Modifiers (Part I)

Coding rules for Colonoscopies are complex, especially those relating to Screening Colonoscopies.  The Cologuard test is becoming more popular as a non-invasive colorectal cancer screening test.  On January 1, 2023, CMS changed its payment policy regarding Colonoscopy after a positive Cologuard test.  This rule change has been widely misinterpreted.  This episode explains how the host, Piyush Sheth, MD, resolved the controversy.CMS Response to Dr. Sheth link:https://drive.google.com/file/d/1glZ5xEoDhm8ZYvEHZpBzkSwF_4Ch5-Hm/view?usp=sharing

The coding changes to Office / Outpatient Services implemented on January 1, 2021 and the complimentary changes to Hospital Services implemented on January 1, 2023 were designed to minimize documentation burden and allow providers to focus more on patient care. This episode discusses one major unintended consequence of these changes: the shift of the E/M CPT coding bell curves to higher levels. Topics discussed in this episode: E/M Documentation, Coding, Audit, RVUs. Don’t forget to subscribe to our podcast Books available on Amazon.com: NEW: Coding Solutions Evaluation and Management Services, 2024: Coding Solutions Evaluation and Management Services, 2024 Coding Solutions General Surgery, 2024: Coding Solutions General Surgery, 2024

These are our 4 wishes to improve documentation, coding, and healthcare from our hosts Neal Sheth and Dr. Piyush Sheth. There is also a free gift for our listeners. Click the free link below to get your free gift: https://drive.google.com/file/d/10tPZ81QkVMskZVKnUkqyzAikYQ6t58Nh/view?usp=sharing

This episode discusses the clinical issues, proper coding (using CPT and modifiers), and current payment policies regarding colonoscopies. Unfortunately, because these three aspects are intimately entwined, colonoscopy coding can get quite complex. Hosts Neal Sheth and Dr. Piyush Sheth try to simplify and clarify the concepts behind coding for colonoscopies.

2023 brings a host of changes to medical coding and billing. Dr. Piyush Sheth talks about ICD, CPT, and reimbursement changes including changes to RVU values.

Episode Summary: Medical Documentation has suffered a decline in integrity due to adoption of  Electronic Medical Records and an incomplete understanding of Documentation Guidelines. Hosts Neal Sheth and Dr. Piyush Sheth explore this topic and provide solutions that can strengthen your medical record documentation and make them stand up to scrutiny during audits. Visit our blog: www.unravelingmedicalcoding.com Don’t forget to subscribe to our podcast: Unraveling Medical Coding CODING SURGERY: General Surgery, 2022 available on Amazon.

Episode Summary: RVU’s (Relative Value Units) are the currency of healthcare. Hosts and General Surgery Certified Coders Neal Sheth and Dr. Piyush Sheth explore the concept of RVU’s and Geographic Practice Cost Indices and how CMS makes payments. Visit our blog: unravelingmedicalcoding.com Don’t forget to subscribe to our podcast: Unraveling Medical Coding Coding Solutions: General Surgery, 2022 is available now on Amazon

Episode Summary: Modifiers are two-digit codes that can be appended to a CPT code in special situations to justify payment for the service when payment otherwise would be denied. Understanding the proper use of modifiers can lead to better reimbursement. Hosts Neal Sheth and Dr. Piyush Sheth explore some of the most common modifiers used. Visit our blog: unravelingmedicalcoding.com Don’t forget to subscribe to our podcast: Unraveling Medical Coding Coding Solutions: General Surgery, 2022 is available now on Amazon

Episode Summary: Modifiers are two-digit codes that can be appended to a CPT code in special situations to justify payment for the service when payment otherwise would be denied. Understanding the proper use of modifiers can lead to better reimbursement. Hosts Neal Sheth and Dr. Piyush Sheth explore some of the most common modifiers used. Show Links: Buy the Book Full Transcript Available at: www.unravelingmedicalcoding.com

Episode Summary: CMS released their Calendar Year 2022 Medicare Physician Fee Schedule Final Rule on November 2nd. There are significant changes to the PFS conversion factor, billing for Shared/Split inpatient services, Critical Care services, Telehealth services, and Colorectal Screening procedure co-insurance payments among others. Hosts Neal Sheth and Dr. Piyush Sheth try to make sense of these changes and how they affect documentation, coding, and billing. Show Links: CMS CY2022 MPFS Final Rule Summary of CMS CY2022 MPFS Final Rule Full Transcript Available at www.unravelingmedicalcoding.com