Welcome to the January Wesgram. This edition contains important coding updates, as well as information from Palmetto GBA and other payers.  You'll also find information about upcoming educational opportunities.
Coding Updates
Effective Jan. 1st, CMS began paying for complex Chronic Care Management services ( 99487 – 99489 ) in addition to normal Chronic Care Managment ( 99490 ).  You will need to ensure that all services are clearly documented per CPT code description.

CMS has also created a new add-on G code — G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services [List separately in addition to primary monthly care management service]). G0506 covers the additional work associated with assessing CCM services and generating a care plan. This used to be bundled into payment for an office visit ( 99201 – 99215 ), but in 2017, if you have good documentation, physicians may bill for the code. Other CCM billing changes include the elimination of the beneficiary consent form and removing the requirement for 24/7 access to care.

The most significant changes this year for diagnostic and interventional radiology involve mammography bundling, ultrasound screenings for abdominal aortic aneurysm (AAA) and fluoroscopy services. Fluoroscopy codes 77002-77003 are now subject to the global period concept and are designated as add-on codes.

Mammography services now include computer – aided detection (CAD), which eliminated the add-on codes reported in previous years. CMS is still requiring the use of HCPCS G-codes and will not eliminate these codes until 2018.
  • 77065 — Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
  • 77066 — Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
  • 77067 — Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
  • G0202 — Screening mammography, producing direct digital image, bilateral, all views
  • G0204 — Diagnostic mammography, producing direct 2D digital image, bilateral, all views
  • G0206 — Diagnostic mammography, producing direct 2D digital image, unilateral, all views
A new code has been created to specifically screen for an abdominal aortic aneurysm. This CPT code will replace G0389 , which has been used in previous years.
  • 76706 — Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
Update on Telehealth Billing
Effective January 1, 2017, CMS created a new POS code 02 for use by the physician or practitioner furnishing telehealth services from a distant site.  The  descriptor states that 02 is  “The location where health services and health related services are provided or received, through telecommunication technology.”     READ MORE
(information from Palmetto GBA)
Provider Enrollment Revalidation Teleconference: January 25

Palmetto GBA will hold a Provider Enrollment Revalidation Question and Answer Teleconference on Wednesday, January 25, 2017 from 10-11 a.m. ET.    

eServices Update

Did you know you can view your latest Electronic Comparative Billing Report ( eCBR   ) in eServices? Be sure to check them out today! Current eCBR topics include E/M - Established Patient Visit, Chiropractic Services and Subsequent Hospital Visits.  

CMS Contractors Verify Compliance  

CMS employs several review contractors to measure, prevent and identify improper payments. These review contractors manually review claims against the submitted medical documentation to verify the providers' compliance with Medicare rules and regulations. These review contractors include: Palmetto GBA; Comprehensive Error Rate Testing Contractors (CERT), Recovery Auditor Contractor (RA) and Zone Program Integrity Contractors (ZPIC). With so many 'eyes' watching, you should ensure documentation is complete prior to submitting.   READ MORE
Payor News

PEIA Update
Effective 4/1/2017, PEIA restricts any Cesarean Section, labor induction or any delivery following labor induction to the following criteria:   

     Gestational age of the fetus must be determined to be at least 39 weeks and fetal lung maturity must be established before delivery.       

     If the delivery occurs prior to 39 weeks, maternal and/or fetal conditions must dictate medical necessity for the delivery.  

     Any Cesarean section, labor induction, or delivery that follows labor induction and that occurs prior to 39 weeks of gestation will be denied if the procedure is not considered to be, and documented as, medically necessary or the result of spontaneous labor.  

Physician claims for obstetric delivery will require one of the following modifiers:  
     UB-Medically necessary delivery prior to 39 weeks of gestation UC-Delivery at 39 weeks of gestation or later

     UA-Non-medically necessary delivery prior to 39 weeks of gestation  

Records will be subject to retrospective review.   If a Cesarean section, labor induction, or delivery following labor induction fails to meet the criteria for medical necessity, payments made will be subject to recoupment.  

Recoupment will apply to the physician charge for delivery.   I f you have questions, you may call HealthSmart Benefit Solutions at 1-888-440-7342 or PEIA at 1-888-680-7342.      

UniCare Health Plan Update  

Unicare invites all providers to monthly provider orientation sessions.  
Date:  Third Tuesday of each month
T ime:  noon – 1:00 PM Event Number:  593 498 042  

You will learn about:  

Who UniCare is
Healthcare Management Services
Case Management
Community Outreach Initiatives
Customer Service
Other Resources Available  

If you have additional questions, contact UniCare at (888) 611-9958. 

Educational Opportunities  
 
2017 CMOM Class Scheduled!
 
The WVSMA will hold the annual CMOM (Certified Medical Office Manager) class in February at the WVSMA office in Charleston. The dates for the four day course are  Thursday/Friday, February 16/17 and Thursday/Friday, February 23/24.
 
If you've wanted to obtain your certification, this is the time to do it. You may download a registration form  here , or from our  website .

March Conference
 
The WVSMA and the WVMGMA will again combine forces this year to host a conference for physicians, management and staff. Mark your calendars now for  Friday, March 24th at the Embassy Suites in Charleston.   

The groups are preparing a wide variety of programming to keep you apprised of all that is happening in the healthcare arena.  Speakers include nationally known healthcare attorney Robert Liles,  MGMA national speaker/author Dave Gans, along with Palmetto GBA’s Shannon Chase and Jezreel Harrison RN .  

The conference will also include concurrent break out sessions on various topics, so you may want to send several people from your practice in order to not miss out on any updates.   

Plan now to attend and watch both association websites for updates!