This week's Medicare updates include a Quality Payment Program proposed rule; new guidance for formatting plans of correction; clarification regarding Conditions for Coverage for End Stage Renal Disease facilities; and more!
We have trouble billing multiple units of injections and infusions—mostly CPT add-on codes 96375 (injection, each additional sequential intravenous push of a new substance/drug) and 96376 (injection, each additional sequential intravenous push of the same substance/drug provided in a facility)—that are done during observation stays and exceed the medically unlikely edits number. What is the correct way to bill these and get paid?
The release of the Quality Payment Program proposed rule introduced virtual groups as a way to reduce burden on small practices and clinicians. While the MACRA legislation laid out the initial concept of virtual groups, this proposed rule revealed many more details about how virtual groups will function.
Q: When multiple procedures are performed, is it appropriate to charge an additional set-up fee? For example, a facility performs a colonoscopy and an esophagogastroduodenoscopy, which took a total of 20 minutes in the procedure room. The facility charged two set-up fees plus an additional five minutes of OR time. Would this be considered a duplicate charge?