Industry News, January 2022 - Revenue Cycle Coding Strategies Inc.

January Industry News

PHE Renewed

Effective January 16, 2022, the public health emergency (PHE) was renewed once again for an additional 90 days. This provides an extension to the flexibilities and waivers granted under the PHE until at least April 16, 2022.

Split (or shared) E/M Updates

CMS has updated their policies for split (or shared) E/M visits to reflect the evolving role of non-physician practitioners (NPPs) and to clarify payment conditions that must be met. For CY 2022 CMS has established the following:

  • Definition of split (or shared) visit to mean an evaluation and management (E/M) visit in the facility setting (does not apply to office setting) that is performed in part by both a physician and a nonphysician practitioner who are in the same group, in accordance with applicable law and regulations such that the service could be billed by either the physician or nonphysician practitioner if furnished independently by only one of them. The visit is billed by the physician or practitioner who provides the substantive portion of the visit.
  • The definition of substantiative portion:
    • For CY 2022, the substantive portion of the visit can be history, physical exam, medical decision-making, or more than half of the total time.
    • Starting CY 2023 the substantive portion of the visit will be defined as more than half of the total time spent.
  • Spit (or shared) visits can now be reported for new as well as established patients, initial and subsequent visits, as well as prolonged services.
  • Development of Modifier FS (Split (or shared) evaluation and management visit) with the requirement to be appended to identify theses services
  • The medical record must contain documentation identifying the two individuals who performed the visit. The physician or practitioner who provided the substantive portion must sign and date the medical record.

ADDITIONAL INFO

Telehealth Updates

The Centers for Medicare and Medicaid Services (CMS) has published an updated list of approved telehealth services for calendar year (CY) 2022.

Updated as of January 5, 2022, the List of Telehealth Services for Calendar Year 2022 provides information to provide clarification on which codes are temporarily added to the list during the public health emergency (PHE). The list also identifies which codes will be available as telehealth services through December 23, 2023. CMS also included some additional comments to several codes. The MLN Matters® article was also updated based on the CY 2022 MPFS final rule and provides information regarding changes to the originating site facility fee and mental telehealth services.

ACR Challenges MAC Transparency

The American College of Radiology (ACR) has joined other provider groups in challenging Medicare Administrative Contractors’ (MACs) lack of transparency when reaching local coverage determinations (LCDs).

ACR, along with 17 other provider groups, compiled a joint letter to CMS expressing their concerns with the 2018 revised process in the development and implementation of local coverage policies. The letter outlines the lack of opportunity for public notice and comment, challenges with contractor advisory committee engagement, as well as the process challenges and lack of transparency regarding coverage policies. The letter also outlines six different recommendations to address the processes short comings.

One major concern involves the lack of specified timeline for the local coverage determination process. While MACs are restricted to 60 days to determine if an LCD request is complete, there is no timeframe for them to issue a draft coverage determination. Additionally, the letter provides examples of the lack of opportunity to provide comments on new or revised local coverage articles (LCAs).

ACR Challenges MAC Transparency

The American College of Radiology (ACR) has joined other provider groups in challenging Medicare Administrative Contractors’ (MACs) lack of transparency when reaching local coverage determinations (LCDs).

ACR, along with 17 other provider groups, compiled a joint letter to CMS expressing their concerns with the 2018 revised process in the development and implementation of local coverage policies. The letter outlines the lack of opportunity for public notice and comment, challenges with contractor advisory committee engagement, as well as the process challenges and lack of transparency regarding coverage policies. The letter also outlines six different recommendations to address the processes short comings.

One major concern involves the lack of specified timeline for the local coverage determination process. While MACs are restricted to 60 days to determine if an LCD request is complete, there is no timeframe for them to issue a draft coverage determination. Additionally, the letter provides examples of the lack of opportunity to provide comments on new or revised local coverage articles (LCAs).

DOJ Hits Back at Texan Physicians Over No Surprises Act Suit

The Department of Justice (DOJ) has hit back at the Texas Medical Association who filed a lawsuit in October 2021, stating the physicians have failed to demonstrate the law will negatively impact physicians.

The Texas Medical Association was the first to file suit against the DOJ challenging the portion of the No Surprises Act which addresses how disputes between payers and providers will be settled. The Texas physicians, as well as others who have subsequently filed lawsuits including the American College of Radiology and the American Medical Association, believe too much weight is placed on the “qualifying payment amount” and favors insurers over physicians. However, the DOJ has argued that the lawsuit only provides speculation on how the dispute-resolution process will negatively impact physicians and lacks sufficient detail and proof.

Oral arguments in the case are slated to start February 4.

First Coast Updated LCAs

The following Local Coverage Articles (LCAs) have been updated by First Coast Service Options, servicing Florida, Puerto Rico, and the Virgin Islands

  • Billing and Coding: Pegfilgrastim (A57725)
  • NCD Coding Article for PET Scans Used for Oncologic Conditions (A58826)

Congress Urged to Increase Cancer Research Investments

The American Society for Radiation Oncology (ASTRO), along with 49 other organizations, submitted a letter urging Congress to appropriate an increase in monetary investments into cancer prevention and research.

The One Voice Against Cancer (OVAC) which is comprised of 50 member organizations, including ASTRO, highlighted in their letter to the Senate Appropriations Subcommittee on Labor, Health, and Human Services, education and Related Agencies (LHHS) an increased demand for cancer research funding and prevention. The specificities of the letter include:

  • $7.609 billion for the National Cancer Institute (NCI)
  • $51.733 billion for the National Institutes of Health (NIH)
  • $559 million for the CDC Division of Cancer Prevention and Control

OVAC is requesting LHHS carve out the spending in the FY 2022 LHHS Appropriations bill.

January Coding Corner

Within this section, current topics will be the focus. In some cases, the Q&A could reflect common questions received by Revenue Cycle Coding Strategies and in other cases, represent current issues encountered by Revenue Cycle Coding Strategies professionals.

Question: Has CMS approved the use of the 93 modifier that is in your December Issue?  Is this used only with Phone only remote visits?

Advice: CMS has not released anything addressing the modifier, they require the real-time audio/video capabilities for services on the telehealth list and when audio only billing of the audio only codes.

Question: We are seeing some push back from MCR on the unlisted code 77399 that our clinic has defined as Fusion of advanced imaging data sets such as CT, MRI and PET for dosimetry treatment planning purposes including physician involvement.  I have a biller saying that MCR has bundled 77399 with 77301 and 77300 and is asking if there is a possible modifier to unbundle 77399?  Is there one or is this just a normal thing to have it bundled with other codes?

Advice: Unlisted codes are not typically listed in edits because it is uncertain how they are being used. Per the other guidelines for IMRT planning, any planning services prior to or as part of the IMRT planning process are bundled. Fusion is part of the IMRT planning process, so this is common for payers to not allow as it is considered inherent to the IMRT planning process. Modifiers are not applied to unlisted codes because there are no established edits with the codes.

Question: For hydration therapy given on the same day as a therapeutic infusion, is it appropriate to bill for 96361 in the saline ran independent for 43 minutes. Are you aware of any billing guideline that hydration billed in this scenario must run 91 minutes in order to be billable?

Advice: As long as no other drug ran during those 43 minutes you may bill 96361 x 1. It is recommended that there be an order for hydration therapy or labs that show the hydration is needed to prove medical necessity. The recommendation to be able to count 1 unit of hydration would be that it meets a minimum of 31 minutes. To count the next hour for additional hours of the same bag it would need to run at least 91 minutes.