News from ACOI

Often, I talk about the importance of documentation.  For many, the creation of this documentation increasingly relies on the use of artificial intelligence (AI) to generate the patient note.  While I am old school and prefer the handwritten note, the use of AI is here to stay.

The 2025 Medicare Physician Fee Schedule (PFS) Final Rule released a new complexity add-on HCPCS code. Although this code has similarities to the G2211 complexity add on code, it has significant restrictions on who can submit claims for its use. The new code, G0545, is a code that is for use by “a physician with specialized training in infectious diseases.”

With the new year comes more uncertainty. As you know, flexibility for telehealth services under Medicare was set to expire on December 31, 2024. Expiration of the flexibility would have meant that most telehealth visits conducted with patients since shortly after declaration of the COVID-19 Public Health Emergency (PHE), would not be eligible for payment. Telehealth visits would once again be subject to geographic and originating site restrictions.

What documentation is required to show a provider is performing prescription drug management? It has been a question since the changes to the Office or Other Outpatient Services codes was announced by the American Medical Association (AMA) in 2021.

In offices that perform minor procedures like lesion removal or skin biopsies, selecting the proper diagnostic code prior to a final diagnosis from a pathology report is relatively easy. Code what you know at the time of service.

I was recently researching the newly payable complexity of care code G2211 to see if there was new information to help better understand Medicare’s position on the code. I came across something that surprised me.

Nuances of diagnostic coding from the ICD-10-CM coding book include additional codes that supply further information relevant to the main diagnosis.

Your office manager just received notice of an insurance audit. Now what? Notification of a request for an audit, or a seemingly innocent request for records from a payer, is always a surprise that can be unsettling.

Telemedicine was in use before the COVID-19 Public Health Emergency (PHE) with specific rules and regulations published by the Centers for Medicare and Medicaid Services (CMS).

What does it mean and when can it be used? The descriptor for this add-on code reads, “Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition.” After the 2021 PFS Final Rule was released, the Consolidated Appropriations Act (CAA) of 2021 imposed a moratorium on Medicare payment for this service. It prohibited CMS from making payment for the G2211 code before January 1, 2024. The code was assigned a bundled payment status.

The Medicare Physician Fee Schedule (PFS) Final Rule was released on November 3, 2023. Included in the final rule are significant policy changes for 2024 of which offices and physicians should be aware.

I am often frustrated with those who post their questions on blogs and web pages instead of looking for the answer themselves. All too often the answers I see in response to these questions are incorrect. You will see a discussion with multiple people involved discussing how they handle a specific coding or billing situation, and their answers are all wrong. None of them know they are wrong and, in doing so, continue to distribute incorrect information.