Faculty Group Practice Newsletter

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G2211 Complexity Code

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.

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eConsultations

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.

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Managing the Patient Financial Experience

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.

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Split or Shared Visit Changes for 2024

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.

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NEW CODE for 2024 – G2211 for Medicare and Medicare Managed Care Patients

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.

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New vs. Established Patient

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.

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ICD-10 Diagnosis Code Changes Effective October 1, 2023

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

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Evaluation and Management Services Based on Total Time

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).

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Amputation Operative Notes

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.

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Medicare Preventive Care

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.

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NEW! Medicare Advanced Beneficiary Notice

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.

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Laterality - ICD-10 Diagnosis Coding

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.

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Colorectal Cancer Screening: Medicare Changes Coverage Policy

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.

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Split or Shared Visit FAQ

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

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