Shared Visits in the Hospital for Medicare

Question:

I have a question regarding 2023 shared visit rules. I am reviewing an E&M note where I will select the level of E&M based on the MDM being the substantive part and not time. My question: does each provider have to document their individual time if not a factor in the level of E&M I recommend?

Answer:

No, the documentation of time is not required if Time will not be a determining factor in E&M code selection.

CMS has delayed the implementation of Time as driver for defining the substantive part of the shared encounter until January 2024.

The following excerpt is from the Final Rule published in November 2022.

Page 212:
“..After consideration of public feedback, we proposed to delay implementation of our definition of the substantive portion as more than half of the total time until January 1, 2024. We continued to believe it is appropriate to define the substantive portion of a split (or shared) service as more than half of the total time, and proposed that this policy will be effective beginning January 1, 2024….”

You may consider working with your providers to start documenting time should CMS move forward with a final implementation of Time as the driver of substantive time in 2024. This would allow them to become familiar with including this in their notes, while informational at this time, if the code is to be selected on the MDM and not time.

*This response is based on the best information available as of 08/17/23.

Allergy Injections

Question:

After a physician has signed off an order for the administration of allergy injections, is he/she required to sign off on each allergy injection administered by his staff?

Answer:

Allergy immunotherapy is not under the diagnostic guidelines but rather the incident to guidelines. The physician should provide direct supervision and the physician should indicate a review of the allergy injection schedule during follow-up. A guideline has not been published indicating that the physician must sign off on each individual injection.

*This response is based on the best information available as of 08/03/23.

Allergy Testing Help

Question:

What is the daily maximum allowable unit for CPT 95017 [Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests] by Medicare in 2023?

Answer:

The MUE’s (medically unlikely edits) for 2023 IS 27.

*This response is based on the best information available as of 07/20/23.

Removing a Nasal Pack

Question:

I have looked everywhere and cannot find a CPT code for removing a posterior nasal pack. I found CPT code 30906 for reporting control of a nasal hemorrhage when removing and replacing the pack. Can I report 30906 with Modifier 52 since my doctor is just removing the posterior nasal pack?

Answer:

No, you do not report 30906. There is not a code ore removing a posterior pack unless you are replacing the pack at the same time. If you are only removing a pact then report an E/M CPT code or nasal endoscopy code (31231) whichever is more appropriate.

*This response is based on the best information available as of 07/06/23.

Reshaping of the Internal Nasal Valve Region

Question:

My physician has started doing repairs for nasal valve collapse using low energy radiofrequency. We have been using the unlisted code 30999. Another coder told me that is no longer the correct code. Can you help?

Answer:

There is a new CPT code 30469 for reporting remodeling of the nasal airway using low energy temperature controlled radiofrequency which was previously reported with the unlisted code 30999.

*This response is based on the best information available as of 06/22/23.

Sleep Endoscopy

Question:

Can I report a nasal endoscopy with a diagnostic drug induced sleep endoscopy?

Answer:

No, when reporting CPT code 42975 for a diagnostic drug induced sleep endoscopy you cannot report a nasal endoscopy 31231 unless it is performed for a separate condition other than sleep disordered breathing and using a separate endoscope.

*This response is based on the best information available as of 06/08/23.