CMS urges you to use the latest version of ABN with effect from November 1.
A couple of months back, the Centers for Medicare & Medicaid (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for year 2012. This 621-page document zooms in on how the agency configures its relative value unit (RVU) assignments.
Imaging pay will see further cuts if the proposed rule becomes final. Right now, when you carry out multiple radiological procedures on the Multiple Procedure Payment Reduction (MPPR) list during a single session, Medicare brings down the Technical Component (TC) of the lower paid procedures by half.
The agency is proposing that next year, it'll not only slash the TC of subsequent radiological procedures by 50 percent, but will also bring down the PC by half. Total payment would be made for the PC and TC of the highest paid procedure and payment would be brought down by half for the PC and TC for every additional procedure provided to the same patient in the same session.
Note: Payment cuts to radiology procedures could be even more in 2013 and after.
Reaction to radiology cuts:
Professional societies raised their voices at CMS' radiology cuts. The AMA opposed a proposal to use significant cuts to Medicare payments for diagnostic imaging to offset the cost of a trade pack.
What's more, many radiologists noted that multiple interpretations of exams carried out on one patient are not less work-intensive than multiple interpretations of separate patients.
ABN deadline
The time to upgrade to a newer version of the ABN is a couple of months away - mandatory use of the new version starts on November 1, 2011.
Why the upgrade: The present ABN form had an expiration date on it, and as a rule forms are updated every three years based on provider comments.
Showing posts with label Medicare Fee Schedule. Show all posts
Showing posts with label Medicare Fee Schedule. Show all posts
Tuesday, September 6, 2011
Friday, September 2, 2011
Fee Schedule: There's a Distinct Difference Between XXX & 000 Global Periods
The classification XXX means that the service is completely free of global surgical bundling issues while the 000 indicator applies to the date of the procedure only.
The Centers for Medicare and Medicaid (CMS) has changed the global periods for both 51736 and 51741 from 000 to XXX in this year's January release of the Medicare Physician Fee Schedule. The agency drastically brought down the payment you get for both simple and complex uroflowmetry for this year. However in doing that they put the code in the category of 'global concept doesn't apply'.
Remember: The change to XXX applies to the global codes - 51736 and 51741 – as well as their Professional Component (PC) and Technical Component (TC). This means that whether you bill 51736/51741, 51736/51741-26 or 51736/51741-TC, there is no global period related with these flow rate size.
XXX versus 000
Even though both XXX and 000 global periods appear free of global bundling issues, you should know that there's a distinct difference between these two.
The classification XXX means that the service is completely free of global surgical bundling issues, and you can separately report services that your urologist carries out on the same day as the surgical procedure.
The value of this global period has always meant that the global concept does not apply to the procedure. Its value has always meant that the global concept does not apply to the procedure.
While the 000 indicator applies to the date of the procedure only. As such, Medicare will bundle all services that the physician carries out on that surgery date into codes with this indicator. On the other hand, 000 is for endoscopic procedures or minor procedures. If you have a code with a zero day global period make sure you include related pre operative and post operative care on the day of the procedure only.
Here's how other global periods function: Key surgical procedures covers a 90-day global period while lesser surgical procedures may include a global period of 10 days.
What you need to remember: The YYY global period to unlisted procedures only to unlisted-procedure codes and points to the fact that the payer is free to determine a global period for the procedure. The ZZZ designation denotes an add-on procedure for which the global period is covered in the primary procedure.
Here's what you should do: You should verify your payers' policies before you code your next claim. For more global-period information, go to the Medicare Fee schedule database available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/PhysicianFeeSched/
The Centers for Medicare and Medicaid (CMS) has changed the global periods for both 51736 and 51741 from 000 to XXX in this year's January release of the Medicare Physician Fee Schedule. The agency drastically brought down the payment you get for both simple and complex uroflowmetry for this year. However in doing that they put the code in the category of 'global concept doesn't apply'.
Remember: The change to XXX applies to the global codes - 51736 and 51741 – as well as their Professional Component (PC) and Technical Component (TC). This means that whether you bill 51736/51741, 51736/51741-26 or 51736/51741-TC, there is no global period related with these flow rate size.
XXX versus 000
Even though both XXX and 000 global periods appear free of global bundling issues, you should know that there's a distinct difference between these two.
The classification XXX means that the service is completely free of global surgical bundling issues, and you can separately report services that your urologist carries out on the same day as the surgical procedure.
The value of this global period has always meant that the global concept does not apply to the procedure. Its value has always meant that the global concept does not apply to the procedure.
While the 000 indicator applies to the date of the procedure only. As such, Medicare will bundle all services that the physician carries out on that surgery date into codes with this indicator. On the other hand, 000 is for endoscopic procedures or minor procedures. If you have a code with a zero day global period make sure you include related pre operative and post operative care on the day of the procedure only.
Here's how other global periods function: Key surgical procedures covers a 90-day global period while lesser surgical procedures may include a global period of 10 days.
What you need to remember: The YYY global period to unlisted procedures only to unlisted-procedure codes and points to the fact that the payer is free to determine a global period for the procedure. The ZZZ designation denotes an add-on procedure for which the global period is covered in the primary procedure.
Here's what you should do: You should verify your payers' policies before you code your next claim. For more global-period information, go to the Medicare Fee schedule database available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/PhysicianFeeSched/
Tuesday, August 9, 2011
Medicare fee schedule: CMS to expand the potentially misvalued code initiative
According to CMS, the total payments under the Medicare Physician Fee Schedule (MPFS) in CY 2012 will be $80 billion.
In an effort to ensure Medicare is paying appropriately for physician services and more closely managing the payment system, the agency is expanding the potentially misvalued code initiative, a July 1 CMS press release notes.
In 2011, the agency is focusing on the highest volume and dollar codes billed by physicians to find out whether these codes are overvalued and if E/M codes are undervalued. Prior to this, the agency targeted specific codes for review that may have impacted a few procedural specialties like cardiology, radiology or nuclear medicine however not taken a look at the highest expenditure codes across all specialties, the agency cites.
Strong efforts are required to assess fee schedule for Medicare ( Source "http://www.supercoder.com/coding-tools/fee-schedules") to see to it that it is paying right and ensuring that Medicare beneficiaries remain to have access to vital services, the release stresses. That aside, the agency is also proposing some changes in how it adjusts payment for geographic variation in the cost of practice.
Other changes in the proposed rule include:
The agency is also proposing to expand its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services, the agency release cites.
The agency is also proposing criteria for a health risk assessment to be used with AWVs for which coverage began on January 1 this year under the affordable care act.
The agency will accept comments on the proposed rule until August 30 this year.
For more on this fee schedule update, click here
In an effort to ensure Medicare is paying appropriately for physician services and more closely managing the payment system, the agency is expanding the potentially misvalued code initiative, a July 1 CMS press release notes.
In 2011, the agency is focusing on the highest volume and dollar codes billed by physicians to find out whether these codes are overvalued and if E/M codes are undervalued. Prior to this, the agency targeted specific codes for review that may have impacted a few procedural specialties like cardiology, radiology or nuclear medicine however not taken a look at the highest expenditure codes across all specialties, the agency cites.
Strong efforts are required to assess fee schedule for Medicare ( Source "http://www.supercoder.com/coding-tools/fee-schedules") to see to it that it is paying right and ensuring that Medicare beneficiaries remain to have access to vital services, the release stresses. That aside, the agency is also proposing some changes in how it adjusts payment for geographic variation in the cost of practice.
Other changes in the proposed rule include:
The agency is also proposing to expand its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services, the agency release cites.
The agency is also proposing criteria for a health risk assessment to be used with AWVs for which coverage began on January 1 this year under the affordable care act.
The agency will accept comments on the proposed rule until August 30 this year.
For more on this fee schedule update, click here
Thursday, April 14, 2011
+33225: Find out Which Primary Code this Case Study Supports
Here's a real-life case study to see if you can pinpoint the codes this documentation does – and does not – back up.
Start by analyzing the report excerpt
An incision was made along the left deltopectoral groove, and an ICD pocket was dissected out, was prepared with extensive dissection.
Three different guidewires were advanced into the left subclavian vein utilizing the Seldinger technique across the open pocket. Then the middle of these wires was used to further a coronary sinus sheath for placement of the left ventricular lead. With some difficulty, we're able to further the coronary sinus sheath in the mid coronary sinus and an angiogram was got. After this a left ventricular lead was then advanced in the lateral cardiac vein and the tip was advanced to the near LV apex. Electrical testing was carried out at three difficult locations and the rest of these noted a lead impedance of 840 ohms and an R wave value of 17.1 mV.
After this, the bipolar right ventricular defibrillator active fixation lead was advanced to the right ventricle, various areas were checked and the lead was finally fixated along the RV.
Hereafter the bipolar right ventricular defibrillator active fixation lead was advanced to the right atrium. Various areas checked and the lead was finally fixated along the RV septum and tested.
Then a bipolar screw in type right atrial lead was advanced to the right atrium while the lead was fixated to the right atrial wall. After this the coronary sinus sheath was removed with the cutting device maintaining a good lead position of the LV lead.
After this, all the three leads were then sutured to the pectoral fascia over the Silastic sleeves. The ICD pocket was irrigated. Soon the leads were then attached to the ICD/BiV device. Post this, the ICD was placed in the pacer pocket after a standard dose of thrombin material in the pocket. The ICD pocket was sutured closed.
The patient was provided propofol and the following establishment of sufficient general anesthesia. Ventricular fibrillation was encouraged. The advice analyzed and delivered three separate DC countershocks, at last at 36V and the patient converted back to normal sinus rhythm. Patient was made to wake up from sedation without obvious side effects.
Add-On Code
The case study appears to be a new implant of a Biventricular Defibrillator with follow-up testing at implant. While going through the first two paragraphs, you should focus on the terms describing placement of the left ventricular lead via the coronary sinus. The right code for this portion is +33225.
Tips for documentation: You may see this lead referred to as either a left ventricular (LV) lead or coronary sinus lead.
For that add-on code, add the primary code
The next few paragraphs of the documentation describe lead fixation for the RV and RA. What's more, the cardiologist attaches the leads to the device, places the device in the pacer pocket, and sutures the pocket closed. One code 33249 covers all of this.
Add-on note: CPT lists 33249 as a proper primary code for add-on code +33225.
Defib Testing gets you the final code
The last paragraph of the case study excerpt describes 93641. As far as defib testing is concerned, you want to see impedance in the documentation.
Term tip: The defibrillation threshold is the minimum energy amount required during ventricular arrhythmia to defibrillate the heart dependably. Being aware of the patient's DFT helps the cardiologist confirm that the cardioverter-defibrillator (ICD) programming will provide enough of a shock to defibrillate the patient's heart.
Add modifiers to at least one code
Code 93641 requires modifier 26 (PC) to indicate you are claiming only the physician work (and practice expense and malpractice expense) for this service. For this code, the Medicare Fee Schedule (Physician) lists a PC/TC indicator of "1". This means you may use modifier 26 with the code.
You may require a modifier on 33225 because it is an add-on code for 33249. However you may need a 59 modifier on the 93641, depending on the carrier. You should not need one, however you never know with carrier's software.
Source URL : - http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/electrophysiology-33225-decide-which-primary-code-this-case-study-supports-article
Your practice should hit these points
In a case such as this, the doctor would normally use fluoroscopy, too; but again it is not documented in this case.
No documentation of fluoroscopy means you shouldn't bill fluoroscopy. When fluoroscopy is documented, you should report 71090-26.
ICD-9: The case-study excerpt also does not mention indications for you to choose ICD-9 diagnosis codes.
What's more, check your local requirements for diagnosis codes that support medical necessity for 33225.
Start by analyzing the report excerpt
An incision was made along the left deltopectoral groove, and an ICD pocket was dissected out, was prepared with extensive dissection.
Three different guidewires were advanced into the left subclavian vein utilizing the Seldinger technique across the open pocket. Then the middle of these wires was used to further a coronary sinus sheath for placement of the left ventricular lead. With some difficulty, we're able to further the coronary sinus sheath in the mid coronary sinus and an angiogram was got. After this a left ventricular lead was then advanced in the lateral cardiac vein and the tip was advanced to the near LV apex. Electrical testing was carried out at three difficult locations and the rest of these noted a lead impedance of 840 ohms and an R wave value of 17.1 mV.
After this, the bipolar right ventricular defibrillator active fixation lead was advanced to the right ventricle, various areas were checked and the lead was finally fixated along the RV.
Hereafter the bipolar right ventricular defibrillator active fixation lead was advanced to the right atrium. Various areas checked and the lead was finally fixated along the RV septum and tested.
Then a bipolar screw in type right atrial lead was advanced to the right atrium while the lead was fixated to the right atrial wall. After this the coronary sinus sheath was removed with the cutting device maintaining a good lead position of the LV lead.
After this, all the three leads were then sutured to the pectoral fascia over the Silastic sleeves. The ICD pocket was irrigated. Soon the leads were then attached to the ICD/BiV device. Post this, the ICD was placed in the pacer pocket after a standard dose of thrombin material in the pocket. The ICD pocket was sutured closed.
The patient was provided propofol and the following establishment of sufficient general anesthesia. Ventricular fibrillation was encouraged. The advice analyzed and delivered three separate DC countershocks, at last at 36V and the patient converted back to normal sinus rhythm. Patient was made to wake up from sedation without obvious side effects.
Add-On Code
The case study appears to be a new implant of a Biventricular Defibrillator with follow-up testing at implant. While going through the first two paragraphs, you should focus on the terms describing placement of the left ventricular lead via the coronary sinus. The right code for this portion is +33225.
Tips for documentation: You may see this lead referred to as either a left ventricular (LV) lead or coronary sinus lead.
For that add-on code, add the primary code
The next few paragraphs of the documentation describe lead fixation for the RV and RA. What's more, the cardiologist attaches the leads to the device, places the device in the pacer pocket, and sutures the pocket closed. One code 33249 covers all of this.
Add-on note: CPT lists 33249 as a proper primary code for add-on code +33225.
Defib Testing gets you the final code
The last paragraph of the case study excerpt describes 93641. As far as defib testing is concerned, you want to see impedance in the documentation.
Term tip: The defibrillation threshold is the minimum energy amount required during ventricular arrhythmia to defibrillate the heart dependably. Being aware of the patient's DFT helps the cardiologist confirm that the cardioverter-defibrillator (ICD) programming will provide enough of a shock to defibrillate the patient's heart.
Add modifiers to at least one code
Code 93641 requires modifier 26 (PC) to indicate you are claiming only the physician work (and practice expense and malpractice expense) for this service. For this code, the Medicare Fee Schedule (Physician) lists a PC/TC indicator of "1". This means you may use modifier 26 with the code.
You may require a modifier on 33225 because it is an add-on code for 33249. However you may need a 59 modifier on the 93641, depending on the carrier. You should not need one, however you never know with carrier's software.
Source URL : - http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/electrophysiology-33225-decide-which-primary-code-this-case-study-supports-article
Your practice should hit these points
In a case such as this, the doctor would normally use fluoroscopy, too; but again it is not documented in this case.
No documentation of fluoroscopy means you shouldn't bill fluoroscopy. When fluoroscopy is documented, you should report 71090-26.
ICD-9: The case-study excerpt also does not mention indications for you to choose ICD-9 diagnosis codes.
What's more, check your local requirements for diagnosis codes that support medical necessity for 33225.
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