Medicare Coding Updates 2021

by | Sep 20, 2020 | Medicare

Allowing Claims with Z diagnosis codes

Appropriate Use Criteria (AUC) Program

The requirement to obtain preauthorization when ordering CT scans, PET, nuclear medicine and MRIs has been delayed until January 01, 2022.

Relative Value Units (RVUs)

Medicare is proposing to establish relative value units (RVUs) for 2021  to ensure that payment systems are updated to reflect changes in medical practice and the relative value of service.  The bad news is the proposed conversion factor is $32.26 (a decrease of $3.83, or 10.6 percent, from 2020.

Medicare Coding Webinars in Florida

Dual Diagnosis Requirements

Effective for services on and after 03/15/2020, there are new dual diagnosis requirements for cardiovascular stress test procedures.

For example:

ICD-10 codes I09.8, I11.0, 113.0 and 113.2, also needs to have an additional diagnosis code to identify the type of heart failure.

ICD-10 codes I12.0, I12.9, I13.0 I13.10, I13.11 and I13.2, needs to also identify the stage of chronic kidney disease.

ICD-10 code I25.10 requires a second diagnosis of Z95.1 or Z98.61 to indicate the post-percutaneous coronary intervention (PCI) or post-coronary artery bypass grafting (CABG) bypass surgery.

Care Management Services Code Refinements

Medicare is proposing code refinements related to remote physiologic monitoring (RPM) to clarify code descriptors and instructions associated with 99453, 99454, 99091 and 99457 and their use to describe remote monitoring of physiologic parameters of a patient’s health.  Clarifications include:

  • The medical device should digitally (automatically) upload patient physiologic data (data are not patient self-recorded and/or self-reported).
  • The device must be reasonable and necessary for the diagnosis or treatment of the patient’s illness or injury or to improve the functioning of a malformed body member.
  • Be used to collect and transmit reliable and valid physiologic data that allow understanding of a patient’s health status to develop and manage a treatment plan.
  • Can only be ordered and billed by physicians and NPPs who are eligible to bill Medicare for E/M services.
  • RPM services are services furnished to patients with chronic conditions. Practitioners may furnish these services to remotely collect and analyze physiologic data from patients with acute conditions, as well as from patients with chronic conditions.
  • “Interactive communication” involves, at a minimum, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission.

COVID Laboratory Tests Billing for Clinician Services

Physicians and non-physician practitioners (NPPs) can bill for services related to COVID-19 symptom and exposure assessment and specimen collection.

  • Use 99211 to bill for assessment and collection provided by clinical staff, unless you are reporting another E/M code
  • Submit the CS modifier with 99211 (or other E/M code for assessment and collection) to waive cost sharing (deductible and co-insurance)

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Lorraine Molinari
Queen Bee of Medicare
www.MedicareCoding.com