Billing & Coding

Billing Nutrition Counseling

Billing nutrition counseling services may not be as straight-forward as you might think.

New Bipartisian Budget Act of 2018 Provisions

On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. There were some changes which will affect Medicare payments. The following is a brief summary, for a more comprehensive summary see the References.

Whenever there is a high-cost item, CMS has historically evaluated usage to determine appropriateness of billing and this is another example. A Decision Memo was released on February 15, 2018 which included the following changes:

New Modifiers Released in 2018

There were 13 new modifiers released in 2018, be sure you are using them if appropriate.  The five new HCPCS modifiers or the  "X" modifiers are used for voluntary reporting and do not change the meaning of the procedure being reported. These are used for MACRA patient relationship categories and codes. 

Medicare Requiring Specific Modifiers on Therapy Services

Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:

Psychiatric Partial Hospitalization Programs

BACKGROUND

According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence:

One of the significant coding changes with ICD-10-CM was including laterality within the code itself. This concept should help reduce billing errors and claim denials. Interestingly, CMS issued a statement regarding the reporting of laterality in their provider newsletter (emphasis added).

At HIPAA Summit, OCR head Jocelyn Samuels also outlines forthcoming efforts with ONC, FDA.

Phase II of the federal HIPAA audit program remains "under development," Jocelyn Samuels, director of the Health and Human Services Department's Office for Civil Rights, said Monday at the 23rd National HIPAA Summit in the District of Columbia.

Read the entire article by FierceHealthIT here.

Bill chronic care management (CCM) services on the last day of the calendar month the service was done. Therefore, if the service began in January, you would bill 99490 with the date of service as January 31. 

You cannot bill CCM for the care of a patient only due to having two chronic illnesses; to bill CCM, the chronic conditions must be showing significant risk of death, acute exacerbation, decompression or functional decline.

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