Medicare 2023

Medicare Part B Deductible is $226

Appropriate Use Criteria

Appropriate Use Criteria is when a physician orders (which includes performing in his office) an advanced diagnostic imaging study (PET, CT scan, MRI and nuclear) will not begin 01/01/2023, even if the PHE for COVID-19 ends in 2022. Until further notice, the educational and operations testing period will continue. CMS (Medicare) is unable to forecast when the payment penalty phase will begin.

Conversion Factor

The proposed 2023 conversion factor is $33.08, a decrease of $1.53 to the 2022 conversion factor ($34.61).

Evaluation and Management (E/M) Visits

Similar to the revised coding guidelines in 2021 for office and other outpatient visits, Medicare is proposing to adopt these changes in coding and documentation for other E/M visits (i.e., hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services and cognitive impairment assessment), effective 01/01/2023.

These revised coding and reimbursement guidelines will include:

·  New descriptor times (where relevant)

·  Revised interpretive guidelines for levels of medical decision making

·  Choice of medical decision making or time to select level (except for a few families like emergency department visits and cognitive impairment assessment), which are not timed services

·        Eliminate use of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam.

Telehealth Services

It appears that telehealth will potentially end 151 days following the end of the PHE. In addition, delaying the in-person visit requirement for mental health services furnished via telehealth until 152 days after the end of PHE. A new modifier (-93) will become available to indicate that a Medicare telehealth service was furnished via audio-only verses the use of Modifier -95.

Split (or Shared) E/M Visits

Medicare is proposing to delay the split (or shared) visits policy for the definition of substantive portion, as more than half of the total time, for one year with a few exceptions. The substantive portion of a visit may be met by any of the following elements:

·        History

·        Performing a physical exam

·        Making a medical decision

·        Spending time (more than half of the total time spent by the practitioners who bills the visit

Under the proposal, clinicians who furnish split (or shared) visits will continue to have a choice of history, physical exam or medical decision making, or more than half of the total practitioner time spent to define the substantive portion, instead using total time to determine the substantive portion, until 2024.

Chronic Pain Management

Medicare is proposing new codes for chronic pain management and treatment. The proposal includes:

·        Diagnostic assessment and monitoring

·        Administration of a validated pain rating scale or tool

·        Development, implementation, revision and maintenance of a person-centered care plan

·        Overall treatment management

·        Facilitation and coordination of any necessary behavioral health treatment

·        Mediation management

·        Pain and health literacy counseling

·        And more….

Audiology Services

Medicare is proposing to allow patients to have direct access, when appropriate, to an audiologist without a physician referral. A new code would indicate that the service is being furnished by the audiologist and would permit audiologists to bill the direct access (without referral) once every 12 months).

 ICD-10 2023 

REVISION – prior list had a type on codes I71.4

Every year there are changes to the ICD-10 codes. Most often codes are raised to a higher level of specificity, meaning there are more digits added to particular ICD-10 codes. Below are the changes that I believe to be the most relevant. If you would like a complete list of all the changes, please let us know.

EFFECTIVE for dates of service on or after 10/01/2022

E87.20 see below for high specificity

               E87.20  Acidosis, unspecified

               E87.21  Acute metabolic acidosis

               E87.22  Chronic metabolic acidosis

               E87.29  Other acidosis

New

I25.112 Atherosclerotic heart disease of native coronary artery with refractory angina pectoris

I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris

I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris

I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris

I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris

I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris

I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris

I25.792 Atherosclerosis of other coronary artery bypass grafts(s) with refractory angina pectoris

I31.3 see below for higher specificity

I31.31  Malignant pericardial effusion in diseases classified elsewhere

                               (Code first underlying neoplasm (C00-D49)

 I31.39   Other pericardial effusion (noninflammatory)

I34.8 see below for higher specificity

               I34.81   Nonrheumatic mitral (valve) annulus calcification

               I34.89   Other nonrheumatic mitral valve disorders

I47.2 see below for higher specificity

               I47.20   Ventricular tachycardia, unspecified

               I47.21   Torsades de pointes

               I47.29   Other ventricular tachycardia

I71.01 see below for higher specificity

               I71.010 Dissection of ascending aorta

               I71.011 Dissection of aortic arch

               I71.012 Dissection of descending thoracic aorta

               I71.019 Dissection of thoracic aorta, unspecified

I71.1 see below for higher specificity

               I71.10   Thoracic aortic aneurysm, ruptured, unspecified

               I71.11   Aneurysm of the ascending aorta, ruptured

               I71.12   Aneurysm of the aortic arch, ruptured

               I71.13   Aneurysm of the descending thoracic aorta, ruptured

I71.2 see below for higher specificity

               I71.20   Thoracic aortic aneurysm, without rupture, unspecified

               I71.21   Aneurysm of the ascending aorta, without rupture

               I71.22   Aneurysm of the aortic arch, without rupture

               I71.23   Aneurysm of the descending thoracic aorta, without rupture

I71.3 see below for higher specificity

               I71.30   Abdominal aortic aneurysm, ruptured, unspecified

               I71.31   Pararenal abdominal aortic aneurysm, ruptured

               I71.32   Juxtarenal abdominal aortic aneurysm, ruptured

               I71.33   Infrarenal abdominal aortic aneurysm, ruptured

I71.4 see below for higher specificity

               I71.40   Abdominal aortic aneurysm, without rupture, unspecified

               I71.41   Pararenal abdominal aortic aneurysm, without rupture

               I71.42   Juxtarenal abdominal aortic aneurysm, without rupture

               I71.43   Infrarenal abdominal aortic aneurysm, without rupture

I71.5 see below for higher specificity

               I71.50   Thoracoabdominal aortic aneurysm, ruptured, unspecified

               I71.51   Supraceliac aneurysm of the abdominal aorta, ruptured

               I71.52   Paravisceral aneurysm of the abdominal aorta, ruptured

I71.6 see below for high specificity

               I71.60  Thoracoabdominal aortic aneurysm, without rupture, unspecified

               I71.61   Supraceliac aneurysm of the abdominal aorta, without rupture

               I71.62   Paravisceral aneurysm of the abdominal aorta, without rupture

N14.1 see below for high specificity

               N14.11 Contrast-induced nephropathy

               N14.14 Nephropathy induced by other drugs, medicaments and biological substances

NEW

               Z79.85  Long-term (current) use of injectable non-insulin antidiabetic drugs