Medicare updates & Decoding Nerve Conduction Studies
Medicare has a few updates that will start soon.
New Place of Service Code:
A key update is the introduction of Place of Service (POS) code 27 - Outreach site/street. This change, effective from October 1, adds complexity to Medicare billing. It's important to remember that Medicare Administrative Contractors (MACs) have until January 1, 2024, to fully integrate POS 27 for claims processing.
Understanding POS 27: POS 27 is officially described as "A non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals."
Insight from CMS:
In transmittal 12202, CMS sheds light on the reasoning behind POS 27 for Medicare Part B claims. This new code targets services provided in unconventional settings, specifically for unsheltered homeless individuals.
Service Added to Home Health Consolidated Billing List: Alongside POS updates, CMS has revised the Home Health Consolidated Billing List. Starting January 1, 2024, wound suction (reported with A9272 Wound suction, disposable, includes dressing, all accessories and components, any type, each) is now part of the non-routine supplies subject to consolidated billing under the Home Health Prospective Payment System (HH PPS). It's crucial to note that MACs will not separately reimburse HCPCS Level II code A9272 when a beneficiary is under a home health episode. The primary HHA will handle reimbursement directly.
Staying vigilant about these subtle changes is essential for healthcare professionals navigating Medicare billing intricacies. Adapting to the ever-evolving healthcare landscape requires a keen awareness of these nuanced shifts to maintain precise and efficient billing practices. For official guidance on the Home Health Consolidated Billing List update, consult CMS Manual System Pub 100-04 Medicare Claims Processing Transmittal 12197, Change Request 13295, issued on Aug. 10, 2023.
Bonus content on Nerve Studies
Decoding Nerve Conduction Studies for Proper Coding
When it comes to nerve conduction studies, precision is key. The American Association of Physical Medicine and Rehabilitation (AAPMR) advises physicians to test only the essential nerves needed for an accurate diagnosis. Following this guidance not only aligns with medical best practices but also ensures proper coding based on the Current Procedural Terminology (CPT®) recommendations.
Coding Basics: The Unit System
Coding for a nerve conduction study operates on a unit system. The study involves analyzing latency, amplitude, and conduction velocity. This analysis is done using the F-wave of a sensory or motor nerve, with or without additional F-wave or H-reflex tests. There exist seven CPT® codes specifically for nerve conduction studies, numbered 95907 to 95913. The selection of the appropriate code is determined by the number of studies conducted. It's essential to count each type of study only once, even if performed on the same nerve at multiple sites.
Refer to Appendix J for Guidance
For a comprehensive guide on indications and the maximum number of studies for nerve conduction studies, look no further than Appendix J in the CPT® code book. This table provides valuable insights into the scenarios where nerve conduction studies, when performed with electromyography, are most applicable. Appendix J emphasizes counting each nerve as one unit of service.
Understanding Unit Counting
To clarify, if the median sensory nerve undergoes stimulation in both the first and third digits, these instances are counted as two distinct studies. When testing nerves in their contralateral counterpart for a comparative study, each is counted as a separate unit of service toward the total number of nerves studied. This meticulous approach not only ensures accurate coding but also aligns with the principles of effective and precise medical examination.
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I hope this information is useful, Jen
Medicare updates & Decoding Nerve Conduction Studies
Medicare has a few updates that will start soon.
New Place of Service Code:
A key update is the introduction of Place of Service (POS) code 27
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