Tag: Billing
BCBSTX to Require E/M Codes for Consultation Services
Starting Nov. 18, Blue Cross and Blue Shield of Texas (BCBSTX) will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology (CPT) codes 99242 – 99245 and 99252 – 99255.
Instead, the payer says physicians will need to report consultation services with an appropriate office outpatient or inpatient evaluation and management (E/M) code representing where the visit occurred and its level of complexity.
According to the health plan, consultation claims reported with CPT codes after Nov. 18 will be denied.
Updated 12/10/2024, to add BCBS website information
Evaluation and Management Coding – Professional Provider Services
Policy Number: CPCP024
Version 1.0
Enterprise Clinical Payment and Coding Policy Committee Approval Date:
August 7, 2024
Plan Effective Date: November 18, 2024
(Blue Cross and Blue Shield of Texas Only
Consultation(s) CPT Codes 99242-99245 ,99252-99255 Effective 11/18/2024, the plan will no longer reimburse for office/outpatient consultation codes (CPT codes 99242–99245) and inpatient consultation codes (CPT codes 99252–99255). Consultation services should be reported with an appropriate office/outpatient or inpatient E/M code representing the location where the visit occurred and the level of complexity of the visit performed, such as code ranges 99221-99223, 99304-99306, and 99202-99215.
Have Questions About Capturing Telehealth Visits?
Teleheath appears to become increasingly complex on a daily basis.
The following is a list of guidelines provided by MGMA:
Click on the title to follow the link.
Cigna Denies Claims without Z-Code
Starting July 14th
Cigna Healthcare will deny certain claims that are billed with a Z-code and without documentation. A move that could add to your administrative burden.
Cigna will deny claims when practices bill certain evaluation and management (E/M) codes (99202-99215) with a preventive service code and a supporting Z diagnosis code – but not supplemental medical record documentation.
Physicians will need to refer to multiple policies by the payer to utilize both preventive services and problem-oriented E/M services for new and established patients on the same date of service, which Texas Medical Association billing and code experts caution could add to practices’ workload. Moreover, these services will not be payable by Cigna when billed with a Z diagnosis code alone.
TMA experts recommend including supporting medical record documentation with the diagnosis code for the problem E/M claim to identify why a preventive service – like dietary counseling, for example – was performed.
Physicians can also check Cigna’s preventive services policy for examples of Z codes or refer to Cigna’s E/M Reimbursement Policy for more payment information from the payer.
UHC Network News July 1, 2024
Take Note: Quarterly CPT and HCPCS Code Updates
Effective Jul. 1, 2024, all applicable Medical Policies and Medical Benefit Drug Policies have been updated to reflect the quarterly Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) code additions, revisions, and deletions. Refer to the following sources for information on the code updates:
Smart Edits are Going Away
Smart Edits were introduced in July of 2023 to analyze claim data and will be removed effective June 28th. No action is needed. The removal of these edits will not impact your electronic billing routine. The typical workday using electronic billing will remain the same.
Cigna and Zelis
If you have accidently signed up to receive virtual credit card (VCC) payments, and would like to change back to Automated Clearinghouse (ACH), please call Zelis.
Zelis Customer Service:(877) 828-8770
If you have questions regarding claim payments, please contact Cigna Healthcare Provider Service Line (800) 882-4462.
UHC Notably Absent from Congressional Hearing
Quotes from Texas Medicine 4/19/2024, Emma Freer Article
“The attack has exposed the vulnerability in our health care system and the disproportionate burden placed on physician practices by insurers, government payers, and third-party vendors,” Dr. Bruggeman told lawmakers.
“The Change outage was disruptive to the business of my practice, but most importantly it was disruptive to my patients,” he said. “Every minute my staff spent trying to reconcile [electronic remittance advice] with received payments, assessing which patients received incorrect bills, [and] resubmitting prior authorizations is time taken away from patient care.”
“To add insult to injury, some of these practices were purchased by Optum during the crisis,” he said. “There were even reports of Optum using the financial emergency caused by the cyberattack on its own subsidiary as legal justification to expedite its acquisition of physician practices.”
In the meantime, Dr. Bruggeman called on Congress to pass legislation that would insulate physician practices from industry consolidation and other existential threats.
“Allowing physicians to practice in the setting that is best for them, their patients, and the broader community should be the hallmark of our United States health care system,” he said. “Instead, the increase in administrative burden, including the new threat of potential cyberattacks, makes such events catastrophic for many providers.”
For the full very interesting article: https://www.texmed.org/TexasMedicineDetail.aspx?id=64062&utm_campaign=TMT&utm_medium=email&_hsenc=p2ANqtz-9E4jpFAqBr1fYThi6pjc3ECIrkJtF4-urerPcLF78JmZ4BixUPkxoA-ngiRvbPx06ORd5U2bsbiOEFK-CaqUP6-URb8jMZ6SEHyZL-aPXwfFmCQ9w&_hsmi=303492305&utm_content=303492305&utm_source=hs_email
Code Selection and Level of Service Training
“CodingIntel” is launching new courses, and the first is E/M Expertise: Go Beyond the Basics!
“We’ve developed a four-module course intended for those with a strong E/M knowledge base. The content is supported by CMS and CPT citations. When the citations are definitive, you’ll have a definitive answer. When they aren’t, you’ll be able to explain the gray areas clearly.”
This isn’t an introductory course. Knowledge and experience in E/M codes and selection is a prerequisite for this course.
This course has 3.5 AAPC CEUs for those who view the entire course and have at least a 70% score on the post-test.
The 1st course will drop March 4, 2024. POET will post the link as soon as we get it.
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