Reimbursement Policy Updates

Update: Assistant Surgeon Coding - Professional

In our Assistant Surgery Services Coding Chart dated June 315, 2018, we are adding procedure codes 15733, 19294, 20939, 31241, 31253, 31257, 31259, 31298, 36465, 36466, 36482, 36483, 38222, 55874, 0479T, 0483T, 0484T, C9738, C9748, G0516, G0517, G0518, effective January 1, 2018), and C9749 (effective April 1, 2018) to our “Assistant Surgeon Not Allowed” code list to document our edit that these codes are not eligible for reimbursement when reported by an assistant surgeon. Please note that we are deleting code 44360 from the list as this code does allow an assistant surgeon; we are also removing deleted codes 44347, 44349, and 44350 from the “Assistant Surgeon Not Allowed” code list. 

 

Update: Documentation and Reporting Guidelines for E/M Services - Professional

We are adding new information to our policy dated January 1, 2019 regarding new patient vs. established patient visits.  When a provider changes physician group practices and has seen a patient within the past three years at the previous practice, the evaluation and management encounter for the same patient at the new practice is considered an established patient visit and would NOT be considered a new patient visit.  For more information regarding this update, along with other non-substantive updates (minor language, punctuation, etc.), review the policy dated January 1, 2019 by visiting empireblue.com/provider > Select “Find Resources in New York” > Provider Home > Answers @ Empire > Reimbursement Policies.

 

Update: Routine Obstetrical Services - Professional

We are adding new information for our policy dated January 1, 2019 that reimbursement for global obstetric codes is based on all aspects of global obstetric services (antepartum, delivery and postpartum) being provided by the provider or provider group reporting under the same TIN. If a provider or provider group reporting under the same TIN does not provide all antepartum, delivery and postpartum services, global obstetrical codes may not be used and providers are to submit for reimbursement only the elements of the obstetric services that were actually provided. For more information regarding this update, along with other non-substantive updates (minor language, punctuation, etc.), review the policy dated January 1, 2019 by visiting empireblue.com/provider > Select “Find Resources in New York” > Provider Home > Answers @ Empire > Reimbursement Policies.