How do I report a measure using CPT Category II?
Beginning January 1, 2013, Functional Reporting requires therapy practitioners and providers to report nonpayable G-codes and modifiers to convey information about the beneficiary’s functional status including projected goal status throughout the episode of care. Functional Reporting is required on therapy claims for certain dates of service ...
Where do I enter CPT codes for service providers?
Jun 18, 2007 · CPT Category II or CPT II codes, developed through the CPT Editorial Panel for use in performance measurement, serve to encode the clinical action(s) described in a measure’s numerator. CPT II codes consist of five alphanumeric characters in a string ending with the letter “F.” CPT II codes are published annually in the CPT code manual.
What is the CPT for successful reporting and performance?
Oct 03, 2018 · Do not report CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 in addition to codes for psychiatry services on the same date. ICD-10 CM diagnosis code(s) reflecting the physical condition(s) being treated must be present on …
What are the modifiers for a CPT code?
Mar 13, 2014 · by Medical Billing | Mar 13, 2014 | CPT modifiers. Category II Code Description. 0509F Urinary incontinence plan of care documented. 0518F Falls plan of care documented. 0521F Plan of care to address pain documented. 1031F Smoking status and exposure to second hand smoke in the home assessed. 1032F Current tobacco smoker OR currently exposed to ...
How do you use FS modifier?
How do I bill 67820 to Medicare?
What CPT codes are not accepted by Medicare?
How would you report two separate procedure codes that are unrelated to each other?
Does CPT code 67820 require a modifier?
Does CPT 69990 need a modifier?
What modifiers are not accepted by Medicare?
Does Medicare use CPT codes?
Does Medicare pay for CPT code 64999?
In what situation would a code that is indicated as a separate procedure be reported by itself?
When a Radiology procedure is canceled report a code to describe the of the procedure performed?
What is the separate procedure rule?
What is severity modifier?
The severity modifiers reflect the beneficiary’s percentage of functional impairment as determined by the providers or practitioners furnishing the therapy services. Therefore, the beneficiary’s current status, projected goal status, and discharge status are reported via the appropriate severity modifiers.
What is functional reporting?
Functional Reporting gathers data on beneficiaries’ functional limitations during the therapy episode of care as reported by therapy providers and practitioners furnishing physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) services. The Functional Reporting system will better our understanding of beneficiary conditions, outcomes, and expenditures. This system was established through the Calendar Year (CY) 2013 Physician Fee Schedule final rule (77 Federal Register 68958). Implementation of the claims-based data collection strategy for outpatient therapy services was required by The Middle Class Tax Relief and Jobs Creation Act of 2012 (MCTRJCA).
What is Pub. 100-04?
Pub. 100-04: Medicare Claims Processing Manual, chapter 5, section 10.6 (PDF) for details about the Functional Reporting requirements on claims for therapy services
What is CR 8005?
CR 8005: Implementing the Claims-Based Data Collection Requirement for Outpatient Therapy Services — Section 3005 (g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012 (PDF)
How often is functional report required?
Functional Reporting is required on therapy claims for certain dates of service (DOS) as described below: At the outset of a therapy episode of care, i.e., on the DOS for the initial therapy service; At least once every 10 treatment days on the claim for services on the same DOS that the services related to the progress report are furnished;
When did functional reporting requirements end?
The Functional Reporting requirements of reporting the functional limitation nonpayable HCPCS G-codes and severity modifiers on claims for therapy services and the associated documentation requirements in medical records have been discontinued, effective for dates of service on and after January 1, 2019. The below instructions apply only to dates of service when the functional reporting requirements were effective, January 1, 2013 through December 31, 2018.
How many G codes are there?
There are 42 functional G-codes that are comprised of 14 functional code sets with three types of codes in each set. Six of the G-code sets are generally ...
What are CPT II modifiers?
CPT II modifiers are unique to CPT II codes and may be used to report PQRI measures by appending the appropriate modifier to a CPT II code if allowed for a given measure. The modifiers for a code are mutually exclusive and their use is guided by the measure’s coding instructions, which are included in the numerator coding section of the PQRI Measure Specifications. Use of the modifiers is unique to CPT II codes and may not be used with other types of CPT codes. Descriptions of each modifier are provided below to help identify circumstances when the use of an exclusion modifier may be appropriate. Note that in a pay- for-reporting model, accurate reporting on all selected applicable measures counts the same, whether reporting that the clinical action was performed or not.
How are PQRI measures arranged?
PQRI measures and their components are arranged alphabetically by clinical condition/topic in this section of the Handbook to facilitate review and selection of measures.
What are the two categories of CPT II code modifiers?
CPT II code modifiers fall into two categories, exclusion modifiers and the 8P reporting modifier .
What is CPT 2?
CPT Category II or CPT II codes, developed through the CPT Editorial Panel for use in performance measurement, serve to encode the clinical action(s) described in a measure’s numerator. CPT II codes consist of five alphanumeric characters in a string ending with the letter “F.” CPT II codes are published annually in the CPT code manual. Updates to CPT II codes are published every January and July and are available on the CPT II web pages at the American Medical Association’s website: http://www.ama-assn.org/ama/pub/category/10616.html
What factors should be considered when selecting measures for reporting?
At a minimum, the following factors should be considered when selecting measures for reporting: • Conditions usually treated • Types of care typically provided – e.g., preventive, chronic, acute • Settings where care is usually delivered – e.g., office, ED, surgical suite
Why is the 8P modifier used?
The 8P modifier serves to include the patient in the numerator when reporting rates are calculated for PQRI.
How many times does a clinical test need to be reported?
If the measure calls for a clinical test result, then the most recent test result only needs to be obtained, assessed, and reported one time per reporting period . A test does not need to have been performed within the reporting period, nor does it need to have been performed by the same eligible professional.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33834 Health and Behavior Assessment/Intervention provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What happens if you don't submit an unlisted code?
The unlisted code will be denied as a billing error. Medicare payment will be based on the information submitted. If the required information is not submitted, any unlisted procedure or service will be denied as unprocessable.
What is an unlisted procedure?
An unlisted procedure or NOC code must have a concise description of the service or procedure rendered in Item 19 on the CMS-1500 claim form or electronic equivalent. In the concise description of the procedure, it is helpful to include how the procedure was performed (e.g. laparoscopic, transnasal, infusion, with clip, type of graft, etc.), the body area treated and why it was performed.
What is the responsibility of the provider to ensure all information required to process an unlisted procedure or NOC code is included
It is the responsibility of the provider to ensure all information required to process an unlisted procedure or NOC code is included on the CMS-1500 form or the electronic media claim (EMC) when the claim is submitted. If required information is missing, the code will be deemed unprocessable.
How many characters are in item 19?
The electronic equivalent for Item 19 holds up to 80 characters for the concise statement. If the description does not fit in Item 19, providers who submit paper claims should include an attachment to describe the service or procedure. Also, an attachment can be submitted for EMC claims using the PWK submission method. See PWK article titled "Submitting Paperwork (PWK) Electronically."
What is an exception to the unclassified drug code instruction above?
An exception to the unclassified drug code instruction above is the billing of compound drugs (often prepared by special pharmacies), which should be billed as outlined in the companion articles published simultaneously with this article:
What is the charge for CPT II?
Therefore, CPT II codes are billed with a $0.00 billable charge amount.
How many characters are in CPT 2?
CPT II codes contain five characters – the first four numerical characters are followed by an alphabetical fifth character, the letter ‘F’.
When is CPT II updated?
CPT II codes are released annually as part of the full CPT code set and are updated semi-annually in January and July by the AMA . The current listing of CPT II codes can be found on the AMA Web site at: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billinginsurance/cpt/about-cpt/category-ii-codes.page. ...
What is the purpose of the 8P modifier?
Modifier 8P (performance measure reporting modifier—action not performed, not otherwise specified) is used as a reporting modifier to allow the reporting of circumstances when an action described in a measure’s numerator is not performed and the reason is not otherwise specified
What is a 2P modifier?
Modifier 2P (performance measure exclusion modifier due to patient choice) is used to report that the performance measure was not performed because of a patient’s religious, social, or economic reasons; the patient declined (ie, noncompliance with treatment); or other specific reasons.
What is clinical component?
• Clinical components, such as those typically included in evaluation, management, or other clinical services;#N#• Results from clinical laboratory or radiology tests and other procedures;#N#• Identified processes intended to address patient safety practices; or#N#• Services reflecting compliance with state or federal law.
Can CPT II be used for HEDIS?
Not only can using CPT II codes ease the administrative burden of chart review for many HEDIS™ performance measures, use of these codes enables organizations to monitor internal performance for key measures throughout the year, rather than once per year as measured by health plans and Pay for Performance. By identifying opportunities for improvement, interventions can be implemented to improve performance during the service year.
