99292 CMS change

[chessknt]

Just found out about the new CMS rules requiring the full 30 minutes before 99292 charges. This effectively makes 99291 30-103 minutes now. Nothing says thank you like hitting charge capture for cognitive time spent on a difficult case. Outpatient medicine can now outpace CCM billing with this new change if you have a difficult patient.

Just a psa for us based providers about the love CMS is showing us after the pandemic.

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[Siggy]

Just found out about the new CMS rules requiring the full 30 minutes before 99292 charges. This effectively makes 99291 30-103 minutes now. Nothing says thank you like hitting charge capture for cognitive time spent on a difficult case. Outpatient medicine can now outpace CCM billing with this new change if you have a difficult patient.

Just a psa for us based providers about the love CMS is showing us after the pandemic.

Do you have a source for this?

 

[chessknt]

Do you have a source for this?

https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf

30.6.12.4

When one practitioner begins furnishing the initial critical care service, but does not meet the time required to report CPT code 99291, another practitioner in the same specialty and group can continue to deliver critical care to the same patient on the same date. The total time spent by the practitioners is aggregated to meet the time requirement to bill CPT code 99291. Once the cumulative required critical care service time is met to report CPT code 99291, CPT code 99292 can only be reported by a practitioner in the same specialty and group when an additional 30 minutes of critical care services have been furnished to the same patient on the same date (74 minutes + 30 minutes = 104 total minutes).


Basically instead of always rounding up now we always round down. **** the heroes hurrah!

 

[Siggy]

https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf

30.6.12.4

When one practitioner begins furnishing the initial critical care service, but does not meet the time required to report CPT code 99291, another practitioner in the same specialty and group can continue to deliver critical care to the same patient on the same date. The total time spent by the practitioners is aggregated to meet the time requirement to bill CPT code 99291. Once the cumulative required critical care service time is met to report CPT code 99291, CPT code 99292 can only be reported by a practitioner in the same specialty and group when an additional 30 minutes of critical care services have been furnished to the same patient on the same date (74 minutes + 30 minutes = 104 total minutes).


Basically instead of always rounding up now we always round down. **** the heroes hurrah!

Thanks. I’m going to forward it to our billing people.

 

[chessknt]

Thanks. I’m going to forward it to our billing people.

This represented about a 30% revenue loss so far this year for us, big surprise CMS didn't even mention except as a goddamn footnote in an obscure manual.

I suppose next year if you provide <74 minutes of CC time you just don't get to charge anything.

 

[CCM-MD]

We rarely bill 99292s and are at 90th percentile MGMA for wRVUs.

 

[Siggy]

We rarely bill 99292s and are at 90th percentile MGMA for wRVUs.

With split share, it’s been easy for us to justify 92s on the night shift so far this year. I don’t know what the break down for billing is for us.

That said, the majority of my group has terrible documentation, even when it comes to the low hanging fruit such as keeping a running total of critical care time.

 

[chessknt]

We rarely bill 99292s and are at 90th percentile MGMA for wRVUs.

You run a ridiculous census though. Remember how the safe census is supposed to be 12ish? When your census is smaller it is easier to round longer, hold longer family meetings or updates, tinker with vents etc etc to use up some of this time every day. This change won't mean anything for you but it is a huge kick in the dick for smaller programs.

Also tagging on any significant cross-cover stuff for people sitting at 50-65 mins was an easy extra 3ish wrvu. Now it's all free though!