November 2018 Client Newsletter
ICD-10 Codes - Urgent
Just a reminder to send all ICD-10 codes relevant to each visit as a means to support the level of E&M code(s) you are billing. Showing the patient has multi-system disease, co-morbidity, etc. helps to show why you spent more time and that the level of decision-making was more complex when insurers are looking at the data in their system. The additional diagnoses will also likely decrease the likelihood for audits.
CPB software can accept up to 12 ICD-10 codes, which is the currently maximum that insurers can accept. Be sure to make it clear which ICD-10 codes go with each CPT code when you bill more than 1.
Advanced Care Planning
Advanced Care Planning (99497 & 99498) is being successfully used by one of our clients and something you may want to add to your services.
The brief descriptions for each code are:
99497: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.
99498: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure). 99498 must be used with 99497.
The payments are primarily Medicare & Medicare Advantage plans, but some commercial patients have been seen – and all were paid. Caution: many insurances are NOT represented so some could deny. Allowed amounts range from $64 – $91. Payments range from $29 – $91. Some insurances require a Patient Co-pay or Co-insurance and all appear to be subject to deductibles (might be good to wait until annual deductibles are met prior to providing this service). Highest copay in the database is $35.
For medical record (and audit) documentation purposes, we believe the record should include the forms the patient completes, and a brief narrative showing the provider reviewed those forms and discussed their content with the patient/care giver. It also should mention specific aspects of what the patient wants done – or not done. For an audit, the record needs to show what the provider did as a result to support that a service was performed. Cloned EHR notes are very risky and could result in denial of coverage and recoupment of money paid.
If you want the longer CPT descriptions or have any questions, contact Rich.
Be sure to continue to ask Medicare patients for their NEW Medicare cards. CMS has finished mailing the cards to all NJ residents so they should have them. As always, be sure to send a copy of the New cards to CPB so we can update the file.
Deadline October 31: CDS Registration Renewal/NJPMP Compliance
The physician controlled dangerous substances (CDS) registration renewal is currently open through October 31, 2018. Physicians who maintain a CDS registration, but have failed to register to access the New Jersey Prescription Monitoring Program (NJPMP) in accordance with N.J.A.C. 13:45A-35, will not be permitted to renew their CDS registration during the 2018 renewal cycle until they register to access the NJPMP. CDS physicians who have not yet registered to access the NJPMP must register immediately. Once registered to access the NJPMP, physicians should notify the New Jersey Drug Control Unit via email.