Billing & Coding

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.

Anthems original plan was to take a 50% reduction when providers reported claims using modifier 25, it was then lowered to a 25% reduction and has now been fully rescinded, to the relief of providers.  The policy was to go into effect March 1, 2018, however, due to strong opposition from the American Medical Association and other groups Anthem decided it was not in the best interest between payers and providers. 

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. 

Q: Can two untimed codes be performed at the same time? For instance can I perform lumbar traction (97012) at the same time as e-stim (97014)?

A: Please click on the link: https://www.chirocode.com/blog/241

Traumatic Subluxation Coding Controversy

There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated.

How to Properly Report Prolonged Evaluation and Management Services

Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement?

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:

Intensive Outpatient Treatment (IOP)

Intensive Outpatient Programs (IOPs) are considered to be an intermediate level of care which is commonly considered after the patient has been discharged from inpatient care. For some patients and/or conditions they can also provide an effective level of care when hospitalization is not clinically indicated or preferred. The following ...

Psychiatric Partial Hospitalization Programs

BACKGROUND

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