by Wyn Staheli, Director of Research
April 1st, 2019
One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics.
We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which have been corrected on our website. Corrections are identified by strikeout and green text.
- “Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?” Published March 15, 2019.
Correction: While technically you may treat the patient with one visit under the Choice Program, additional visits must be authorized through TriWest. To clarify the policy, the following paragraph needs to be revised:
Did you obtain an authorization for these services? An authorization is not necessarily the same thing as a referral. Check with the provider relations department to determine their requirements. Although the first visit does not need to be authorized under the Choice Program, yYou will may need to obtain an authorization number for subsequent visits which would need to be entered on Item Number 23 of the 1500 Claim Form.
Also, as of September 30, 2018, HealthNet no longer has a contract with the VA so they were removed for the bullet about contracts.
- “Medicare Supplemental Policies (MediGap) and Extremity Adjustments” Published February 25, 2019.
Correction: “Medicare Advantage (Part C) policies” was left out of the following paragraph:
Keep in mind that MediGap policies generally pay for the deductible and coinsurance for covered services. MediGap policies must follow federal and state laws and it must clearly be identified as a “Medicare Supplement Insurance.” Even though “Supplement” plans mainly involve Medicare Part A and Part B out-of-pocket costs, like deductibles and copayments, some Medicare Advantage (Part C) policies also cover additional benefits such as:
2019 ChiroCode DeskBook
Patient-Centered Community Care
The VA Patient-Centered Community Care (VAPCCC or VAPC3) is a Veterans Health Administration (VHA) program created to provide eligible Veterans access to specialized services. PC3 has a contract with contracts for different regions have been awarded to HealthNet and TriWest to provide care when the local VA is unable to readily provide those needed services. Providers must be contracted (in network) with the TriWest associated payer for their region in order to provide services. It is important to note that TriWest has partnered with EmpowerChiro for that chiropractic care so you will need to be contracted with them. See Resource 135 for information by EmpowerChiro. for the TriWest regions is provided through EmpowerChiro.
Note: As of September 30, 2018, the VA discontinued its contract with HealthNet for the services provided in the eastern region of the U.S. TriWest now covers all of the U.S.
Note: The VA MISSION Act, which was signed into law on Wednesday, June 6, 2018, consolidates the Patient Centered Community Care (PC3) and the Veterans Choice Program (VCP) into one program called the Community Care Network (CCN). Watch for further announcements regarding implementation timelines. See Resource 136 for information.
- The new flag is missing on code M79.18 “Myalgia, other site on pages 291 and 293.
- On page 292, M48.06 “Spinal stenosis, lumbar region is incorrectly listed as a code and not a sub-category. There are additional required characters. It should not be bold.
- The “revised” icon is missing on sub-category M79.1-
- Codes 99451 and 99452 should not have been indented so that they appeared to be part of the 99446-99449 group of codes.
- The description for code 99452 incorrectly includes the first part of code 99453 at the end of the official description.
Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/ requesting physician or other qualified health care professional, 30 minute Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial;
- Code E0850 is incorrectly listed for "Cervical traction, free standing stand". It should be code E0855.
2019 HCPCS Codes
The following HCPCS codes were added or changed, effective January 1, 2019. At the time of publication, these codes were not available. Although there were hundreds of code changes, the following are those that might be applicable to a chiropractic office:
- G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment
- G2011 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes
- G2012 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion