Cpt 2011: IP Catheter Code Changes

For intraperitoneal (IP) catheter coding, confusing terms such as 'temporary' and 'permanent' are a thing of the past. Here's how CPT 2011 freshened up your options:

New code 49418 begins the IP catheter code changes

Defined as a 'complete' procedure, you will find multiple services covered by new code 49418 (Insertion of tunneled intraperitoneal catheter [example dialysis, intraperitoneal chemotherapy instillation, management of ascites], complete procedure, including imaging guidance, catheter placement, contrast injection when carried out, and radiological supervision and interpretation, percutaneous).

Medicare assigned this just-in code a 0-day global period, which means Medicare does not bundle visits on subsequent days into the procedure payment.

Progress carefully: Medicare's national fee schedule prices for 49418 differ significantly based on whether you're reporting a facility service ($234.78) or non-facility service ($1,519.08). That is a difference of more than $1,200; as such be sure to watch your place of service code.

Rectify the codes listed in 49419's line note

Overall, changes show the 'coding lag' that occurs in keeping up with advances in new surgical procedures. In fact, the addition of 49418 is part of a larger reworking of tunneled intraperitoneal (IP) catheter codes to bring them in line with present practice. To begin with, CPT revises 49419:

2010: 49419

2011: 49419

Here's why: By referencing subcutaneous port, the code language reflects present technology.

What's more, CPT removed the term 'cannula' as doctors commonly carry out these procedures using a catheter only.

According to AMA's published errata: You will require correcting the CPT manual note following 49419. The note should read as follows: 49420 has made an exit. To report open placement of a tunneled peritoneal catheter for dialysis, report 49421. To report open or percutaneous peritoneal drainage or lavage, take a look at 49020, 49021, 49040, 49041, 49080, 49081 as proper. To report percutaneous insertion of a tunneled peritoneal catheter without subcutaneous port, go for 49418.

Among other code changes, focus on 49422 note

Other changes related to IP catheter coding include the following:

According to the symposium, these changes are part of an attempt to 'clean up' codes that overlapped and caused confusion. For instance, the terms temporary and permanent (used last year), caused confusion over whether they referred to placement or to the device itself. That apart, CPT 2011 added the term 'tunneled' to acknowledge the subcutaneous channel in which the physician places the catheter.

Exit: See to it that you catch that this year's CPT deleted 49420. The revisions and additions of other, more specific codes made 49420 obsolete.

Vital instruction: Do not miss the note with 49422. This code is for removal of a tunneled catheter only. If the physician removes a non-tunneled IP catheter, CPT guides you to use the proper E/M code.

Source URL :- http://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/cpt-2011-49418-49422-changes-bring-ip-catheter-coding-up-to-date-article

Obama Budget to Delay Medicare Cuts for Two More Years

Last December, Part B practices heaved a sigh of relief when Congress froze Medicare payments at 2010 levels throughout 2011. And because of that vote, you have not had to deal with the potentially devastating 25 percent cuts that you would have faced on January 1 this year.

However the cuts are still poised to take effect next year. Until and unless of course Obama's new budget proposal clears administrative barriers.

On February 14 this year, the White House Office Management and Budget made its new budget proposal public. Accordingly, this would delay Medicare cuts for a couple of years more, through December 31, 2013. The pay cuts would still kick in as of 2014; however physician advocacy groups hope that a lasting solution to the Medicare payment issues (http://supercoder.com/)will be established by then.

According to a statement from Office of Management and Budget director Jack Lew, "In December, there was a bipartisan agreement to pay for a one-year extension of the so called 'doc fix,' which was not needed by budget rules; however was the right thing to do." "Building on that, our budget identifies $62 bn of specific health savings to pay for the coming two years of this fix, establishing a clear pattern that, consistent with our budget, this needs to be paid in the times to come.

Aside from this, Obama's budget proposal also includes $250 M in grants to states to reform the way medical liability disputes are resolved. The Department of Justice would award the grants with the Department of Health and Human Services.

Correct Date of Service is Imperative

OIG released the results of its audit 'Review of Medicare Parts A and B Services Billed With Dates of Service After Beneficiaries' Deaths

On September 23 this year, the OIG released the results of its audit 'Review of Medicare Parts A and B Services Billed With Dates of Service After Beneficiaries' Deaths', which revealed that CMS paid approximately $8.2 million in benefits for claims with dates of service after the beneficiaries' deaths.

The OIG noted that Medicare will only shell out money for expenses 'reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member as medically necessary items or services can't be provided after beneficiaries'deaths, no items or services are allowable' thereafter.

Since the OIG is tracking dates of service by investigating the date the patient passed away, you should make it a point to ensure your ob-gyn practice records the correct date of service (DOS) on your Medicare claims. In many instances, some practices are still charging for services long after their patients died, and it is costing the Medicare system big money.

Correct date of service is very important : Even though many practices might be surprised to find that they've made a mistake like this, the OIG found some problems with claims for over 69,000 deceased beneficiaries between Parts A and B over a two-year period.

Safeguard your practice by following this advice

Watch your date protocol: Sometimes there are errors where practice employees misinterpret the dates that the physician writes down. If the physician notes down '06-04-10,' he might mean June 4, 2010, while someone else might interpret that as April 6, 2010 as the date is written differently by different people."

Advice: If you enter the DOS into the patient's claim form manually, be sure and have a uniform way of writing the date at your practice, between all providers and back office staff members. To add to it, you should cross-reference the DOS against the records for all deceased patients to ensure that you have recorded all dates correctly.

Follow through with other data: If you are making errors on deceased patients' records, it is likely that you have also applied the wrong date on other patients' claims as well. Ensure that everyone in your practice is using the same criteria to apply DOS. If some doctors still write the date with the numbers for the month and year transposed, it might be a good idea to ask all the practitioners to begin writing out the month instead. For example, instead of 06-04-10, you might have to ask everyone to start writing out June 4, 2010.

For more tips on ways to write the correct DOS and for other medical coding news pertaining to this, sign up for a medical coding guide like http://www.supercoder.com/