Effective Date: August 1, 2017
Implementation Date: January 2, 2018

The influenza virus vaccine code set is updated on a quarterly basis. This update will include one new influenza virus vaccine code: 90756. 
Effective for claims processed with dates of service (DOS) on or after January 1, 2018, 
influenza virus vaccine code 90756 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) will be payable by Medicare. This new code will be included on the 2018 Medicare Physician Fee Schedule Database file update and the annual Healthcare Common Procedure Coding System (HCPCS) update. 

During the interim period of August 1, 2017, through December 31, 2017, Palmetto will use code Q2039 (Influenza virus vaccine, not otherwise specified) to handle bills for this new influenza virus vaccine product (Influenza virus vaccine, quadrivalent (ccIIV4). Q2039 is already an active code.   

E/M  Tip:  Billing Rule

Physicians in the same group practice, but who are in different specialties, may bill and be paid without regard to their membership in the same group. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. 

E/M Tip: History Component 'Unable to Obtain'

If you are unable to obtain the review of systems (ROS) and past, family and social history from the patient/source, the documentation must clearly describe the patient's condition or other circumstance.  

E/M Tip:   Medical Decision Making Complexity

The levels of evaluation and management (E/M) services recognize four types of medical decision making (straightforward, low complexity, moderate complexity and high complexity). Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option as measured by:

   Number of possible diagnoses and/or the number of management options that must be considered

  Amount and/or complexity of medical records, diagnostic tests and/or other information that must be  obtained, reviewed and analyzed

  Risk of significant complications, morbidity and/or mortality, as well as comorbidities, associated with the patient's presenting problem(s), the diagnostic procedure(s) and/or the possible management options

CERT TIP:  Create a Signature Log 

If a provider does not have a signature log currently in place, the provider may create a signature log at any time. Medicare contractors will accept all submitted signature logs regardless of the date on which they were created.

Advanced Care Planning: CPT Codes

Providers are required to make every effort to assist beneficiaries in the completion and execution of the advance care planning process. While the topic may seem daunting to approach, educating beneficiaries on advanced care planning (ACP) allows them the opportunity to be involved in the decision making process.

Although efforts to assist patients with this sometimes uncomfortable topic may be challenging, this article should provide some assistance.

Update on Scribes

A scribe can be a non-physician practitioner (NPP), nurse or other appropriate personnel designated by the physician/NPP to document or dictate on their behalf. A scribe does not have to be an employee of the physician/NPP.

Scribes are not providers of items or services. When a scribe is used by a provider in documenting medical record entries (e.g. progress notes), the Centers for Medicare & Medicaid Services (CMS) does not require the scribe to sign/date the documentation. The treating physician’s/NPP’s signature on a note indicates that the physician/NPP affirms the note adequately documents the care provided.

The Medicare Administrative Contractor is only required to look for the signature (and date) of the treating physician/NPP on the note. Services shall not be denied for items or services because a scribe has not signed/dated a note.

Change to Check Mailing Addresses

Palmetto GBA has reduced the number of addresses used for submitting provider checks to satisfy Medicare debts.  Please immediately begin using the address below to submit payment for any Medicare Debts. All other PO Boxes will be closed.

Part B
PO Box 100246
Columbia, SC 29202

Please note that the new PO Boxes will be reflected on all forms and letters. This will not affect payments being submitted by eCheck.

Providers are strongly encouraged to submit payment electronically using eCheck via Palmetto GBAs eServices.  Providers can electronically submit their payment and PDF attachments online. Once submitted, you will receive a confirmation from Palmetto GBA indicating that the payment has been received.