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  • Global Surgery Coding in 2025 - AAPC Knowledge Center
    Providers can separately bill and get paid for the following: Surgeon’s first evaluation to determine whether there is a need for a major surgery Bill this E M visit separately with modifier 57 (defined below) Other providers’ related surgery services, except when there is an agreed upon transfer of care between the surgeon and other
  • Updates Clarify Medicare Split Shared Billing - AAPC
    1 Allowable places of service The concept of the split shared visit only applies in the facility setting, where incident-to is not applicable Facility settings include hospitals, skilled nursing facilities, and nursing facilities Office visits are excluded, where incident-to applies This is not new 2 Providers who can bill split shared
  • Billing Medicare for Telehealth Services in 2024 - AAPC
    The service must be conducted using audio and video technology Telehealth Policy Changes for 2024 Many of the telehealth flexibilities allowed during the COVID-19 public health emergency were extended through Dec 31, 2024, through either the Consolidated Appropriations Act, 2023, or the 2024 Medicare Physician Fee Schedule final rule
  • Telehealth: Medicare Policy for CY 2025 - AAPC
    In the end, though, CMS finalized for 2025 that “an interactive telecommunications system may include two-way, real-time, audio-only communication technology for any telehealth service provided to a patient in their home if the distant site provider is technically capable of using an audio-video telehealth system, but the patient isn’t
  • Decoding Value-Based Payments - AAPC Knowledge Center
    Example: An accountable care organization (ACO) uses this model to encourage coordinated care across multiple providers Bundled Payments This model offers a single payment for all services related to a treatment or episode of care, promoting efficiency and coordination Providers must manage the entire care episode within this payment structure
  • Bill G2211 With Confidence (and Modifier 25) - AAPC
    Train providers how to document the services described by G2211 appropriately While providers need guidance on capturing visit complexities of ongoing patient relationships in their notes, coders must learn to identify eligible visits and ensure proper documentation aligns with CMS’ guidelines
  • Billing Prolonged Services in 2024 - AAPC Knowledge Center
    CPT® add-on codes +99417 and +99418 describe prolonged services with or without direct patient contact on the date of an E M service in the outpatient or inpatient setting, respectively You will use these codes to report additional time a healthcare provider spends beyond the total time requirement for the highest-level primary E M service
  • Advance Beneficiary Notice of Noncoverage (ABN) - AAPC
    the service Note: Health care providers may not issue ABNs to shift financial liability to a beneficiary when full payment is made through bundled payments (e g , National Correct Coding Initiative) ABNs cannot be used when the beneficiary would otherwise not be financially liable for payments for the service because Medicare made full payment
  • Wiki Problem: 2 Specialties, 2 E Ms, Same Day - AAPC
    See CPT Appendix A mod 27 for OP Hospital E M encounters this may help with some of the rejections Since this case is inpatient service I would use a modifier 25 on the service because most likely there is something linking the two providers such as tax ID billing address etc The diagnosis codes should support the separate service
  • When (and When Not) to Issue an ABN - AAPC Knowledge Center
    The service or item is not a benefit of Medicare (never payable) The use of the ABN in this circumstance is a courtesy to the patient, so that the patient can make an informed decision prior to the service being rendered It also allows your office to provide documentation in case the cost of the service to the patient is questioned at a later





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