Coding

Code Carefully for Bilateral Procedures - 10/02/2024

Coding for bilateral procedures can be confusing. See how payers differ in how they apply CPT modifier 50 to their coding and payment policies.

BCBSTX to Require E/M Codes for Consultation Services - 09/03/2024

Starting Nov. 18, Blue Cross and Blue Shield of Texas will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology codes 99242 – 99245 and 99252 – 99255.

Coding with Care: Knowing Billing Codes for Complex Care Can Maximize Revenue, Access to Care - 08/28/2024

Knowing billing codes for complex care can maximize revenue and access to care.

G-Code Payment Frustration Persists With Inconsistent Implementation - 06/25/2024

Deepening ongoing physician concerns over Medicare’s add-on code for complex care, two major payers have either reduced payment for G2211 claims or announced plans to stop paying certain claims associated with the code altogether. Read more.

Cigna to Deny Claims Without Z-Code Documentation - 04/24/2024

Starting July 14, Cigna Healthcare will deny certain claims that are billed with a Z code and without documentation, a move that could add to physicians’ administrative burden.

Aetna Set to Pay Medicare Advantage G2211 Claims - 03/27/2024

The list of health plans providing payment for Medicare’s new add-on “G” code continues to grow with Aetna as the latest insurer to cover G2211 for Medicare Advantage claims Aetna confirmed with Texas Medical Association coding experts that its Medicare Advantage claims platform was updated in March to allow payment for the code, used to document the coordination of care for patients with complex or serious conditions. For now, the plan’s policy is only accessible through a physician’s Aetna portal.

Quality of Life: Pay-for-Quality Programs Increasingly Address Nonmedical Drivers of Health - 03/15/2024

Insurance payers seldom give physicians incentives to address nonmedical drivers of health, especially in traditional fee-for-service payer contracts. Those incentives remain rare even in pay-for-quality programs that emphasize value-based care, but they are gaining traction.

Coding Changes in Fee Schedule Promote More Accurate Payment for Complex Visits - 03/05/2024

The 2024 Medicare physician fee schedule allows physicians to list G2211 in addition to codes used in office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians also can use it for telehealth visits.

Novitas Makes Mass Payment Adjustment for Telehealth Claims - 02/27/2024

Thanks to the vigilance of the Texas Medical Association’s payment specialists, Medicare administrative contractor Novitas Solutions updated its system to ensure all claims billed with place of service (POS) code 10 will be paid correctly.

Practice e-Tips on Coding - 02/20/2024

Get practice tips on all things coding. Learn about coding methods, correct coding, resources, coding related to Workers' Comp and more.

Your Billing and Collections Checklist for 2024 - 12/19/2023

TMA’s Reimbursement Services staff work year-round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2024 to keep your billing and collections on track throughout the year.

Add-On Payment Code for Complex Visits to Start in 2024 - 12/08/2023

Beginning in January, physicians will be able to receive more accurate payment for complex visits with Medicare add-on code G2211. But the Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.

CMS to Implement Street Medicine Code - 10/25/2023

Following advocacy from the Texas Medical Association and medical student members, the Centers for Medicare & Medicaid Services (CMS) created a place of service code for street medicine, making it possible for physicians to get paid for services provided to people who are currently unhoused effective Oct. 1.

Billing Errors to Avoid: Pulmonary, Mohs Procedures - 08/21/2023

Medicare audits have revealed recurring errors in billing for pulmonary procedures and Mohs surgery. Here are some guidelines for correct billing.

Medicare Coding Errors to Avoid: Add-on, Place of Service, and Modifiers - 08/21/2023

Medicare audits have revealed recurring errors in billing with add-on and place-of-service codes as well as claims that appear to be duplicate because they lack an appropriate modifier. Here are some guidelines for correct billing.

Use Modifiers to Override Correct Coding Initiative Edits - 08/21/2023

Correct Coding Initiative Edits Now Free on Internet

More Medicare Payment Updates for 2015 - 08/21/2023

Find out changes affecting pneumococcal vaccine, preventive and screening services, and new waived tests, plus a revalidation tip and how to learn more about Physician Compare.

Payers Axe Consultation Codes - 07/25/2023

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations. UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19.

E&M Coding — Are You Under, Over, or on Target? - 07/20/2023

E&M Coding — Are You Under,Over,or on Target?

Document Time for Psychotherapy Services - 07/20/2023

Year-old changes in psychiatry and psychotherapy CPT codes are still tripping up physicians. According to Medicare, distinguishing between evaluation and management services and psychotherapy is the key.

CMS To Deny Incomplete Claims on Discarded Drugs Starting in October - 06/22/2023

Starting Oct. 2, the Centers for Medicare & Medicaid Services (CMS) will kick back certain claims involving discarded or unused drugs if practices fail to implement a new billing and coding policy the payer has been phased in since the beginning of the year.

Cigna Delays Problematic Modifier 25 Policy - 05/31/2023

Cigna will delay its demanding requirement for physicians to submit additional documentation for routine, minor procedure claims after the Texas Medical Association, American Medical Association, and dozens of other medical organizations urged the payer to immediately rescind the policy in April.

Medicine Urges Cigna to Withdraw Far-Reaching Modifier 25 Policy - 05/03/2023

Demonstrating the far-reaching impact of a new Cigna policy, the Texas Medical Association joined organized medicine and other health professionals in collectively and vociferously calling on the payer to “immediately rescind” an onerous requirement for additional documentation for routine, minor procedure claims starting in June.

Update: New Cigna Policy Requires Additional Documentation for Same-Day Procedures - 04/03/2023

Despite medicine’s pushback, Cigna plans to move forward with burdensome billing policy requiring additional documentation for routine, minor procedure claims starting in June.

Prevent Improper Code Bundling With New Medicare Tool - 02/15/2023

Physicians can take advantage of a new Medicare tool to sort through the thousands upon thousands of service codes that can be bundled together for claims payment – and avoid improper billing.