{"id":12351,"date":"2024-07-10T12:15:42","date_gmt":"2024-07-10T12:15:42","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=12351"},"modified":"2024-07-10T12:15:42","modified_gmt":"2024-07-10T12:15:42","slug":"prior-authorization-medical-billing-cpt","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/prior-authorization-medical-billing-cpt\/","title":{"rendered":"Prior Authorization and CPT Codes | Recent Changes in Medical Billing"},"content":{"rendered":"\r\n<div id=\"rank-math-toc\" class=\"wp-block-rank-math-toc-block has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\"><nav>\r\n<ul>\r\n<li><a href=\"#original-proposal-by-dr-shteynshlyuger\">Original Proposal by Dr. Shteynshlyuger<\/a><\/li>\r\n<li><a href=\"#am-as-response-and-proposal-retraction\">AMA&#8217;s Response and Proposal Retraction<\/a><\/li>\r\n<li><a href=\"#cpt-code-descriptions-and-prior-authorization\">CPT Code Descriptions and Prior Authorization<\/a><\/li>\r\n<li><a href=\"#am-as-cpt-changes-and-information-dissemination\">AMA&#8217;s CPT Changes and Information Dissemination<\/a><\/li>\r\n<li><a href=\"#billing-for-prior-authorization\">Billing for Prior Authorization<\/a><\/li>\r\n<li><a href=\"#future-plans-and-ama-updates\">Future Plans and AMA Updates<\/a><\/li>\r\n<li><a href=\"#am-as-support-for-physicians\">AMA&#8217;s Support for Physicians<\/a><\/li>\r\n<li><a href=\"#upcoming-resources-from-ama\">Upcoming Resources from AMA<\/a><\/li>\r\n<li><a href=\"#fa-qs\">FAQs<\/a>\r\n<ul>\r\n<li><a href=\"#1-how-are-cpt-codes-being-updated-to-reflect-prior-authorization-requirements\">1. How are CPT codes being updated to reflect prior authorization requirements?<\/a><\/li>\r\n<li><a href=\"#2-why-was-a-recent-proposal-regarding-cpt-codes-and-prior-authorization-retracted\">2. Why was a recent proposal regarding CPT codes and prior authorization retracted?<\/a><\/li>\r\n<li><a href=\"#3-how-is-the-ama-helping-physicians-adapt-to-changes-in-cpt-codes-related-to-prior-authorization\">3. How is the AMA helping physicians adapt to changes in CPT codes related to prior authorization?<\/a><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/nav><\/div>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">A recent suggestion to inform insurance plans about <\/span><a href=\"https:\/\/distilinfo.com\/healthplan\/prior-authorization-into-a-cpt-code\/\"><b>prior authorization<\/b><span style=\"font-weight: 400;\"> using CPT codes<\/span><\/a><span style=\"font-weight: 400;\"> was retracted last minute by its physician advocate after discovering that some <\/span><b>medical coding<\/b><span style=\"font-weight: 400;\"> already had prior authorization requirements in specific situations.<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"original-proposal-by-dr-shteynshlyuger\" class=\"wp-block-heading\"><b>Original Proposal by Dr. Shteynshlyuger<\/b><\/h2>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">Alex Shteynshlyuger, M.D., head of urology at New York Urology Specialists, had previously presented a plan based on time to make sure doctors are paid for time spent on <\/span><b>prior authorization<\/b><span style=\"font-weight: 400;\"> claims. He thought that the alterations would also decrease the quantity of <\/span><b>insurance claims<\/b><span style=\"font-weight: 400;\"> stipulations dictated by <\/span><b>healthcare policy<\/b><span style=\"font-weight: 400;\"> and restrict the number of appeals, which could result in improved patient results.<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"am-as-response-and-proposal-retraction\" class=\"wp-block-heading\"><b>AMA&#8217;s Response and Proposal Retraction<\/b><\/h2>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">After receiving the suggestion, the <\/span><a href=\"https:\/\/www.ama-assn.org\/practice-management\/prior-authorization\/prior-authorization\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">American Medical Association (AMA)<\/span><\/a><span style=\"font-weight: 400;\"> told Shteynshlyuger that <\/span><b>prior authorization<\/b><span style=\"font-weight: 400;\"> is clearly stated in official descriptions for six <\/span><b>medical codes<\/b><span style=\"font-weight: 400;\">. Shteynshlyuger had to retract the <\/span><b>physician services<\/b><span style=\"font-weight: 400;\"> proposal to make revisions and resubmit it at a later time.<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"cpt-code-descriptions-and-prior-authorization\" class=\"wp-block-heading\"><b>CPT Code Descriptions and Prior Authorization<\/b><\/h2>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">Every CPT code comes with a brief explanation of the visit or examination type. Extended descriptions found in <\/span><b>authorization<\/b><span style=\"font-weight: 400;\"> documents are also saved in databases available for purchase, although they are not frequently encountered.<\/span><\/p>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">&#8220;I have never seen a long description in my entire life,&#8221; remarked Shteynshlyuger.<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"am-as-cpt-changes-and-information-dissemination\" class=\"wp-block-heading\"><b>AMA&#8217;s CPT Changes and Information Dissemination<\/b><\/h2>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">Every year, the AMA releases a CPT Changes book detailing the changes made in the previous year. The company also offers an online data management system, and providers can collaborate with organizations such as Optum which are regularly updated with the latest changes. However, the majority of doctors are unaware of how to find or would not consider searching for <\/span><b>authorization<\/b><span style=\"font-weight: 400;\"> information in those descriptions.<\/span><\/p>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">The AMA allowed Shteynshlyuger to share them with the press. Short descriptions do not refer to <\/span><b>prior authorization<\/b><span style=\"font-weight: 400;\">, unlike their inclusion in the longer descriptions.<\/span><\/p>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">He stated that the AMA CPT panel had recently updated the detailed description of the CPT codes for <\/span><b>medical procedures<\/b><span style=\"font-weight: 400;\"> and quietly included <\/span><b>prior authorization<\/b><span style=\"font-weight: 400;\"> in it. &#8220;I don&#8217;t know why physicians have not been informed yet.&#8221;<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"billing-for-prior-authorization\" class=\"wp-block-heading\"><b>Billing for Prior Authorization<\/b><\/h2>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">Billing for <\/span><b>prior authorization<\/b><span style=\"font-weight: 400;\"> is only applicable in specific situations under these CPT codes. In these situations, the codes specifically focus on same-day evaluation management appointments and the amount of time a physician spends finalizing the <\/span><b>insurance claims<\/b><span style=\"font-weight: 400;\">. Billing done by <\/span><b>prior authorization<\/b><span style=\"font-weight: 400;\"> specialists or medical assistants will not be considered.<\/span><\/p>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">If all of these criteria are fulfilled, the <\/span><b>reimbursement process<\/b><span style=\"font-weight: 400;\"> of all the health insurance policies must adhere to the instructions.<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"future-plans-and-ama-updates\" class=\"wp-block-heading\"><b>Future Plans and AMA Updates<\/b><\/h2>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">Shteynshlyuger plans to resubmit his proposal with &#8220;dedicated codes&#8221; as per the <\/span><b>healthcare regulations<\/b><span style=\"font-weight: 400;\">. Once they are prepared due to numerous instances where CPT codes are not suitable for reimbursing physicians. Furthermore, CPT codes enable a more detailed examination of the impact of <\/span><b>prior authorization<\/b><span style=\"font-weight: 400;\">, ultimately enhancing the delivery of healthcare over time. In its CPT handbook for 2021, the AMA updated the codes and guidelines for <\/span><b>pre-approval<\/b><span style=\"font-weight: 400;\"> of outpatient evaluation and management services.<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"am-as-support-for-physicians\" class=\"wp-block-heading\"><b>AMA&#8217;s Support for Physicians<\/b><\/h2>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">In a news release, the president of the AMA, Dr. Susan Bailey, said that the AMA is aiding doctors and healthcare groups in getting ready for the upcoming transition by providing reliable resources for forecasting the changes in operational, infrastructural, and administrative workflows.<\/span><\/p>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">AMA members can also utilize <\/span><b>medical coding<\/b><span style=\"font-weight: 400;\"> for assistance with coding and billing inquiries. It aids clinicians in challenging <\/span><b>insurance claims<\/b><span style=\"font-weight: 400;\"> and answering other daily inquiries.<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"upcoming-resources-from-ama\" class=\"wp-block-heading\"><b>Upcoming Resources from AMA<\/b><\/h2>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">The organization in the recent proposal stated that the upcoming statements will be released on its website to assist physicians and coders. This will help them comprehend evaluation and management office visit codes when reporting work related to <\/span><b>authorization<\/b><span style=\"font-weight: 400;\"> requirements with the help of the CPT Assistant.<\/span><\/p>\r\n\r\n\r\n\r\n<p><span style=\"font-weight: 400;\">Looking for a reliable platform that can provide <\/span><b>medical updates <\/b><span style=\"font-weight: 400;\">in the <\/span><b>healthcare sector<\/b><span style=\"font-weight: 400;\">? Discover the latest <\/span><a href=\"https:\/\/distilinfo.com\/healthplan\/\"><b>payers&#8217; news updates<\/b><\/a><span style=\"font-weight: 400;\"> with a single click. Follow DistilINFO HealthPlan and stay ahead with the timely payer&#8217;s news updates. Join our community today!<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"fa-qs\" class=\"wp-block-heading\"><b>FAQs<\/b><\/h2>\r\n\r\n\r\n\r\n<h4 id=\"1-how-are-cpt-codes-being-updated-to-reflect-prior-authorization-requirements\" class=\"wp-block-heading\"><b>1. How are CPT codes being updated to reflect prior authorization requirements?<\/b><\/h4>\r\n\r\n\r\n\r\n<p><b>Ans:<\/b> Some CPT codes now include prior authorization in their detailed descriptions, particularly for same-day evaluation management appointments and physician time spent on insurance claims.<br \/><b><\/b><\/p>\r\n\r\n\r\n\r\n<h4 id=\"2-why-was-a-recent-proposal-regarding-cpt-codes-and-prior-authorization-retracted\" class=\"wp-block-heading\"><b>2. Why was a recent proposal regarding CPT codes and prior authorization retracted?<\/b><\/h4>\r\n\r\n\r\n\r\n<p><b>Ans:<\/b> The proposal was retracted when it was discovered that prior authorization was already included in official descriptions for six medical codes, necessitating revisions to the plan.<br \/><b><\/b><\/p>\r\n\r\n\r\n\r\n<h4 id=\"3-how-is-the-ama-helping-physicians-adapt-to-changes-in-cpt-codes-related-to-prior-authorization\" class=\"wp-block-heading\"><b>3. How is the AMA helping physicians adapt to changes in CPT codes related to prior authorization?<\/b><\/h4>\r\n\r\n\r\n\r\n<p><b>Ans:<\/b> The AMA is providing resources to help physicians prepare for the transition, including updates to the CPT handbook and plans to release statements on their website to assist with understanding new evaluation and management office visit codes.<br \/><b><\/b><\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>A recent suggestion to inform insurance plans about prior authorization using CPT codes was retracted last minute by its physician&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/prior-authorization-medical-billing-cpt\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":12352,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[228],"class_list":{"0":"post-12351","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"tag-prior-authorization","9":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12351"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=12351"}],"version-history":[{"count":4,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12351\/revisions"}],"predecessor-version":[{"id":12356,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12351\/revisions\/12356"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/12352"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=12351"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=12351"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=12351"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}