May 4, 2023
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted:
Drugs Administered in a Physician Office
- Created a new section, codes/coding guidelines, and referenced the policies noted in the cross-reference section of this policy for coding and billing guidelines for NDC codes and drug wastage.
- 2 new resources added.
Manipulation Services
- In the cross-reference section added the global surgery policy.
- In the chiropractic manipulative treatment section added clarification from the CPT codebook that an assessment is considered part of the manipulation procedure code. Also added reference to the CMS National Physician Fee Schedule stating
that the CMT codes are classified as minor procedures.
- The manual therapy section title was changed to Therapeutic Services on the Same Date as CMT, and the section revised for clarity to be more reflective of the actual policy edit.
- In the osteopathic manipulative treatment section, added that an assessment is considered part of the manipulation procedure code. Also added reference to the CMS National Physician Fee Schedule stating that the CMT codes are classified as minor
procedures.
- In the codes/coding guideline section, added a new section titled Physical Medicine and Rehabilitation Therapeutic Services listing the therapeutic service procedure codes.
Modifier 23 – Unusual Anesthesia
- Minor clarification to the fourth paragraph indicating the performing surgeon would append modifier 23 to the main surgical procedure.
Modifier 24 – Unrelated Evaluation & Management Service by the same Physician in the Post-Operative Period
- Deleted two duplicate sub-bullets of examples where modifier 24 is inappropriate.
Multiple Surgical Reductions
- In the add-on surgical procedure section, added the last sentence indicating that if the primary code is denied, the add-on code will also be denied.
Site Specifying Modifiers
- Added a paragraph after the list of site specifying modifiers indicating that only one site specifying modifier should be appended to a procedure code.