Cents and Sensibility: Navigating PM&R Billing Codes with Finesse (Member Resource)-Session Recording

Video Transcription

Video Summary

The video session explores billing and coding nuances in physical medicine and rehabilitation (PM&R) with insights from experts Lauren Shapiro, Carolyn Millett, and Clarice Sin. They discuss the G2211 code for outpatient longitudinal care, clarifying its use, and emphasizing its relationship-based application instead of diagnosis-focused. The segment also elucidates the role of G codes within the HCPCS system and their importance in accurately capturing reimbursable services, particularly for Medicare.<br /><br />Further, the session delves into the complexities of modifiers like FS for split/shared services with non-physician practitioners, and modifier 25 for significant, separately identifiable E&M services alongside procedures. Clarice Sin articulates the correct usage of modifier 25, underscoring documentation requirements to validate E&M service beyond usual pre/post-operative care.<br /><br />The discussion expands to medical team conference billing, highlighting how to appropriately document and use relevant CPT codes for such settings. Lauren Shapiro provides updates on the Medicare conversion factor, alarmingly indicating proposed cuts and urging action to prevent further reductions in physician reimbursement.<br /><br />Telemedicine billing challenges are also addressed, noting Medicare’s temporary pandemic-induced waivers and urging awareness of evolving policies as these flexibilities phase out. As the field adapts to technological advancements, including telehealth and RTM, staying informed on payer policies is essential. Lastly, the video notes potential changes in acupuncture service reimbursements, reflecting slight adjustments following AMA’s valuation recommendations. The session concludes by encouraging direct contact for further inquiries on reimbursement policies.

Keywords

billing

coding

physical medicine

rehabilitation

G2211 code

HCPCS system

Medicare

modifier 25

telemedicine

reimbursement