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Coding
Emergency Room Encounter With Surgery
“If a Medicare patient is seen in the emergency department and then surgery is performed later that day or night, can the emergency department consult be billed with a modifier -57 along with the surgery? We have been under the impression that, at least in the office, the visit to decide to do the surgery is included in the surgical fee. Are we correct and does this apply to the encounter in the emergency department too?”
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MIPS
Opportunity to Earn $4,000 Incentive Payments
In about 2 months you need to report your quality metrics to CMS for the 2024 performance year. That means you only have 2 months left to make sure you meet the quality measures and optimize your score.
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FDA Recalls
HIPAA
Antitrust Lawsuit Filed Against EPIC
Particle Health filed a federal antitrust lawsuit claiming that EPIC is blocking access to patient records. The lawsuit states that Epic is using its power to eradicate competition in the Healthcare Marketplace.
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Coding
Subsequent Debridements
“I have been getting insurance denials for subsequent billing of CPT code 11042 after one has been previously performed. Regardless of what level of tissue is debrided, my biller is saying I can only bill CPT code 11042 every 60 days. The biller is telling me that if I debride any level of tissue within those 60 days, I should bill CPT code 97597 until 60 days have passed. Then after 60 days, I can bill CPT code 11042. This does not seem appropriate. Should we appeal?”
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