June 2021 Client Newsletter

DO NOT BILL 99211 WITH OTHER CPT/HCPCS CODES

 

Insurers will not pay 99211 when billed with injections or other minor procedures.  For each procedure there is a built-in amount of evaluation.  The general rule is to NOT bill 99211 with injections – therapeutic or vaccinations. 

 

The only time this may be payable is if the 99211 is for a separate & distinct reason.  But then you should be sure your documentation clearly reflects the difference and medical necessity for the 99211.  Different ICD-10 codes would be likely as well.  To get paid we will likely need to appeal with the office notes.

 

Cognitive Impairment: Medicare Provides Opportunities to Detect & Diagnose

 

Copied from MLN Matters, 5/13/21 edition:

 

“Do you have a patient with a cognitive impairment? Medicare covers a separate visit for a cognitive 

assessment so you can more thoroughly evaluate cognitive function and help with care planning.

 

3 Things You Need to Know:

1. If your patient shows signs of cognitive impairment at an Annual Wellness Visit or other routine visit, you may perform a more detailed cognitive assessment and develop a care plan.

2. The Cognitive Assessment & Care Plan Services (CPT code 99483) typically start with a 50-minute face-to-face visit that includes a detailed history and patient exam, resulting in a written care plan. 

3. Any clinician eligible to report Evaluation and Management (E/M) services can offer this service, including: physicians (MD and DO), nurse practitioners, clinical nurse specialists, and physician assistants.

 

Effective January 1, 2021, Medicare increased payment for these services to $282 (may be geographically adjusted) when provided in an office setting, added these services to the definition of primary care services in the Medicare Shared Savings Program, and permanently covers these services via telehealth.

 

Get details on Medicare coverage requirements and proper billing at www.cms.gov/cognitive .”

 

If you decide to begin billing this code, be sure to the requirements. 

 

Medicare's Outpatient Rehabilitation Therapy Services:  

Comply with Medicare Billing Requirements

 

In today’s “MLN Matters” publication Medicare has notified providers that 61% of the payments they made for outpatient physical therapy did NOT comply with requirements and thus were NOT payable.  With that high of a percentage, it is VERY likely they will be auditing a LOT of PT’s medical records.  

 

This is a SERIOUS issue.  We STRONGLY suggest that you review the attached booklet from Medicare, AND that you review the OIG Report (link below).  Make sure your medical records comply with Medicare’s requirements.  

 

“An Office of Inspector General report found that payments for physical therapy services didn’t comply with 

Medicare billing requirements. Review the Outpatient Rehabilitation Therapy Services: Complying with 

Documentation Requirements booklet to help you bill correctly, reduce common errors, and avoid overpayments.”

 

1. The booklet is attached.  

2. The OIG Report can be found at:  Many Medicare Claims for Outpatient Physical Therapy Services Did Not Comply With Medicare Requirements, A-05-14-00041 (hhs.gov)

 

What OIG Found 

Sixty-one percent (61%) of Medicare claims for outpatient physical therapy services that we reviewed did not comply with Medicare medical necessity, coding, or documentation requirements. Specifically, of the 300 claims in our stratified random sample, therapists claimed $12,741 in Medicare reimbursement on 184 claims that did not comply with Medicare requirements.