AUC Medical Code Technical Advisory Group (MCT) Thursday, March 9, :00 a.m. to 12:00 p.m.

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1 AUC Medical Code Technical Advisory Group (MCT) Thursday, March 9, :00 a.m. to 12:00 p.m. HealthPartners, 8170 Building, Bloomington, St. Croix 1 st floor AGENDA WebEx Information 1. To start the WebEx session, go to: 2. Under Attend a Session click Live Sessions 3. Click on the session for AUC Medical Code TAG 4. Provide your name, address, and the following password: Mct2010! 5. Click Join now Teleconference Information Call-in line: Participant Access Code: ** Callers are responsible for any long distance charges ** Page 1 of 4

2 AGENDA 1. Welcome and Introductions Attendance tracking: Deb Sorg Membership request and/or updates: Deb Sorg 2. Review of Antitrust Statement 3. Review of last meeting s minutes February 9, Telemedicine JoAnne Wolf, Children s Health Network The expanded telemedicine benefit is a legislated benefit effective for state public programs 1/1/16 and then is effective for commercial plans on 1/1/17. I think we need to make sure we have some coding guidelines for this service or if using the telemedicine modifiers on an E/M would work. POS might be an issue though since the patient could be located anywhere (home, work, etc.) not just at a host facility. 9/8/16 Questions raised regarding newly legislated benefits expanded so that now patients can be anywhere and services performed will be HIPAA compliant. How to report services? What HCPCS or CPT codes are to be used? DHS requires attestation for all of its state public programs. Will attestation be implemented by all commercial plans by January 1, 2017? It was agreed that guidance is needed. Researched place of service for telehealth (POS); and found there is nothing available that addresses telehealth services being provided at a patient s home. POS for telehealth being proposed by CMS addresses typical telemedicine not Skype type visits or e-visits. Issue to be resolved is billing for online video consult. Need to define visit type e-visit or video. Issues regarding privacy of Skype/electronically provided services. Issues need to see CMS policy, to include POS to determine how it fits under Minnesota s telemedicine policy. AUC, what is Medicare policy; do we want a state policy different from Medicare benefit. How does MN differ from Medicare? Should there be a different MN rule. Also consider AMA website The TAG decided to consider the national guidelines being proposed by CMS and the AMA and then determine Minnesota s position, i.e., to follow Medicare or to develop a Minnesota rule. MCT will also review AMA s website to determine what information available regarding telemedicine/telehealth and include in discussion. The TAG will meet after the national guidelines have been published on Thursday, December 1, 2016 from 9:30 am to 11:30 a.m. 2 nd Floor, Cedar Room. OPEN Pending info from CMS/AMA. SBAR may be needed. Page 2 of 4

3 10/1/16 Deb reported the AMA has added a new symbol, a star, which denotes all services that can be used for telemedicine services: mental health; E&M, including inpatient E&M; diagnostic service; nutrition; etc. AMA is also proposing a new modifier 95 for telehealth/telemedicine. MCT members attending the CPT symposium will provide update to TAG. Faith will allow extra time for the discussion. OPEN 12/1/16 After much discussions and review of Medicare guides, for Medicare, the new place of service 02 pulls a facility payment. The coding still includes reporting the originating site code Q3014 with the appropriate place of service; however, where the patient received services is reported with place of service 02 and the GT (or GQ) modifier. The intent of the new modifier 95 is the same as GT. Because these guides are accepted Medicare guides, nothing needs to be added to the Guides. There is still question on other types of telemedicine and the need to develop a policy. Included would be reporting the place of service based on patient or provider location. Kathy Sijan volunteered to obtain additional information from the AMA. 2/9/17 Dave Haugen researched Medicare and state laws and put together a white paper. There are three sets of statutes. Most are the same with some differences. The need for a modifier is consistent; however, modifier may differ. There is no mention of place of service or practitioner in any policy. However, it is assumed that the 02 place of service is for distance site. Also an attestation is required for Medicaid claims. Dave also put together a power point for a WEDI webinar and will share with the MCT. Because these guides are accepted Medicare guides, nothing needs to be added to the Guides, JoAnne Wolf will present a policy to consider. OPEN 5. Decision Tree Creation Reminder Judy Edwards, MDH TAG members need to create a decision tree for SBARs and present for discussion and approval. 9/8/16 Judy reminded the MCT that members were asked to come up with their version of a decision tree to be reviewed by the TAG at a future meeting. To date, Faith has not received any proposed decision trees from anyone. Medical Code TAG members are requested to submit their version of a decision tree to Judy and Faith prior to the October meeting so they can be incorporated into one document. The next meeting is October 13; decision tree forms are due to Faith and Judy by end of day on Thursday, October 6. OPEN Page 3 of 4

4 10/13/16 Judy reported that two proposed decision trees had been submitted; recommendations that no changes in the current decision tree form was needed. The TAG edited one of the submitted drafts and asked that copies of the proposed decision trees be forwarded to them for their review prior to the next meeting. Judy will incorporate flip chart illustration to decision tree form and forward to TAG along with other drafts. Faith will send to TAG members. OPEN 12/1/16 Not discussed. 2/9/17 The decision tree were intended as a tool to help with deciding the direction of a proposed SBAR (Medicare, DHS, Commercial impact, etc.); however, most decision trees are not completed. Instead of a separate decision tree, can we enhance the SBAR will some of the information found on the decision tree? A mockup will be done. OPEN 6. CEMT provider type legislation Shawnet Healy 2/9/17 Waiting. 7. Additional Agenda Items/ Announcements Next scheduled meeting: April 13, 9:00-12:00, St. Croix 1st floor, HealthPartners, 8170 Building, Bloomington. Reminder: AUC UPDATE newsletter coding article volunteers needed. Page 4 of 4

5 AUC Medical Code Technical Advisory Group (MCT) Thursday, February 9, 2017 MINUTES 1. Welcome and Introductions Attendance tracking: Deb Sorg Membership request and/or updates: Deb Sorg Faith called for introductions and reminded everyone to forward updates and membership requests to Deb Sorg. She also instructed those participating by phone to their attendance to Deb. CLOSED 2. Review of Antitrust Statement Faith read AUC anti-trust statement. CLOSED 3. Review of last meeting s minutes December 1, 2016 The minutes were approved. CLOSED 4. Telemedicine JoAnne Wolf, Children s Health Network Dave Haugen researched Medicare and state laws and put together a white paper. There are three sets of statutes. Most are the same with some differences. The need for a modifier is consistent; however, modifier may differ. There is no mention of place of service or practitioner in any policy. However, it is assumed that the 02 place of service is for distance site. Also an attestation is required for Medicaid claims. Dave also put together a power point for a WEDI webinar and will share with the MCT. Page 1 of 3

6 JoAnne Wolf will present a policy to consider. OPEN 5. Decision Tree Creation Reminder Judy Edwards, MDH The decision tree were intended as a tool to help with deciding the direction of a proposed SBAR (Medicare, DHS, Commercial impact, etc.); however, most decision trees are not completed. Instead of a separate decision tree, can we enhance the SBAR will some of the information found on the decision tree? A mockup will be done. OPEN 6. CEMT Provider Type Legislation Shawnet Healy Waiting. OPEN 7. G0500 acceptance and approved POS Chris Beckman Mayo Clinic This is a Medical Assistance issue only. Examples should be sent to DHS. There is no indication that this problem is specific to any POS. CLOSED 8. Recent DHS Changes Dave Haugen Dave discussed the upcoming DHS changes for CLOSED 9. Additional Agenda Items/ Announcements Dave Haugen discussed the proposed consideration of removing DHS specific guides in the companion guides and point to the DHS website. Other payer comments include that this will affect commercial involvement with the MSHO members and it may cause contracting differences. It was noted that there are additional DHS guides within the body of the Appendix A of the guide. Faith Bauer noted that the AMA has developed new coding. The first of the codes are effective February 1, Following is the information on the new coding. The American Medical Association (AMA) is releasing PLA (Proprietary Laboratory Analyses) codes on a different quarterly basis. Proprietary Laboratory Analyses (PLA) codes describe proprietary clinical laboratory analyses and can be either provided by a single ( sole-source ) laboratory or licensed or marketed to multiple providing laboratories (eg, cleared or approved by the Food and Drug Administration (FDA). Page 2 of 3

7 Below is some information on this new coding. You will also notice that the new codes are numeric/alpha and end with the letter U. There is a new set of molecular pathology test codes that the AMA is calling Proprietary Laboratory Analyses (PLA) codes. These are codes that are being developed by the AMA in compliance with the Protecting Access to Medicare Act of 2014 otherwise known as PAMA. In order to have CPT codes rather than HCPCS G codes for these tests, CPT had to initiate a more timely code review process and release calendar. There will be new PLA codes released quarterly this is the schedule for the coming year: the fall codes were released 12/1 and become effective 2/1, the winter codes will be released 3/1 and become effective 5/1, the spring codes will be released 6/1 and be effective 8/1 and the summer codes will be released 8/31 and become effective 11/1. The AMA recently released three of these new codes that are effective 2/1/17. Next scheduled meeting: March 9, 2017, 9:00-12:00, St. Croix 1st floor, HealthPartners, 8170 Building, Bloomington Reminder: AUC UPDATE newsletter coding article volunteers needed. CLOSED Page 3 of 3

8 AUC BUSINESS NEED EXPLANATION FORM (SBAR) After completing sections I and II, submit to the AUC inbox at health.auc@state.mn.us. Section III (Medical Code TAG Decision Tree) must be completed for medical coding issues. It is recommended that the Decision Tree be completed first. Section IV to be completed by the Department of Health. Section I General Information All fields must be completed. Incomplete forms will be returned to the submitter. SBAR Information SBAR Title: Telemedicine/Telehealth Version #: Date Submitted to AUC: 11/16/16 Contact Information for person completing this form Name: JoAnne Wolf Title: Coding Manager address: joanne.wolf@childrensmn.org Telephone: Organization Information Name: Children's Health Network Address: 910 E 26 th Street, Suite 330, Minneapolis, MN SBAR presenter (if different from above) The SBAR presenter must be in attendance or available during the meeting(s) for the SBAR to be discussed. Name: Title: Same as above address: Phone number: Page 1 of 5

9 SBAR Title: Telemedicine/Telehealth Section II SBAR Information Concise and specific description of the issue to be addressed. All fields must be completed before the SBAR will receive consideration. SITUATION Describe the problem or issue to be addressed (What is the current business practice?): There does not appear to be a coding scenario to report telemedicine/telehealth services in which a HIPAAcompliant skype type of service is performed. In these situations, the patient is not at a host site, but could be anywhere (home, office, school, etc.). The traditional telemedicine services are reported by both the consultant and the host site. The coding rules around this type of telemedicine are published and clear. There are specific rules around coding (modifier use, place of service and CPT/HCPCS code(s) reported). Likewise there are published rules around other types of telemedicine such as telephone calls and e-visits. The previously published coding rules for these types of telemedicine do not seem to fit or seem adequate for the reporting of the new emerging types of telemedicine. BACKGROUND Explain the pertinent history of the business practice (How does this work today?): Telemedicine or telehealth encompasses several types of service including telephone calls, e-visits and traditional telemedicine (patient is at a host facility and consultant is at a distant site). However, there are other types of telemedicine that are emerging such as a HIPAA compliant Skype type of visit. The coding rules around the traditional telemedicine services do not fit for this service. Traditional telemedicine involves the billing of HCPCS code Q3014 by the host site and the consultant billing the CPT that would describe the service as if the consultant was with the patient. Example: If the patient was in a host site that was an outpatient hospital, the POS billed would be 22 (patient location) and the CPT code used would represent an outpatient E/M (eg, 99203) billed with modifier GT or GQ. ASSESSMENT Summarize your analysis of this issue (What are the challenges? Who does it impact? How does it apply to the AUC? Any standards that might help address the situation?): Telemedicine services have a legislated mandated benefit beginning in 2017, which includes commercial plans New types of telemedicine services are emerging including the HIPAA compliant Skype type of visits Clinics and other organizations are beginning to utilize these alternative ways of delivering healthcare Other considerations: New place of service code for telemedicine services (02) Page 2 of 5

10 New Appendix P and CPT codes with a start symbol in CPT 2017 indicating CPT codes that may be used for synchronous telemedicine services RECOMMENDATION Provide your recommendation (Including any known timing that needs to be considered): I recommend that the providers and health plans in the state of MN review the appropriate coding for emerging types of telemedicine (specifically the Skype type of visit) including appropriate CPT/HCPCS code, modifier and place of service. Page 3 of 5

11 SBAR Title: Telemedicine/Telehealth Section III Medical Code TAG Decision Tree 1. Does Medicare apply and there are no other concerns? Yes - STOP - do not submit an SBAR, follow Medicare No - continue 2. Do the HCPCS/CPT code and/or guides apply and address the issue? Yes - STOP - do not submit an SBAR, follow HCPCS/CPT guides No - continue 3. Does the issue apply to more than one payer? Yes - submit the SBAR continue to determine what information needs to be included No - STOP - do not submit an SBAR, contact the payer 4. Identify the claim format. What needs to be included? a. 837P (professional) HCPCS/CPT: Modifier: Place of Service: b. 837I (institutional) Inpatient Revenue Code: Outpatient Revenue Code: HCPCS/CPT: Modifier: Page 4 of 5

12 SBAR Title: Telemedicine/Telehealth Section IV AUC Response Response Information Date Received: Log No.: Date Closed: Date Sent to AUC Executive Committee: Date Sent to AUC TAG Co-chair(s): TAG Recommendation Accept Reject Date [SBAR Response Approved by TAG]: Reviewed by [AUC TAG Name]: AUC Co-Chair(s): Discussion/Summary Key Findings and Recommendation(s): Disposition status: Decision Summary AUC Response Accept Reject AUC Approval Date: Date Decision Sent to Originator: Page 5 of 5

13 AUC BUSINESS NEED EXPLANATION FORM (SBAR) After completing sections I and II, submit to the AUC inbox at health.auc@state.mn.us. Section III (Medical Code TAG Decision Tree) must be completed for medical coding issues. It is recommended that the Decision Tree be completed first. Section IV to be completed by the Department of Health. Section I General Information All fields must be completed. Incomplete forms will be returned to the submitter. SBAR Information SBAR Title: Version #: Date Submitted to AUC: Contact Information for person completing this form Name: Title: address: Telephone: Organization Information Name: Address: SBAR presenter (if different from above) The SBAR presenter must be in attendance or available during the meeting(s) for the SBAR to be discussed. Name: Title: Same as above address: Phone number: Page 1 of 4

14 SBAR Title: Section II SBAR Information Concise and specific description of the issue to be addressed. All fields must be completed before the SBAR will receive consideration. SITUATION Describe the problem or issue to be addressed (What is the current business practice?): BACKGROUND Explain the pertinent history of the business practice (How does this work today?): ASSESSMENT Summarize your analysis of this issue (What are the challenges? Who does it impact? How does it apply to the AUC? Any standards that might help address the situation?): RECOMMENDATION Provide your recommendation (Including any known timing that needs to be considered): Page 2 of 4

15 SBAR Title: Section III Medical Code TAG Decision Tree 1. Does Medicare apply and there are no other concerns? Yes - STOP - do not submit an SBAR, follow Medicare No - continue 2. Do the HCPCS/CPT code and/or guides apply and address the issue? Yes - STOP - do not submit an SBAR, follow HCPCS/CPT guides No - continue 3. Does the issue apply to more than one payer? Yes - submit the SBAR continue to determine what information needs to be included No - STOP - do not submit an SBAR, contact the payer 4. Identify the claim format. What needs to be included? a. 837P (professional) HCPCS/CPT: Modifier: Place of Service: b. 837I (institutional) Inpatient Revenue Code: Outpatient Revenue Code: HCPCS/CPT: Modifier: Page 3 of 4

16 SBAR Title: Section IV AUC Response Response Information Date Received: Log No.: Date Closed: Date Sent to AUC Executive Committee: Date Sent to AUC TAG Co-chair(s): TAG Recommendation Accept Reject Date [SBAR Response Approved by TAG]: Reviewed by [AUC TAG Name]: AUC Co-Chair(s): Discussion/Summary Key Findings and Recommendation(s): Disposition status: Decision Summary AUC Response Accept Reject AUC Approval Date: Date Decision Sent to Originator: Page 4 of 4

17 AUC BUSINESS NEED EXPLANATION FORM (SBAR) After completing sections I and II, submit to the AUC inbox at health.auc@state.mn.us. Section III (Medical Code TAG Decision Tree) must be completed for medical coding issues. It is recommended that the Decision Tree be completed first. Section IV to be completed by the Department of Health. Section I General Information All fields must be completed. Incomplete forms will be returned to the submitter. SBAR Information SBAR Title: CEMT Provider Type Legislation Version #: 6 Date Submitted to AUC: 12/12/6 Contact Information for person completing this form Name: Shawnet Healy Title: MN DHS Benefit Policy Specialist address: shawnet.healy@state.mn.us Telephone: Organization Information Name: MN DHS - Andersen Building Address: 540 Cedar Street, St. Paul, MN SBAR presenter (if different from above) The SBAR presenter must be in attendance or available during the meeting(s) for the SBAR to be discussed. Name: Title: Same as above address: Phone number: Page 1 of 6

18 SBAR Title: CEMT Provider Type Legislation Section II SBAR Information Concise and specific description of the issue to be addressed. All fields must be completed before the SBAR will receive consideration. SITUATION Describe the problem or issue to be addressed (What is the current business practice?): Minnesota Statutes, section 256B.0625 was amended to authorize community emergency medical technician as a new provider type to provide services when ordered by a treating physician ; 1) post-hospital discharge visits 2) safety evaluation visits - These are to an individual who has repeat ambulance calls due to falls, has been discharged from a nursing home, or has been identified by the individual s primary care provider as at risk for nursing home placement when ordered by a primary care provider and documented in the individual s care plan. These services are provided to patients covered by medical assistance. BACKGROUND Explain the pertinent history of the business practice (How does this work today?): The commissioner of human services, in consultation with representatives of emergency medical service providers, public health nurses, community health workers, the Minnesota State Fire Chiefs Association, the Minnesota Professional Firefighters Association, the Minnesota State Firefighters Department Association, Minnesota Academy of Family Physicians, Minnesota Licensed Practical Nurses Association, Minnesota Nurses Association, and local public health agencies, shall determine specified services and payment rates for these services to be performed by community medical response emergency medical technicians certified under Minnesota Statutes, section 144E.275, subdivision 7, and covered by medical assistance under Minnesota Statutes, section 256B Services must be in the CEMT skill set and may include interventions intended to prevent avoidable ambulance transportation or hospital emergency department use. CEMTs provide services to hospital discharge patients, nursing home discharges or repeated ambulance calls. For hospital discharges: The patient s physician (hospitalist or primary care) orders the post-hospital discharge visit. The visit is included in the patient s care plan. Included components: Page 2 of 6

19 Provide verbal or visual reminders of discharge orders Recording and reporting of vital signs to the patient s primary care provider Medication access confirmation Food access confirmation Identification of home hazards For nursing home discharges or repeated fall calls- Primary care would coordinate and be responsible for the treatment plan ordering the CEMT services. Circumstances that may trigger a safety evaluation visit: o o o Repeat ambulance calls due to falls Nursing home discharges Individuals identified by primary care as at risk for nursing home placement Included components: o o o Medication access confirmation Food access confirmation Identification of home hazards Community Emergency Medical Technician Services II. Legislation Minnesota Session Laws 2015, Chapter 71, Article 9, Sec. 18. COMMUNITY MEDICAL RESPONSE EMERGENCY MEDICAL TECHNICIAN SERVICES COVERED UNDER THE MEDICAL ASSISTANCE PROGRAM. Minnesota Statutes 256B.0625 subd 60a Community Emergency Medical Technician Services Minnesota Statutes 144E.275 subd. 7 Medical Response Unit Registration Minnesota Statutes 144E.001 subd. 5h, Definitions ASSESSMENT Summarize your analysis of this issue (What are the challenges? Who does it impact? How does it apply to the AUC? Any standards that might help address the situation?): Currently there is no provider type to do these home visits post hospital discharge, or when someone is returning home from a nursing home, or when someone has had repeated home calls by paramedics/ambulance services for falls and a safe home check is needed. Pilot program in St. Louis Park that included 4 other communities was very successful in reducing readmits. Page 3 of 6

20 This provider type is to assist in reducing readmission and it is working. This is addressing the first hours post discharge to go over the discharge orders from the primary provider, confirm the recipient has the necessary meds, their food supply is checked and the home is safe. This will be billed by the medical director for the ambulance service in units of 15 minutes. A CEMT must use at least eight minutes of a unit in order to bill it. RECOMMENDATION Provide your recommendation (Including any known timing that needs to be considered): DHS is recommending T1016, with two specific modifiers to denote; 1] a CEMT post hospital visit or 2] a safety evaluation visit. These visits are usually completed within a 30 minute visit and are billed in units of 15 minutes. To qualify for 15 minutes, the visit must be documented that eight or more minutes was performed. The effective date is or upon federal approval, whichever is later. Recommending this be in the MUCG, 837P --> DHS has this coding scenario ready for 1/1/17: CODE Mod1 T1016 U4 - case management, per 15 minutes, CEMT post-hospital discharge visit T1016 U5 case management, per 15 minutes, CEMT safety evaluation visit Page 4 of 6

21 SBAR Title: CEMT Provider Type Legislation Section III Medical Code TAG Decision Tree 1. Does Medicare apply and there are no other concerns? Yes - STOP - do not submit an SBAR, follow Medicare No - continue 2. Do the HCPCS/CPT code and/or guides apply and address the issue? Yes - STOP - do not submit an SBAR, follow HCPCS/CPT guides No - continue 3. Does the issue apply to more than one payer? Yes - submit the SBAR continue to determine what information needs to be included No - STOP - do not submit an SBAR, contact the payer 4. Identify the claim format. What needs to be included? a. 837P (professional) HCPCS/CPT: Modifier: Place of Service: b. 837I (institutional) Inpatient Revenue Code: Outpatient Revenue Code: HCPCS/CPT: Modifier: Page 5 of 6

22 SBAR Title: CEMT Provider Type Legislation Section IV AUC Response Response Information Date Received: July 15, 2016 Log No.: 082 Date Closed: Date Sent to AUC Executive Committee: July 21, 2016 Date Sent to AUC TAG Co-chair(s): July 21, 2016 TAG Recommendation Accept Reject Date [SBAR Response Approved by TAG]: Reviewed by [AUC TAG Name]: AUC Co-Chair(s): Discussion/Summary Key Findings and Recommendation(s): Disposition status: Decision Summary AUC Response Accept Reject AUC Approval Date: Date Decision Sent to Originator: Page 6 of 6

23 HF106 FIRST ENGROSSMENT This Document can be made available in alternative formats upon request 01/09/ /30/ /01/2017 REVISOR ACF H State of Minnesota Printed Page No. HOUSE OF REPRESENTATIVES 106 NINETIETH SESSION H. F. No. Authored by Zerwas and Dean, M., The bill was read for the first time and referred to the Committee on Health and Human Services Reform Adoption of Report: Amended and re-referred to the Committee on Health and Human Services Finance Adoption of Report: Placed on the General Register Read for the Second Time A bill for an act 1.2 relating to human services; modifying criteria for community medical response 1.3 emergency medical technician services; amending Minnesota Statutes 2016, section B.0625, subdivision 60a. 1.5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.6 Section 1. Minnesota Statutes 2016, section 256B.0625, subdivision 60a, is amended to 1.7 read: 1.8 Subd. 60a. Community medical response emergency medical technician services. 1.9 (a) Medical assistance covers services provided by a community medical response emergency 1.10 medical technician (CEMT) who is certified under section 144E.275, subdivision 7, when 1.11 the services are provided in accordance with this subdivision (b) A CEMT may provide a posthospital discharge postdischarge visit, after discharge 1.13 from a hospital or skilled nursing facility, when ordered by a treating physician. The 1.14 posthospital discharge postdischarge visit includes: 1.15 (1) verbal or visual reminders of discharge orders; 1.16 (2) recording and reporting of vital signs to the patient's primary care provider; 1.17 (3) medication access confirmation; 1.18 (4) food access confirmation; and 1.19 (5) identification of home hazards (c) An individual who has repeat ambulance calls due to falls, has been discharged from 1.21 a nursing home, or has been identified by the individual's primary care provider as at risk 1.22 for nursing home placement, may receive a safety evaluation visit from a CEMT when Section 1. 1

24 HF106 FIRST ENGROSSMENT REVISOR ACF H ordered by a primary care provider in accordance with the individual's care plan. A safety 2.2 evaluation visit includes: 2.3 (1) medication access confirmation; 2.4 (2) food access confirmation; and 2.5 (3) identification of home hazards. 2.6 (d) A CEMT shall be paid at $9.75 per 15-minute increment. A safety evaluation visit 2.7 may not be billed for the same day as a posthospital discharge postdischarge visit for the 2.8 same individual. Section 1. 2