NGS Medicare Update
New Conversion factor : January 1, 2020 – $36.09
- RVU= physician work, practice expense (rent, equip, supplies), malpractice
- GPCI= geographic differences (established for each RVU
- Conversion factor= CF converts RVUs into actual dollar amounts
- Fee Schedule to be posted on NGS website soon
Evaluation and Management Update
What parts of the history can be documented by ancillary staff or the beneficiary starting in CY 2019?
- Practitioners need not re-enter in medical record information on patient’s chief complaint and history that has already been entered by ancillary staff or beneficiary
- Policy is to simplify and reduce redundancy in documentation
- Practitioners may simply indicate in medical record that s/he reviewed and verified the information
Simplifying documentation of history and exam for new and established patients E&M office/outpatient visits
- 99201‒99205, 99211–99215, 99221–99223, 99231–99233
- Clinicians can focus on what has changed since last visit
- Review and verify rather than re-enter a Chief Complaint or other historical information already recorded by ancillary staff or by patient
- No longer need to re-record defined list of required elements if there is evidence practitioner reviewed previous information and updated as needed
- Practitioners should still review prior data, update as necessary, and indicate in medical record that they have done so
- No longer need to re-enter in medical record information on patient’s chief complaint and history that has already been entered by ancillary staff or beneficiary
- Simply indicate in medical record reviewed and verified information
This is from October 2019 Medicare BLAST: Podiatry Services Routine Foot Care and Debridement of Nails
Answer are in bold.
1. The Medicare Program generally does not cover routine foot care.
2. National Government Services does have a local coverage determination (LCD) for Routine Foot Care.
3. What services are considered components of routine foot care and not separately billable to the Medicare Program?
a. Cutting or removal of corns and calluses
b. Clipping, trimming, or debridement of nails, including mycotic nails
c. Shaving, paring, cutting or removal of keratoma, tyloma, and heloms
d. All of these
4. A diagnosis of mycotic nails alone is insufficient for payment.
5. When the coverage is based on the presence of a qualifying systemic condition, what modifiers should be appended to the claim?
d. The modifier that fits the patient’s specific medical condition
6. In the absence of a systemic condition, the patient must have the same conditions whether they are an ambulatory patient or non-ambulatory patient.
7. Do global surgery rules apply to routine foot care codes 11055, 11056, 11057, 11719, 11720, 11721 and G0127?
8. Medicare routinely covers fungus cultures and KOH preparations performed on toenail clippings in the doctor’s office.
9. Routine foot care services are considered medically necessary once in 60 days.
10. For ICD-10-CM codes which fall under the active care requirement*, the approximate date when the beneficiary was last seen by the M.D., D.O., or qualifiednonphysician practitioner who diagnosed the complicating condition must be reported in Item 19 of the CMS-1500 form or the electronic equivalent.