CPT Coding Tips
The Refresh With YES: CPT Breast Procedures Learning Path teaches learners how to correctly apply the CPT codes for common breast surgeries and procedures divided into 14-21-minute modules. The courses within this learning path will provide an in-depth discussion of CPT coding for breast biopsies, mastectomies, and more. Operative reports are used as real-world coding scenarios for these CPT breast procedures.
The Center for Medicare & Medicaid Services (CMS) expanded the payment guidelines for professional telehealth services provided to Medicare beneficiaries during the Public Health Emergency (PHE) declared for COVID-19 (CMS, 2020). The temporary protocol expansion was deemed necessary to aid healthcare reimbursement, and will be active only during the PHE. To keep coders and auditors up-to-date on the expanded services and reimbursement guidelines, YES HIM Consulting has gathered all the latest updates to form a telehealth resource center.
The CPT code for antigen testing was approved at a special meeting of the CPT Editorial Panel and released with a June 25, 2020, effective date.
The Refresh With YES: CPT PCI Procedures Webinar provides an overview of the CPT codes for Percutaneous Coronary Intervention (PCI) procedures divided into 14-19-minute modules. During this four-part series on PCI CPT codes, learners will receive information on various PCI procedures, including a review of the heart’s anatomy and pathophysiology of conditions that may necessitate a PCI procedure. The coding guidelines and codes for PCI are thoroughly examined, and case examples of PCI are presented. The modules offered within this course include: Anatomy and Disease Process Review, CPT Guidelines and Coding (Parts 1 and 2), and Review of Case Studies.
This article offers guidelines on how to code screening tests for suspected COVID-19 infection. There are two different kinds of tests for COVID-19: a viral test to detect a current Coronavirus infection, and an antibody test to confirm is the patient previously had COVID-19 (CDC, 2020). The CDC has issued guidance on conducting screening tests for COVID-19 and other recommendations for viral testing (2022).
The Centers for Medicare & Medicaid Services (CMS) has decided to update the CMS billing and coding guidelines for telehealth or in-home provider services due to the urgency of the current 2019-Novel Coronavirus (COVID-19) pandemic (CMS, 2020). CMS has broadened the scope for reimbursement for virtual check-ins and other digital communications with patients to safely and effectively respond to this Public Health Emergency (PHE). In the interim, telehealth services will not be limited by program restrictions put in place by Medicare (Federal Register, 2020). Evaluation and management (E/M) service codes cover these remote and communication technology-based services performed by a physician or non-physician practitioner (NPP).
CMS released the Medicare telemedicine coding and reimbursement guidelines for healthcare providers to use during the COVID-19 pandemic (CMS, 2020). According to the CMS Medicare Telemedicine Health Care Provider Fact Sheet, reimbursement for these visits are considered the same as in-person visits and are paid at the same rate (CMS, 2020). The U.S. Department of Health & Human Services Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs (CMS, 2020).
Adapting to the influx of telehealth services in response to the COVID-19 outbreak, CMS has adjusted the “List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth” in order to provide as much support and care as possible (2020). In addition, CMS issued updated criteria for risk adjustment of Medicare telemedicine services, as well as guidelines on how to bill for telemedicine.
Perhaps the most important upcoming development in the fight against COVID-19 is detecting antibodies to the infection, and new tests for this purpose are being developed. As these are new tests, existing codes do not reflect these antibody studies. To assist, the CPT Editorial Board has fast-tracked the approval of two new CPT codes for the COVID-19 antibody blood testing (AMA, 2020). The new codes were published April 10, 2020, and are effective immediately. Use of the codes will allow for tracking and reporting of antibody tests specifically for COVID-19.
The Refresh With YES: CPT Spinal Fusion Procedures webinar consists of 12-18-minute modules that examine Spinal Fusion procedures and topics.