CODING CORNER… JANUARY 2017

By Becky Priest, Coding Manager

Effective February 1, 2017 coders will begin using the following:

  • For new patients, 8 organ systems is STILL a comprehensive exam.
  • Established patients: This will be VERY important on your established level 4’s (Office/ED settings) and subsequent level 3’s (Inpatient/OBS setting).
    • Instead of needing 2-7 body areas/organ systems, you will now need to document 6-7 BODY AREAS/ORGAN SYSTEMS (Expanded documentation of the areas and/or systems examined; requires more than checklists; it needs to have normal/abnormal findings documented upon

  • For an expanded problem focused exam the requirement now is 2-5 BODY AREAS/ORGAN SYSTEMS (Minimal detail for areas and/or systems examined: check list type documentation without any expansion of findings)

To summarize: The new exam scoring change and the E&M codes it affects, please refer to the table below:

Type of Exam OLD SCORING NEW SCORING A MUST for the following E/M levels:
EXPANDED PROBLEM FOCUSED 2-7 BODY AREAS/ORG SYSTEMS (minimal detail)

 

2-5 BODY AREAS/ORGAN SYSTEMS Office established Patient 99213

Office New Patient 99202 & 99203
ED Patient 99282 & 99283

Hospital subsequent patient 99232 (Inpatient), 99225 (Obs)

 

DETAILED 2-7 BODY AREAS/ORG SYSTEMS (minimal detail) 6-7 BODY AREAS/ORGAN SYSTEMS Office Established Patient 99214

Office New Patient 99203

ED Patient 99284

Hospital subsequent patient 99233 (Inpatient), 99226 (Obs)

COMPREHENSIVE 8 ORGAN SYSTEMS NO CHANGE-STILL 8 ORGAN SYSTEMS Office Established Patient 99215

Office New Patient 99204

ED Patient 99285

New Hospital patient 99222, 99223 (Inpatient), 99219 and 99220 (Obs)

 

If you would like more information please feel free to reach out to us.

If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 or Betsyp@pracfirst.com

BILLING UPDATES – JANUARY 2017

By Tammy Bartlett, Billing Manager

IRS INSURANCE COMPANY PAYMENT SUMMARY

PF will aggregate your IRS Form 1099’s through February 17th.  These forms (1099-Misc) represent all of the payments made to you during calendar year 2016.  The IRS matches the aggregate of all 1099’s to the appropriate line of your entity’s tax return, to make sure recipients properly report their income.  In addition, any interest paid on claims is separately reportable on IRS Form 1099-Int.  This information is also matched and it is critical to properly report this income on the correct line of your tax return to avoid IRS scrutiny for under reporting income.

By law, insurance carriers are required to mail them by January 31st.  However, our past experience indicates that they do not comply with the due date and therefore they are not all generally received until the third week in February.  At that time, we will send them to you by mail or through our courier service. If you have any questions, please feel free to contact us.

UNIVERA – IMPORTANT UPDATE REGARDING PRODUCTS

Univera Healthcare will offer Medicaid Managed Care, Child Health Plus and Health and Recovery Plan (HARP) to Erie County residents beginning in the summer of 2017, pending approval by the New York State Department of Health.

Per Univera, you will have an opportunity to provide services for these product lines under your existing Participating Provider Agreement. The reimbursement schedule will be available on the secure portion of their website on or around February 1, 2017 at: UniveraHealthcare.com/Provider

Univera will provide further administrative details and other important information prior to the date when these products will be offered in Erie County. Please direct questions to your Provider Relations representative directly, or call the Provider Relations department at 716-857-4647.

For Billing questions, please contact Tammy Bartlett at 716-348-3923 or tammyb@pracfirst.com