This section provides the latest and essential industry updates as they become available.
How to Determine New vs. Established Patient
According to the CPT codebook, a “new” patient is, “one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”
CIGNA-Reimbursement Policy Update Regarding E&M Codes Billed with Modifier 25 and Minor Procedures Effective August 13, 2022
As a result of a recent review, CIGNA will require the submission of office notes with claims submitted with evaluation and management (E&M) codes 99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed.
2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Now Open
MIPS eligible clinicians, groups, and virtual groups may submit an application to reweight any or all MIPS performance categories if they've been affected by extreme and uncontrollable circumstances that impact these performance categories.
Understand how Nurse Practitioners (NP) and Physician Assistants (PA) Qualify as Certifying Physicians for Therapeutic Shoes & Inserts
NPs and PAs who are practicing under the supervision of an MD or DO (i.e., “incident to”) as the certifying physician can provide therapeutic shoes to beneficiaries with diabetes if certain criteria are met
Excellus BlueCross BlueShield-Discontinuation of Paper Notification for Claiming Billing Errors
As of February 4, 2022, Excellus BlueCross BlueShield has discontinued its practice of sending paper notification when certain billing errors occur. This change is part of their overall effort to reduce the amount of paper sent to provider practices.
Why Providers Should Prioritize Billing & Coding Oversight
When a miscoded procedure is the result of substantial negligence or fraud, it can be detrimental to a medical practice or physician. That is why it is vital for medical practices to establish robust oversight, audit and remediation procedures that work to ensure accurate coding and billing.
NGS-Nail Debridement: CPT Codes 11719, 11720, 11721 and Paring or Cutting of Benign Hyperkeratotic Lesions: CPT Codes 11055, 11056, 11057
CPT code 11055 (Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion) and CPT code 11720 (Debridement of nail(s) by any method(s); one to five) should not be reported together for services performed on skin distal