b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEANJC Scholarships REHAB Update CHIRO AssistExecutive Directors Update LEGAL Q&A2020 ANJC AWARDSLegislative UpdateINSURANCE Update INSURANCE Update 2021 SPRING Insurance Update TECHNIQUE UpdateBy Matt MinnellaANJC Director of Insurance & Regulatory AffairsHorizon Change Healthcare Coding Advisor Program: Documentation of 99072: The AMA did not include any specifications regarding how to document this code. In their MedicareQ&AMedicare UpdateHorizon has advised that beginning March 2021, they are launching a claim review process run by Change HealthcareCPT Assistant article, they refer to the definition of the codeOUR HEALTHknown as the Coding Advisor Program. The program focusesand note that documentation requirements may vary among on usage of CPT code 98942. The program will not includethird-party payers and insurers; therefore, they should be all chiropractors. Criteria for selection includes whether ancontacted to determine their specifications. As we have not office has billed at least 25 claims to Horizon and if more thanseen any guidance from carriers operating in NJ thus far, we 20% of the offices claims utilize the 98942 code. In this initialrecommend the following as a minimum of documentation round 122 New Jersey Chiropractors are included, amongfor this service if billed:both in and out-of-network providers. Letters should be Document the supplies used above what would normallyarriving to those included in the program this week with be usedgloves, masks, wipes, etc.more details. Document any materials used above what would normallyThis program is not specific to chiropractors. Horizon isbe usedair flow systems, plastic guards, etc.running different versions of the program with Change Document clinical staff time over and above what is usuallyHealthcare on over 4300 providers across 45 differentincludedcleaning time, prep time, patient wait arrange-specialties. Unlike previous coding reviews, this processments, e.g. calls to patients in the car, etc.does not initially require submission of notes for review or immediate pre-payment review status as with the -25 and -59 modifier outlier programs. Change Healthcare will submit a message to the provider on one claim per week via the electronic remittance advice (ERA) that will suggest a review and correction to your coding on that claim. You will be able to change the coding OR maintain the claim as is and it will be paid as originally submitted. This process of messaging suggested coding corrections will continue for six months. If after this time period the provider is still an outlier in terms of percentage of claims with a 98942 billed, a post-payment review of claim documentation will be done. Based on the results, pre-payment review may be instituted for those particular providers.Change Healthcare is to have certified professional coders available for a provider to call and discuss their claims and documentation to discuss any issues or find out more about proper coding of the services they are submitting.New CPT Code 99072 for COVID-19 Supplies:Pricing of 99072:At this time there is no Medicare fee schedule amount for this code. Fair Health, a nationally In September 2020, the AMA released a new CPT code,recognized usual and customary database, has begun to 99072, created to address additional expenses incurredpublish regional data but the results vary widely between by providers as a result of additional safety measures andeven neighboring zip codes in some cases. As such, we cleaning supplies needed due to the COVID-19 pandemic. recommend that when setting a fee for this service for your The formal definition of CPT 99072 is Additional supplies,office that you correlate the charge to the actual additional material, and clinical staff time over and above those usuallyexpenses that your practice has incurred in a reasonable way. included in an office visit or other non-facility service(s),For instance, you could determine from your expenditures when performed during a Public Health Emergency (PHE)how much more you spend on cleaning and sanitary supplies as defined by law, due to respiratory-transmitted infectioussuch as cleaning spray, paper towels, hand sanitizers, wipes, disease. masks, etc. than you did prior to the pandemic in a given 10 I Spring 2021 www.anjc.info'