2023 Proposed E/M Changes
Beginning in 2023 either of these 2 elements may be used to determine the billed level of service for hospital and NH encounters.
What is time or MDM?
This frequency is assigned for Mercy Compliance Regulatory education.
What is Annually?
This modifier is used to indicate that a service was completed as split or shared.
What is FS.
AMA
American Medical Association
This is the annual start date for ICD-CM changes.
What is October 1st?
Beginning in 2023, this category of codes will be deleted and merged into existing hospital care CPT codes.
What are Observation CPT codes? (99217-99220, 99224-99226)
This is Mercy's Chief Compliance Officer and Internal Audit Officer.
Who is Tony Krawat?
Split or shared documentation is not allowed for this type of service and requires the billing provider to document the MDM in its totality.
What is office/outpatient E/M billing?
CPT
Current Procedural Terminology
CMS issues NCD's, but these entities are responsible for issuing LCD's.
What are MACs?
This ED code may be billed when the physicians or other QHPs presence is not required for care.
What is 99281?
Mercy requires this percentage of APP's encounters to be cosigned by their collaborative physician.
What is 10%? (20% if they prescribe narcotics)
This is defined as greater than 50% of total time or documentation of one total E/M element to determine the level of service billed.
What is substantive portion?
LCD
Local Coverage Determination
This website includes both NCDs and LCDs for easy searching.
What is the Medicare Coverage Database?
This category of code may be added when a great amount of time exceeds the typical time associated with the highest level of service billed.
What is Prolonged care?
Where to find Mercy Compliance (billing and privacy) information.
What is the Compliance Hub on Baggot Street?
This modifier is applied to a critical care service that is billed during a surgical global period.
What is FT?
ICD-10-CM
International Classification of Diseases, Tenth Revision, Clinical Modification
CMS releases their annual updated and approved CPT changes via this publication.
What are the Federal Regulations?
This code is billed for a subsequent hospital encounter with a moderate level of MDM documented but a total time of 60 minutes noted.
What is 99233? (this code requires a minimum of 50 minutes)
This is the number of Principles listed in the Mercy Code of Conduct.
What is seven?
APP documents 60 minutes of critical care time, the collaborating physician follows shortly after and documents 30 minutes of critical care time, supporting the billing as such...
What is 99291-FS, 99292-FS (billed under the APP)?
HCPCS
Healthcare Common Procedure Coding System
This CMS developed program addresses whether multiple services are billable together.
What are NCCI edits?