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 untilJanuary 1, 2024. We continued to believe it is appropriate to define thesubstantive portion of a split (or shared) service as more than half of the totaltime, 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..

Anterior and Posterior Labral Repairs

Question:

Our surgeon documented anterior inferior labral repairs and then documented posterior inferior repairs.  The surgeon wants to report 29806 x 2 and I do not believe that is correct.  Will you assist?

Answer:

Thank you for your question. You are correct in that CPT code 29806 may not be reported twice. You will report 29806-22 once that includes both labral repairs. Remember to increase your standard fee to signify this code is different than the traditional code (no modifier).

Costochondral Injection

Question:

We saw a patient who presented with chest pain and the physician diagnosed costal chondritis and the administered an injection into the costochondral junction. We are debating what CPT code to report for the injection? Is it 20550, 20600, 20605 or an unlisted code? We are considering CPT code 20600.

Answer:

Thank you for your inquiry. This is not your typical orthopaedic injection! From a CPT coding perspective, the correct code is CPT code 20605 when Ultrasound Guidance is not a component of the service. The diagnosis is M94.0 (Chondrocostal junction syndrome).

Note: This advice is based on guidance from the AMA’s CPT Knowledge Base, revised in 2015 (KB #5189). The specific Q&A is available through AMA subscription.

Billing for Comparison Views

Question:

Can we bill comparison in-office x-ray views (usually knees or elbows) if the patient is asymptomatic on the contralateral (opposing) side?

Answer:

Unless there is a medically necessary reason for the comparison views on the contralateral body part, they should not be billed separately. If documentation does support billing for both sides, select the CPT by number of views and add the appropriate modifier (e.g., 3 views of the left knee and 2 views of the right knee 73562 LT and 73560 RT).

Portable Ultrasound Equipment

Question:

Our physician’s submitted literature to our administration team related to portable handheld ultrasound equipment for purchase consideration. I was asked if this equipment met CPT requirements for ultrasound. Is this equipment acceptable to use when performing ultrasound guided injections?

Answer:

We recommend you research the website literature for product specifications or contact the vendor. The key will be that the technology must be able to capture and save images in the medical record. The images will need to show the needle localized in the specific anatomic site.

CPT codes that state “with ultrasound guidance” (e.g. Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting) or codes such as CPT code 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) will not be reportable if the technology does not have the capacity to save the images to the medical record.

Modifier Order on CMS Claim Form

Question:

We are submitting a hospital claim form with the modifier 25 and FS modifier. We are unsure which modifier to list first. What is your recommendation?

Answer:

Thanks for contacting KZA and remembering to use the FS modifier for shared services provided in the hospital. KZA recommends placing the modifier 25 first, as this is considered a reimbursement modifier followed by the FS modifier, which is an informational modifier.