News and Intelligence

December 30, 2019

Practicefirst would like to notify our clients of important changes as outlined by CMS for CY 2020 regarding Medical Record Documentation.

As per CMS MLN Matters MM11560:

Medical Record Documentation:

CMS is finalizing, for CY 2020, a proposal to reduce burden by implementing a broadened general principle beyond teaching physicians that will allow:

  1. All physicians,

  2. Physician Assistants (PA’s),

    ...

September 26, 2019

Practicefirst would like to notify our clients about a NCCI update that is effective July 1, 2019. National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edits consist of column one and column two codes.

If a PTP edit has a CCMI (Correct Coding Modifier Indicator) of "1", the PTP edit shall be bypassed if submitted with an NCCI-associated modifier. Modifiers 59, XE, XS, XP, and XU a...

April 1, 2019

Practicefirst’s March client memo referred to the important revisions that CMS has made to Evaluation and Management

Documentation Guidelines, which are effective January 1, 2019.

** Please note the correction to the third bullet below. The requirement should not include the physical exam. We apologize for the miscommunication. 

Highlights of CMS’s revisions include the following:

  • The re...

March 12, 2019

Practicefirst would like to remind its clients about the important

revisions that CMS has made to Evaluation and Management Documentation Guidelines, which are effective January 1, 2019.

Highlights of the changes include the following:

  • The requirement to document medical necessity of furnishing visits in the home rather than office will be eliminated.

  • For established patient office/outpatie...

February 6, 2019

Practicefirst would like to like to remind its clients about the correct usage of modifier 57, Decision for Surgery. This modifier at first glance looks easy to code, but is often used incorrectly and has made it to the list of open issues for the Recovery Audit Contractors (RAC).

A few items to remember when using modifier 57:

  • This modifier is used only on the E/M codes and not on the procedure...

October 1, 2018

Modifier 25

As a reminder to our Practicefirst clients, please review the

description, definition and proper usage of modifier 25 as

stated below:

Description: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.

Definition (As per CPT):

A significant, separately identif...

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