Get Ahead on MPFS, MRI, and ABN Changes

Don't omit the proposal to expand the MPPR starting from technical to professional payment.

As if imaging practices didn't get sufficient bad news in 2011, CMS's payment proposals for 2012 show the situation could get even worse. Look out for the proposed fee schedule changes, as well as news for MRI and Advance Beneficiary Notices (ABNs). Read on for expert radiology medical coding information and take a step closer towards accurate and profitable radiology coding.

1. Concentrate on Possible Imaging Fee Cuts

CMS released its planned Medicare Physician Fee Schedule(MPFS) for 2012. The 621-page document proposes a look into how the agency organizes its relative value unit (RVU) assignments.

Imaging pay, hit rigid over the last years, will observe additional cuts in case the proposed rule is finalized. Presently, while you carry out numerous radiological procedures on the Multiple Procedure Payment Reduction (MPPR) list in a single session, Medicare decreases the technical component of the lower paid procedure(s) by 50 percent.

However Supercoder CMS wishes to further decrease those payments, noting in the proposal,

The cuts: CMS is suggesting that in 2012, it will not only reduce the technical component of radiological procedures by 50 percent, but also will slash the professional component by 50 percent. It also maintains that payment cuts to radiology procedures could be even more in 2013 and beyond.

Professional societies were fast to criticize CMS's radiology cuts. The AMA strongly opposes a proposal to use noteworthy cuts to Medicare payments for diagnostic imaging to balance the cost of a trade agreement.

Besides, various radiologists maintained that multiple interpretations of exams carried out on one patient aren't less tedious than multiple interpretations of distinct patients. The time, intensity, as well as the mental effort it takes to interpret an individual exam is comparatively persistent irrespective of whether the patients' exams are interpreted distinctly or at the similar session. Medicare must support such quality care and not constantly attempt to weaken it.

Coverage for MRI Update Is Now Official

CMS has offered decision memo in support of including MRI scans for patients with MRI-safe pacemakers. At the present that decision memo is declared official.

CMS is firm that the evidence is sufficient to determine that magnetic resonance imaging (MRI) develops health results for Medicare beneficiaries with implanted permanent pacemakers (PMs) while the PMs are used as per the FDA approved labeling for use in an MRI environment.

Use New ABN by Nov. 1

It might appear like just yesterday that you moved to the most recent version of the ABN, but it's in reality time to upgrade again to a newer version.

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Optimize Payment For Occupational Therapy With CPT 97530

You can use 97530 to report dynamic therapeutic activities in a one-on-one setting, in which the therapist examines and treats the patient's limbs and leads them in exercises to increase his/her strength, flexibility, etc.

What are therapeutic activities?

Therapeutic activities involve the use of such parameters as balance, strength, and range of motion, etc. for an improved everyday functionality, and these are advised to patients who require rehabilitative techniques. Through the use of graduated weights and using a series of movements (such as bending, lifting, carrying, reaching, catching, and overhead activities), therapeutic activities increase the body's flexibility, strength, and coordination. These can be specifically designed for a particular body part or they could work on improving the functioning of the entire body in a progressive manner.

Who can report 97530?

The code 97530 is intended for use only by trained occupational therapists, who design therapeutic activities; massage therapists are not eligible to report this code for their services.

Team therapy

Supercoder CMS says that when two or more therapists or therapy assistants work together as a "team" to treat a patient, you cannot bill separately for the same or different service provided at the same time to the same patient. Also, where a physical and occupational therapist both provide services to a patient at the same time, only one therapist can bill for the entire service or the PT and OT can divide the service units. For example, a PT and an OT work together for 30 minutes with one patient on transfer activities. The PT and OT could each bill one unit of 97530. Alternatively, the 2 units of 97530 could be billed by either the PT or the OT, but not both.

Coding confusion-97110 or 97530?

The similarities between CPT 97110 and CPT 97530 (both are time-based-billed per 15 units, focus on balance, strength, and range of motion, and need direct one-on-one contact by the provider) can lead to wrong code choice and a possible denial. Here's how you can pin down the appropriate code:

    Choose 97110 when the activity is performed to achieve only one of the following: strength, endurance, range of motion, or flexibility.

    Go for 97530 when the activity is performed to achieve multiple parameters and improved functional performance (e.g., lifting, pulling, and bending).