2023 brought significant changes to EM code categories, and along with that came significant changes in reporting Prolonged services. CMS and AMA disagree significantly on how to report prolonged services. The AMA made some changes to their prolonged service codes in CPT. Due to their significant disagreement with the AMA, the Centers for Medicare and Medicaid Services (CMS) developed new G codes for reporting prolonged services in association with the new CPT EM code categories. In addition, CMS has new time elements for reporting prolonged services that are not aligned with CPT EM code time elements. All this can lead to significant confusion for providers and coders.
- Review the time reporting controversy between the AMA and CMS
- Understand the new CMS G codes and why they were developed
- Know how to correctly report prolonged service for payers that do not follow Medicare/Medicaid rules
- Exam the background for the differences in time as reported in CPT and CMS’s development of their own time for reporting prolonged attendance
- Develop a template for determining the correct time components for reporting prolonged services based on CMS time requirements
- Know the codes that prolonged attendance may not be reported with
Areas Covered in the Session:
- AMA and CMS have a different perspective on reporting prolonged attendance
- New CMS G codes for prolonged attendance
- Time element differences between CPT and CMS for reporting prolonged attendance
- Documentation to support prolonged services
- Codes that prolonged attendance may not be reported with.
- Reporting prolonged services for ancillary staff
- Examples of prolonged attendance encounters
- Live Q&A Session
- All providers regardless of specialty
- Providers where specialty provides significant counseling services
- Reimbursement managers
- Denial management team
- Auditors inside and outside of the practice
- Office Managers
- Insurance payers
- Payment policymakers
- Billing Staff
- Coding Staff
- Compliance officers
- Clinic Managers
- Physician and Non-physician Practitioners
- Insurance Company Claims Reviewers
Jan Rasmussen, PCS, ACS-OB, ACS-GI, – As a health care consultant Jan has more than 35 years of experience in physician billing, reimbursement and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992 with active membership in the American Academy of Procedural Coders (AAPC). As a member of the AAPC, Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributing to the development of AAPC’s independent study and university education programs and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year. Jan was also a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination committee.
In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Campus audits, designed and conducted physician coding seminars nationwide. She has been a guest speaker for several conferences sponsored by United Communications, Inc//Decision Health, AAPC as well as Coding Institute Specialty Conferences.
In previous consulting positions she was responsible for developing and conducting seminars for basic, intermediate and advanced ICD-9-CM and CPT, teaching physician guidelines as well as specialty seminars for OB/Gyn, Orthopedics, Urology, Gastroenterology, General Surgery, ENT, Cardiology, Emergency Medicine and Evaluation and Management. In her role as an educator she has been teaching E/M documentation and auditing to both physician and coding audiences since 1992 when RBRVS was first implemented.
Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee and served as the coding and reimbursement coordinator for a 37 provider, staff model HMO clinic. As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital, surgical and nursing facility coding, charge ticket development, fee development, reimbursement analysis, claims analysis and physician education.
Snippet From Our Previous Session