Coding Resource Center
February 2021
As part of the Consolidated Appropriations Act of 2021, Congress extended the moratorium on the 2 percent sequestration which was initiated as part of the Interim Final Rules for Covid-19 in March and April 2020. At that time, the moratorium on the sequestration was to end on 12/31/20; however, due to the law signed on […]
CMS will reduce 774 hospitals’ Medicare payments in fiscal year 2021 for having the highest rates of patient injuries and infections by 1%. These penalties are based on inpatient hospital admissions from mid-2017 to 2019 before the COVID-19 pandemic. Under the Affordable Care Act, the Hospital-Acquired Conditions Reduction Program was created to prevent harm to […]
Medicare covers cardiovascular disease screening tests and intensive behavioral therapy for cardiovascular disease. Patients pay nothing when providers accept assignment. Preventative services for cardiovascular disease include: Intense Behavioral Therapy (IBT) for Cardiovascular Disease, AKA CVD risk reduction visit (code G0446) Ultrasound Screening for AAA (code 76706) Cardiovascular Disease Screening Tests (code 80061) To review the […]
In the Medicare Physician Fee Schedule (MPFS) final rule, CMS created add-on code G2211 to report visit complexity for E/M services. This is based on their on the belief that codes 99202-99215 do not adequately capture the resources associated with patient care in some specialties: +G2211 – Visit complexity inherent to evaluation and management associated […]
January 2021
Gore and Associates recently announced FDA approval for the GORE® EXCLUDER® Conformable AAA Endoprosthesis with Active Control System for endovascular aneurysm repair (EVAR). The device “builds on the proven clinical performance of the GORE® EXCLUDER® AAA Device and incorporates design elements similar to the Conformable GORE® TAG® Stent Graft.” The new device introduces the company’s […]
CMS has revised the ERSD PPS CY 2021 final rule by rescinding the requirement for ESRD facilities to report total time of dialysis provided during the billing period by the dialysis machines. All the other finalized policies remain the same, including: Implementation of the ESRD Treatment Choices (ETC) payment model, which mandates adjustment of Medicare […]
On December 27, the Consolidated Appropriations Act, 2021, passed by Congress, has modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS). Changes include: 3.75% increase in MPFS payments for CY 2021; Suspension of the 2% payment adjustment (sequestration) through March 31, 2021; Reinstatement of the 1.0 floor on the work Geographic Practice Cost […]
On January 7, 2021, Alex M. Azar II, Secretary of Health and Human Services (HHS) announced the renewal of the public health emergency (PHE) declared due to the Coronavirus Disease 2019 (COVID-19). The PHE was originally declared on January 31, 2020; and renewed on April 21, 2020, July 25, 2020, and October 23, 2020. These […]
December 2020
The CMS 2021 HOPPS final rule begins the three-year phasing out of the Medicare Inpatient-Only (IPO) List, which designates procedures and services that can only be reimbursed in an inpatient hospital setting. Procedures removed from the IPO list will now be eligible for outpatient payment when outpatient care is deemed appropriate for the case. For […]
Novitas Solutions, Inc. – the proposed local coverage determination for endovenous stenting has been posted for notice and will become effective December 27, 2020. This LCD includes a local coverage article (A56414), which specifies codes for TIPS and DIPS: 37182 – Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein […]
