Medical Coding Changes and Updates for Q3 2024
At PCG Software Inc., we are dedicated to providing our clients with the latest updates and critical insights into the ever-evolving healthcare industry. Our 3rd Quarter 2024 newsletter brings you essential information on regulatory changes, pricing updates, and new guidelines that could impact your operations. Below are some key highlights:
Hospital OPPS Corrections and DMEPOS Fee Schedule Updates- California's New Healthcare Pricing Rule
- Billing and Payment for Caregiver Training
- Modifier GG for Screening and Diagnostic Mammography
- Psychotherapy for Crisis
- Social Determinants of Health Risk Assessment
- Updates to the Required Prior Authorization List
- Replacement of Wheelchairs
- CMS’s New FAQ on Caregiver Training
- Hospital Beds Coded E0290, E0301, & E0304 Requirements
- Medicaid NCCI Edits Differ from Medicare NCCI Edits
- Update for COVID-19 Monoclonal Antibody Therapy
- AMA Releases 26 New PLA Lab Codes
- New CPT Category III Codes for July 2024
- Skin Substitutes Payment Guidelines
- Update to the SNF HCPCS Codes Subject to Consolidated Billing
- HHS Report to Congress on Recoveries
- PPIR Update for July–December 2024
Hospital OPPS Corrections and DMEPOS Fee Schedule Updates
The CMS has announced corrections to status indicators for key CPT and HCPCS codes, which will be retroactively applied to claims dating back to January 1, 2024. These corrections ensure accurate payments and classifications, enhancing your financial operations. The DMEPOS fee schedule update introduces new HCPCS Level II codes, reflecting the latest changes in durable medical equipment and prosthetics.
California's New Healthcare Pricing Rule
Starting in 2025, California will implement a new rule capping annual healthcare price increases at 3%. This stringent measure, aimed at curbing the rising costs of healthcare, places California among the top states enforcing such regulations. Healthcare providers in California will need to adapt their pricing strategies accordingly to remain compliant and competitive.
Billing and Payment for Caregiver Training
CMS has released new FAQs clarifying the billing and payment processes for caregiver training services. These updates emphasize the necessity of medical documentation and the importance of caregiver consent, ensuring that training is appropriately billed and reimbursed.
Modifier GG for Screening and Diagnostic Mammography
A new guideline mandates the use of Modifier GG when a screening mammogram evolves into a diagnostic mammogram on the same date. Detailed documentation of the procedure and the specific abnormality detected is required to ensure proper billing.
Psychotherapy for Crisis
CMS has updated the guidelines for billing psychotherapy for crisis services. CPT codes 90839 and 90840 now encompass urgent assessments and interventions for patients in severe distress, ensuring timely and appropriate care.
Social Determinants of Health Risk Assessment
A new optional element in the Annual Wellness Visit allows for the assessment of social determinants of health. This addition aims to identify and mitigate health-related social needs, promoting preventive care and improved patient outcomes.
Updates to the Required Prior Authorization List
Starting August 12, 2024, new orthoses and osteogenesis stimulator codes will require prior authorization. This change ensures that these devices are used appropriately and that patients receive the necessary care.
Replacement of Wheelchairs
CMS has issued new guidelines for the replacement of wheelchairs when manufacturers exit the business, ensuring continued patient mobility and access to necessary equipment.
Want the Full Information?
This just scratches the surface of our 23-page 3rd Quarter Newsletter that’s only available to our existing VE and VEWS clients who adjudicate and payout claims. If you’re interested in AI Medical Claim Auditing, saving millions with AI Claims Software, then please contact us for a short 20-30 minute initial meeting to see if AI Medical Coding is right for you and if you can gain access to this newsletter for years to come.
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DISCLAIMER: PCG Software Inc. has an AMA license and works with CMS experts to continually update our software solutions and bring forth real-time updates as often as possible about the latest medical coding changes for US Healthcare. We do not ever create medical codes or information relating to medical codes in our publications. We simply report the latest information provide from the AMA, CMS, and WHO.
