Tag: Coding
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.
G-Code Frustration
Deepening ongoing physician concerns over the implementation of Medicare’s add-on code for complex care, two major payers have either reduced payment for G2211 claims or announced plans to stop paying certain claims associated with the code altogether for particular plan members.
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.
Billing for a Pap Smear
Thank you, Betsy Nicoletti ~ Coding Intel, for all your articles
“By now, you’ve seen the new CPT add-on code +99459 for use with office visits, office consults, and preventive medicine services. The AMA, in CPT Changes 2024: an Insider’s View, states that the RVS Update Committee (RUC) developed the code to capture the additional costs for visits that include a pelvic exam. It is valued as a practice expense code, which includes supply costs and 4 minutes of staff time. CPT Changes does not say that there must be a chaperone in order to bill the code. They don’t mention it at all.”
COVID-19 CPT vaccine and immunization codes
After the 2024 CPT book was printed, the AMA deleted 64 codes and Appendix Q.
COVID-19 Vaccines
Administration
• 90480 – Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose
Vaccine Product
• 91318 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (6
months to 4 years) Pfizer
• 91319 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (5-11
years) Pfizer
• 91320 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, forintramuscular use (12 years and older) Pfizer
• 91321 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25mL dosage, for intramuscular use (6 months – 11 years) Moderna
• 91322 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use (12 years and older) Moderna
Receive More Accurate Payment for Medicare Complex Visits.
The new code will take effect Jan. 1, 2024. The 2024 Medicare Physician Fee Schedule allows physicians to list G2211 in addition to codes used in-office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians can also use it for telehealth visits.
Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.
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