 is essential to documenting medical necessity for services rendered, and accurate codes mean better outcomes for the patient, your claims, and your practice or facility.

The only way to trigger the charges for medications administered in the clinic (injection drugs such as steroids, IUD and Nexplanon devices, etc.) is to order and administer the medication in the MAR. Typically nursing staff will complete this; however if it was not completed you may receive a Coding Action Required in Epic.

The Inpatient or Observation Discharge Service is time based. Time for 99239 is required. 99238 – Hospital Inpatient or Observation Discharge Day Management – 30 minutes or less on the date of the encounter 99239 – more than 30 minutes on the date of the encounter

CMS introduces a new complexity code for Infectious Disease, G0545, and makes changes to the G2211 complexity code effective January 1, 2025.

CD released the FY2025 ICD-10-CM changes effective 10/1/2024. There are 252 new codes, 36 deleted codes, and 13 code revisions. Here we share a few highlights.

This month, we are delving into a long-standing belief around hospital follow-up visits at UTMB, or the “HFU” you might see on your schedule. In short, there is no such thing as a "free" hospital follow-up visit.

CPT codes describe the service you performed and the associated ICD-10 diagnosis codes describe the reason you performed that service. Together these codes tell your patient’s story for today’s visit and help to demonstrate medical necessity. It is important that these codes make sense to the payor.

Surgeons and proceduralists are often faced with a high volume of patients, complex cases, and demanding schedules. In this context, it can be challenging to complete and close patient notes in a timely manner. However, closing patient notes is not only a legal and ethical obligation, but also a crucial factor for ensuring patient safety, quality of care, and workflow efficiency.

The G2211 – visits complexity code may be a missed opportunity for you. This code was created by Medicare but other payors are recognizing and reimbursing for this code.

eConsults are an assessment and management service in which a treating faculty or APP requests advice or opinion from a specialist to provide advice and/or opinion in treating and/or management of the patient’s problem without fact-to-face contact with the consultant.

The patient’s experience begins the moment they choose or are referred to UTMB for their healthcare needs. Their experience includes their entire journey from setting the appointment, seeing our providers, receiving treatment, follow up appointments, etc. Every step of their journey is important.

Managing the patient financial experience at UTMB is a group effort, consisting of cross-functional teams within our patient care areas and our financial clearance support. Most recently, this effort has been challenged by the new mandates around price transparency and providing estimated costs prior to service delivery; and the overall trend towards patients being savvier about healthcare costs while plans become savvier about complicating reimbursement.

Happy New Year! 2024 brings changes concerning the necessary documentation for split or shared visits. Just a reminder, split or shared visits involve faculty and an APP furnishing an E/M service on the same date for the same problem.

Medicare is basing the new code on the longitudinal care relationship not the serious or complex condition. They believe this code reflects the time, intensity, and expense required to build longitudinal relationships with patients and address most of their health care needs with consistency and continuity over long periods of time.

There has been some confusion about when a patient is new vs established. CPT’s definition is a bit different from some payor’s definition when it comes to working with APPs. UTMB follows the CPT definition.

Effective Oct. 1, 2023, there are more than 433 diagnosis code changes, including 395 code additions, 25 deletions, and 13 code revisions. This brings us to a grand total of 78,000 diagnosis codes allowing for coding to the highest specificity possible. It is essential everyone involved in coding be educated regarding coding and documentation requirements

With the new 2021 E/M coding guidelines for office visits and most recently, the new 2023 E/M coding guidelines for inpatient services published by the AMA and approved by CMS, we find many providers, nationwide, billing based on Total Time instead of Medical-Decision-Making (MDM).