Faculty Group Practice Newsletter

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).

Choosing the specific amputation procedure code from the surgeon’s operative note can be a challenge for coders. If there is not enough information to know where the amputation took place, the coder will query the surgeon.

Medicare does not cover preventive services in the same way that commercial payors do. However, Medicare does have its own set of preventive services and screening that are a covered benefit.

It is not unusual to perform both a preventive service and a sick visit during the same encounter. CPT and CMS have rules concerning this billing scenario. This month we will cover how to bill for these services using CPT services.

An advanced beneficiary notice (ABN) is a written notice which a provider gives to a Medicare beneficiary before services are furnished when the provider believes that Medicare probably or certainly will not pay for some or all of the services.

This month we will focus on coding for laterality for diagnosis coding as this has been identified as a significant opportunity and is a key element of the coding and the reimbursement process.

As of 2022, colorectal cancer is the third leading cause of cancer-related deaths in both men and women and the second overall when men and women are combined. It is the third most common cancer diagnosis in men and in women in the USA. The majority of this type of cancer is found in people older than 50, however, colorectal cancer is on the rise in young adults and has been for years. Effective January 1, 2023, Medicare has changed its policy coverage for colorectal screening and reduced the patient responsibility.

We continue to receive great questions from providers concerning split or shared visits for both outpatient and inpatient services.