does medicare cover pcr testing10 marca 2023
No fee schedules, basic unit, relative values or related listings are included in CPT. You can collapse such groups by clicking on the group header to make navigation easier. required field. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. Reporting multiple codes for the same gene will result in claim rejection or denial.Multianalyte Assays with Algorithmic Analyses (MAAAs) and Proprietary Laboratory Analyses (PLA)A valid PLA code takes precedence over Tier 1 and Tier 2 codes and must be reported if available. If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. copied without the express written consent of the AHA. regardless of when your symptoms begin to clear. 9 PCR tests (polymerase chain reaction) tests which are generally sent to a lab, but may also include rapid tests such as . Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. Medicare covers both laboratory tests and rapid tests. MVP covers the cost of COVID-19 testing at no cost share for members who have been exposed to COVID-19, or who have symptoms. Both original Medicare and Medicare Advantage plans cover any testing for the new coronavirus performed on or after February 4,. In addition, medical records may be requested when 81479 is billed. If your test, item or service isn't listed, talk to your doctor or other health care provider. These tests are typically used to check whether you have developed an immune response to COVID-19, due to vaccination or a previous infection. People enrolled in Medicare Advantage plans can continue to receive COVID-19 PCR and antigen tests when the test is covered by Medicare, but their cost-sharing may change when the PHE ends. COVID-19 tests for screening purposes (employment, return to work/school, travel etc) for Essential Plan* and Child Health Plus** members only, will be covered. Yes, Medicare COVID test kits are covered by Part B and all Medicare Advantage plans. Medicare covers the cost of COVID-19 testing or treatment and will cover a vaccine when one becomes available. The answer, however, is a little more complicated. Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917). All rights reserved. Revenue Codes are equally subject to this coverage determination. Be Aware: Pharmacies will usually only take your government-issued Medicare card as payment for these no-cost LFT tests. Copyright 2022Medicare Insurance, DBA of Health Insurance Associates LLC All rights reserved. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. As such, if a provider or supplier submits a claim for a panel, then the patients medical record must reflect that the panel was medically reasonable and necessary. Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-Evaluation and Management (E/M) services performed on the same day. This communications purpose is insurance solicitation. Unless specified in the article, services reported under other look for potential health risks. They are inexpensive, mostly accurate when performed correctly, and produce rapid results. The government suspended its at-home testing program as of September 2, 2022. , and there is no indication if, or when, the distribution of at-home Covid tests will be resumed. While Medicare will cover rapid antigen or PCR testing done by a lab without charging beneficiaries, this does not apply to Covid-19 rapid tests at home. The page could not be loaded. Knowing the very serious risks for older individuals, its reasonable to ask the simple question: Does Medicare cover covid tests? Title XVIII of the Social Security Act, Section 1862 [42 U.S.C. The following CPT code has been deleted from the CPT/HCPCS Codes section for Group 1 Codes: 0097U. The government suspended its at-home testing program as of September 2, 2022, and there is no indication if, or when, the distribution of at-home Covid tests will be resumed. Tests must be purchased on or after Jan. 15, 2022. Reporting of a Tier 1 or Tier 2 code in this circumstance or in addition to a PLA code is incorrect coding and will result in claim rejection or denial.Per CPT, the results of individual component procedure(s) that are inputs to the MAAAs may be provided on the associated reporting, however these assays are not reported separately using additional codes. The views and/or positions Consult your insurance provider for more information. Certain Medicare Advantage providers will cover additional tests beyond the initial eight. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Depending on the reason for the test, your doctor will recommend a specific course of action. Medicare continues to pay for COVID tests that are ordered by healthcare providers and that are performed in a lab. The following CPT codes had short description changes. DISCLOSED HEREIN. Call one of our licensed insurance agents at, Medicare Covers Over-the-Counter COVID-19 Tests | CMS, Coronavirus disease 2019 (COVID-19) diagnostic tests, Participating pharmacies COVID-19 OTC tests| Medicare.gov. This looks like the beginning of a beautiful friendship. Thats why countermeasures like vaccination, masking while traveling, and regular testing are important. Medicare Insurance, DBA of Health Insurance Associates LLC. As such, it isnt useful for diagnosis, as it takes weeks for antibodies to develop. You can explore your Medicare Advantage options by contacting MedicareInsurance.com today. This one has remained influential for decades. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. The medical record from the ordering physician/NPP must clearly indicate all tests that are to be performed. The following CPT codes have had either a long descriptor or short descriptor change. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". All Rights Reserved. 7500 Security Boulevard, Baltimore, MD 21244. It is the providers responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. Please visit the, Chapter 15, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, and Section 280 Preventive and Screening Services, Chapter 16, Section 10 Background, Section 40.8 Date of Service (DOS) for Clinical Laboratory and Pathology Specimens and Section 120.1 Negotiated Rulemaking Implementation, Chapter 18 Preventive and Screening Services, Chapter 3 Verifying Potential Errors and Taking Corrective Actions. Yes, most Fit-to-Fly certificates require a COVID-19 test. Please refer to the CMS IOM Publication 100-04, Chapter 16, Section 40.8 for complete information related to the DOS policy.Documentation Requirements. Also, please sign our petition to give back to those who gave so much during World WWII and Korea. This list only includes tests, items and services that are covered no matter where you live. You do not need an order from a healthcare provider. Medicare coverage for at-home COVID-19 tests. You may be responsible for some or all of the cost related to this test depending on your plan. We will not cover or . Before sharing sensitive information, make sure you're on a federal government site. After taking a nasal swab and treating it with the included solution, the sample is exposed to an absorbent pad, similar to a pregnancy test. The following CPT codes have been added to the CPT/HCPCS Codes section for Group 1 Codes: 81349, 81523, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0296U, 0297U, 0298U, 0299U, 0300U, 0301U, and 0302U. Private health insurers are now required to cover or reimburse the costs of up to eight COVID-19 at-home tests per person per month. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. Pharmacies will usually only take your government-issued Medicare card as payment for these no-cost LFT tests. You'll also have to pay Part A premiums if you or your spouse haven't . an effective method to share Articles that Medicare contractors develop. The AMA does not directly or indirectly practice medicine or dispense medical services. While every effort has been made to provide accurate and Always remember the greatest generation. DISTINCT PROCEDURAL SERVICE: UNDER CERTAIN CIRCUMSTANCES, THE PHYSICIAN MAY NEED TO INDICATE THAT A PROCEDURE OR SERVICE WAS DISTINCT OR INDEPENDENT FROM OTHER SERVICES PERFORMED ON THE SAME DAY. The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The Medicare program provides limited benefits for outpatient prescription drugs. End Users do not act for or on behalf of the CMS. However, you may be asked to take a serology test as part of an epidemiological study, or if you are planning on donating plasma. Are you feeling confused about the benefits and requirements of Medicare and Medicaid? Any questions pertaining to the license or use of the CPT should be addressed to the AMA. Can my ex-husband bar me from his retirement benefits? Code of Federal Regulations (CFR) References: National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services: This Billing and Coding Article provides billing and coding guidance for molecular pathology services, genomic sequencing procedures and other multianalyte assays, multianalyte assays with algorithmic analyses, and applicable proprietary laboratory analyses codes and Tier 1 and Tier 2 molecular pathology procedures. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Failure to include this information on the claim will result in Part A claims being returned to the provider and Part B claims being rejected. Article revised and published on 10/06/2022 effective for dates of service on and after 10/01/2022 to reflect the October Quarterly HCPCS/CPT Code updates. Beyond general illness or injury, if you test positive for COVID-19, or require medical treatment or hospitalization due to the . Such billing was termed stacking with each step of a molecular diagnostic test utilizing a different CPT code to create a Stack. Due to the rapid changes in this field, the CMS Clinical Laboratory Fee Schedule pricing methodology does not account for the unique characteristics of these tests. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. The AMA assumes no liability for data contained or not contained herein. Travel-related COVID-19 Testing. While this is increasingly uncommon thanks to advances in LFTs, Medicare will cover one COVID-19 test, in addition to one related test, without prior medical approval. Most lab tests are covered under Medicare Part B, though tests performed as part of a hospitalization may be covered under Medicare Part A instead. Unlike rapid tests, PCR tests cannot be done at home since they require laboratory testing to identify the presence of viral DNA in the patient sample. The medical records must support the service billed.Molecular pathology tests for diseases or conditions that manifest severe signs or symptoms in newborns and in early childhood or that result in early death (e.g., Canavan disease) are subject to automatic denials since these tests are generally not relevant to a Medicare beneficiary.The following types of tests are examples of services that are not relevant to a Medicare beneficiary, are not considered a Medicare benefit (statutorily excluded), and therefore will be denied as Medicare Excluded Tests: Screening services such as pre-symptomatic genetic tests and services used to detect an undiagnosed disease or disease predisposition are not a Medicare benefit and are not covered.In accordance with the Code of Federal Regulations, Title 42, Subchapter B, Part 410, Section 410.32, the referring/ordering practitioner must have an established relationship with the patient, and the test results must be used by the ordering/referring practitioner in the management of the patients specific medical problem.For ease of reading, the term gene in this document will be used to indicate a gene, region of a gene, and/or variant(s) of a gene.Coding GuidanceNotice: It is not appropriate to bill Medicare for services that are not covered as if they are covered. without the written consent of the AHA. Smart, useful, thought-provoking, and engaging content that helps inform and inspire you when it comes to the aspirations, challenges, and pleasures of this stage of life. At UnitedHealthcare, we're here to help you understand what's covered and how to get care related to COVID-19. The Biden administration's mandate, which took effect Jan. 15, means most consumers with private health coverage can buy an at-home test at a store or online and either get it paid for upfront by . Tier 2 molecular pathology procedure codes (81400-81408) are used to report procedures not listed in the Tier 1 molecular pathology codes (81161, 81200-81383). damages arising out of the use of such information, product, or process. Unfortunately, the covered lab tests are limited to one per year. This is a real problem. The Biden administration is requiring health insurers to cover the cost of home Covid-19 tests for most Americans with private insurance. If you are looking for a Medicare Advantage plan, we can help. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. Medicare also will continue to cover the more precise lab-based PCR tests at no cost, but those must be ordered by a clinician or an authorized health care professional. COVID-19 tests are covered by Medicare Part B and all Medicare Advantage (Medicare Part C) plans. These tests are administered by a professional in a clinical setting, and the sample is sent to a lab for testing. Unfortunately, opportunities to get a no-cost COVID-19 test are dwindling. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Major pharmacies like CVS, Rite-Aid, and Walgreens all participate in the program, as do chains like Walmart and Costco. The following CPT codes have been added to the Article: 0355U, 0356U, 0362U, 0363U, 81418, 81441, 81449, 81451, and 81456 to Group 1 codes. Medicare coverage for many tests, items and services depends on where you live. You should also contact emergency services if you or a loved one: Feels persistent pain or pressure in the chest, Feels confused or disoriented, despite not showing symptoms previously, Has pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone. THE UNITED STATES In most instances Revenue Codes are purely advisory. preparation of this material, or the analysis of information provided in the material. End User Point and Click Amendment: Does Medicare Cover At-Home COVID-19 Tests? Does Medicare cover the coronavirus antibody test? If you begin showing symptoms within ten days of a positive test, you should remain isolated for at least five days following the onset of symptoms. This page displays your requested Article. Call one of our licensed insurance agents at (800) 950-0608 to begin comparing your options. Laboratory Tests (PCR and Serology) Laboratory tests are administered in a clinical setting, and are often used as part of a formal diagnosis. Medicare Advantage plans may offer additional benefits to those affected by COVID-19. CMS took action to . ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, A52986 - Billing and Coding: Biomarkers for Oncology, A56541 - Billing and Coding: Biomarkers Overview, DA59125 - Billing and Coding: Genetic Testing for Oncology. However, providers should still include the ordering information if documented and the FDA requirements for prescriptions and state requirements on ordering tests still apply. The PCR and rapid PCR tests are available for those with or without COVID symptoms. There are three types of coronavirus tests used to detect COVID-19. Regardless of the context, these tests are covered at no cost when recommended by a doctor. Venmo, Cash App and PayPal: Can you really trust your payment app? Be sure to check the requirements of your destination before receiving testing. Any FDA-approved COVID-19 medications will be covered under your Medicare plan if you have enrolled in Medicare Part D. If your doctor prescribes monoclonal antibody treatment on an outpatient basis, this treatment will be covered under your Medicare Part B benefits. If you test positive for COVID-19 using an LFT, and are not showing any symptoms, you should self-isolate immediately. that coverage is not influenced by Bill Type and the article should be assumed to Medicare Home Health Care: What is the Medicare Advantage HouseCalls Program? The medical record must clearly identify the unique molecular pathology procedure performed, its analytic validity and clinical utility, and why CPT code 81479 was billed. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Under Article Text revised the title of the table to read, "Solid Organ Allograft Rejection Tests that meet coverage criteria of policy L38568" and revised the table to add the last row. Tests are offered on a per person, rather than per-household basis. resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; This means there is no copayment or deductible required. Medicare covers diagnostic lab testing for COVID-19 under Part B. Medicare covers. Medicareinsurance.com Is privately owned and operated by Health Insurance Associates LLC. Documentation requirements of the performing laboratory (when requested) include, but are not limited to, lab accreditation, test requisition, test record/procedures, reports (preliminary and final), and quality control record. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be Not sure which Medicare plan works for you? Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). Reproduced with permission. The following CPT codes have had either a long descriptor or short descriptor change. Patients with Medicare Part B plans are still responsible for emergency, urgent care or doctor's office visit fees, even if related to COVID-19. Do you know her name? Call 1-800-Medicare (1-800-633-4227) with any questions about this initiative. THIS MAY REPRESENT A DIFFERENT SESSION OR PATIENT ENCOUNTER, DIFFERENT PROCEDURE OR SURGERY, DIFFERNET SITE OR ORGAN SYSTEM, SEPARATE INCISION/EXCISION, SEPARATE LESION, OR SEPARATE INJURY (OR AREA OF INJURY IN EXTENSIVE INJURIES) NOT ORDINARILY ENCOUNTERED OR PERFORMED ON THE SAME DAY BY THE SAME PHYSICIAN. This is in addition to any days you spent isolated prior to the onset of symptoms. There are three types of COVID-19 tests, all of which are covered by Medicare under various circumstances. Sign up to get the latest information about your choice of CMS topics in your inbox. A positive serology test is not necessarily a cause for concern: it merely indicates past exposure. Per Title 42 of the United States Code (USC) Section 1320c-5(a)(3), providers are required by law to provide economical medical services and then, only where medically necessary. For the rest of the population aged 18 to 65, the rules of common law will now apply, with the reintroduction, for all antigenic tests or PCR, of a co-payment, i.e. Original Medicare will still cover COVID-19 tests performed at a laboratory, pharmacy, doctor's office or hospital. diagnose an illness. A non-government site powered by Health Insurance Associates, LLC., a health insurance agency. . As part of its ongoing efforts across many channels to expand Americans' access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th. The submitted CPT/HCPCS code must describe the service performed. . 1 This applies to Medicare, Medicaid, and private insurers. In addition, the Centers for Medicare and Medicaid Services has directed that Medicare Part B will cover all medically necessary COVID-19 testing only. LFTs are used to diagnose COVID-19 before symptoms appear. Depending on which description is used in this article, there may not be any change in how the code displays: 0022U in the CPT/HCPCS Codes section for Group 1 Codes. If additional variants, for the same gene, are also tested in the analysis they are included in the procedure and are not reported separately.Full gene sequencing is not reported using codes that assess for the presence of gene variants unless the CPT code specifically states full gene sequence in the descriptor.Tier 1 codes generally describe testing for a specific gene or Human Leukocyte Antigen (HLA) locus. All documentation must be maintained in the patient's medical record and made available to the contractor upon request. An official website of the United States government. Nothing stated in this instruction implies or infers coverage.Molecular diagnostic testing and laboratory developed testing are rapidly evolving areas and thus present billing and coding challenges. 7 once-controversial TV episodes that wouldnt cause a stir today, 150 of the most compelling opening lines in literature, 14 facts about I Love Lucy, plus our five other favorite episodes, full coverage for COVID-19 diagnostic tests, Counting on Medicare when you travel overseas can be a risky move. Medicare Part D Plans 2023: How Can I Receive a $0 Copay for Formulary Drugs and Prescription Medications? Article revised and published on 01/20/2022 effective for dates of service on and after 01/01/2022 to reflect the Annual HCPCS/CPT Code Updates. The following CPT codes have been added to the CPT/HCPCS Codes section for Group 1 Codes: 0313U, 0314U and 0315U. . The intent of this billing and coding article is to provide guidance for accurate coding and proper submission of claims.Prior to January 1, 2013, each step of the process of a molecular diagnostic test was billed utilizing a separate CPT code to describe that process. Claims reporting such, will be rejected or denied.Date of Service (DOS)As a general rule, the DOS for either a clinical laboratory test or the technical component of a physician pathology service is the date the specimen was collected. Your MCD session is currently set to expire in 5 minutes due to inactivity. If you are covered by Medicare or Medicare Advantage: Medicare covers the lab tests for COVID-19 with no out-of-pocket costs and the deductible does not apply when the test is ordered by your doctor or other health care provider. CMS and its products and services are Contractors may specify Bill Types to help providers identify those Bill Types typically Concretely, it is expected that the insured pay 30% of . The following CPT codes have been deleted and therefore have been removed from the article: 0012U, 0013U, 0014U, and 0056U from the Group 1 Codes. Current Dental Terminology © 2022 American Dental Association. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. Pin-up models (pin-ups) were a big deal in the 1940s and 1950s. Regardless of the context, these tests are covered at no cost when recommended by a doctor. The majority of COVID-19 tests are LFTs, whether they are self-administered or performed by a medical professional. Furthermore, this means that many seniors are denied the same access to free rapid tests as others. All services billed to Medicare must be medically reasonable and necessary. Do I need proof of a PCR test to receive my vaccine passport? Since most seniors are covered by Medicare, you may be wondering whether Medicare covers rapid PCR covid test for travel. AHA copyrighted materials including the UB‐04 codes and apply equally to all claims. Sorry, it looks like you were previously unsubscribed. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. The order by the treating clinician must reflect whether the treating clinician is ordering a panel or single genes, and additionally, the patients medical record must reflect that the service billed was medically reasonable and necessary.CMS payment policy does not allow separate payment for multiple methods to test for the same analyte.We would not expect that a provider or supplier would routinely bill for more than one (1) distinct laboratory genetic testing procedural service on a single beneficiary on a single date of service. There are some exceptions to the DOS policy. Under Part B (Medical Insurance), Medicare covers PCR and rapid COVID-19 testing at different locations, including parking lot testing sites. Screening services such as pre-symptomatic genetic tests and services used to detect an undiagnosed disease or disease predisposition are not a Medicare benefit and are not covered. Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Federal government websites often end in .gov or .mil. Seasonal Affective Disorder and Medicare: What Medicare Benefits Are Available to Those With Seasonal Depression? This, however, leaves many seniors out because medicare does not cover self-diagnostic testing. . It is the MACs responsibility to pay for services that are medically reasonable and necessary and coded correctly. If youve participated in the governments at-home testing program, youre familiar with LFTs. . Medicare Advantage plans can also offer additional benefits to those in self-isolation, such as expanded access to telehealth services and home meal delivery. The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. The instructions for reporting CPT code 81479 have been clarified, multiple CPT codes that did not represent molecular pathology services have been deleted and the following CPT codes have been added in response to the October 2021 Quarterly HCPCS Update: 0258U, 0260U, 0262U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, and 0282U. Medicare COVID-19 Coverage: What Benefits Are There for COVID Recovery? LFTs produce results in thirty minutes or less. You also pay nothing if a doctor or other authorized health care provider orders a test. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. Codes that describe tests to assess for the presence of gene variants use common gene variant names. Medicare covers many tests and services based on where you live, and the tests we list in this guide are covered no matter where you live. Beginning April 4, 2022, Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries with Part B coverage, including those enrolled in Medicare Advantage, will be eligible for up to eight (8) OTC COVID-19 tests from participating pharmacies and providers each calendar month until the end of the COVID-19 public health Coronavirus Pandemic We can help you with the costs of your medicines. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Enrollment in the plan depends on the plans contract renewal with Medicare. These are the 5 most addictive substances on the planet, 6 unusual signs you may have heart disease, Infidelity is raging in the 55+ crowd but with a twist, The stuff nobody tells you about a dying pet, 7 bizarre foods people used to like for some reason, Theres a new way to calculate your dogs age in human years, The one word you should never use to start an email.