Will CMS slash 2011 conversion factor 30 percent?

A long-term solution is the need of the hour, the Fee Schedule notes.

Whether your Medicare payments will be slashed is a question on everyone's mind as we get ready to step into the New Year.

What to expect: There's a possible cut to 2011 payments beginning January 1. There are rumblings that another one-year path to keep rates up is under consideration by Congress. Some newly-elected Senators and House members will be in place in 2011, and it is not clear whether the current Congress will make changes affecting 2011 pay before January or whether they will leave the issues for the new Congress to handle.

The conversion factor for the calendar year 2011 PhysicianFee Schedule(Source "") is $25.5217. This amounts to a dismal 30 percent compared to the present rate of $36.8729.

All of this leaves Part B practices in the dark about the future of payments once again. While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is the need of the hour, the Fee Schedule notes.

Radiology hit hard by RVU cuts as well

Apart from dealing with conversion factor fluctuations, radiology will be among the hardest hit by additional cuts to RVUs and other factors affecting payment. These cuts will have a significant impact on specialty practices that are already stretched financially:

Diagnostic testing facility: 15 percent cut

Radiology: 10 percent cut

Interventional radiology: 5 percent cut

Nuclear medicine: 4 percent cut

Radiation oncology: 1 percent cut.

For more on this and for the latest on the 2011 Fee Schedule, sign up for a medical coding guide like Supercoder!

Cms Plays Spoiltsport on Your Pay

CMS doesn't make payments for preventive medicine services billed under 99381-99397.

Owing to the flawed Sustainable Growth Rate (SGR) formula to calculate Medicare fees, Medicare payments to doctors are also due to fall, and medical practices will face a perfect storm of payment nightmares.

Practices are not sure what will transpire on January 1, 2011. Some newly-elected Senators and House members will be in place in the new year, and it's not clear whether the present Congress will make changes affecting 2011 pay prior to January or whether they'll leave these issues for the new Congress to solve.

Some specialties will face additional cuts apart from dealing with conversion factor fluctuations.While the most affected practices will be those that specialize in radiology, the cuts will most certainly have a significant impact on specialty practices that are already financially stretched.

The Fee Schedule also incorporates several provisions of the Affordable Care Act of 2010 that was passed last March. Firstly, you will see that coverage has been established for annual wellness visits for Medicare patients. The rule that was issued on November is a major step toward improving the health status of Medicare beneficiaries by providing coverage for an annual wellness visit that will allow a physician and patient to forge closer ties to improve the patient's long term health.

"If you carry out a procedure that meets CMS's description of an annual wellness visit, you shouldn't report a code from CPT's preventive medicine section to your Medicare carrier," indicates the Final Rule.

CMS doesn't make payments for preventive medicine services billed under 99381-99397. Instead, you should report one of the following newly-established HCPCS codes(http://www.supercoder.com/hcpcs-codes/):

G0438 -- Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit

G0439 -- subsequent visit.

Even though most of these wellness examinations are normally carried out by the patient's internist or family physician, occasionally a urologist will carry out this service. If so, think about the above codes and information to help you bill properly and be paid for this service.

CMS has assigned 2.43 physician work RVUs to G0438 and 1.50 RVUs to G0439, and these codes will be effective on January 1, 2011. Beneficiaries who have been enrolled in Part B for a year will be eligible for an initial preventive physical exam, (also known as an IPPE, which is billed with G0402).

Post the first 12 months of Part B coverage on or after January 1, 2011, beneficiaries would be eligible for an initial preventive physical exam. After the first 12 months of Part B coverage on or after January 1, 2011, beneficiaries would be eligible for an annual wellness visit as described by the new G codes, thinking that the patient has had an IPPE within the preceding 12 month period, states the Fee Schedule.

43255 Good Bet for Coding for Excessive Blood Loss

Coding for Excessive blood loss, modifier 22 may not be what you are looking for. The answer may depend on more appropriate CPTs such as 43255 and critical care codes.

When you are coding for excessive blood loss, modifier 22 may not be what you are looking for. The answer may depend on more appropriate CPTs such as 43255 and critical care codes.

Think about endoscopy with injection as option

Scenario 1:

The physician injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy. 43239, Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as apt; with biopsy, single or multiple).

Previously, you may opt to use 43239 appended with modifier 22 (Increased procedural services) if the doctor required effort to control the patient's bleeding.

However this option would need you to submit additional paper documentation to support your modifier 22 claim. Instead of submitting yourself to potential hassles, you can accurately describe the session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.

As is obvious from 43255's descriptor, this procedure describes control of bleeding by any method including injection.

Requirement: On your claim, you should append modifier 59 to 43255, and then report 43239. Omitting the modifier would give payers the impression that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.

Extraordinary bleeding requires critical care coding

Scenario 2: When the gastroenterologist is about to carry out an upper GI endoscopy, the patient experiences gastrointestinal bleeding so severe that the doctor must suspend the endoscopy and spend 40 minutes lavaging blood from the gastro-intestinal tract before continuing.

Code it: This time, the critical code 99291 is your best choice.

Here's why" If the gastroenterologist caused the bleeding, you cannot bill for the control of bleeding procedure. You should call on control-of- bleeding codes only when treatment is required to control bleeding that occurs spontaneously, or as a consequence of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention, the CPT Assistant states.

Remember that the time spent at the bedside carrying out services including lavage of gastric blood isn't included in the performance of a subsequent endoscopic procedure and is not part of the E&M service that might be carried out on the same day.

Nevertheless, you should not report a critical care code carelessly for an excessive bleeding situation that's not out of the ordinary. Additional time for emergency bedside services less than 30 minutes does not count as billable critical care service. For prolonged critical care services, the physician should specifically note the amount of time in his notes.

Four Question to Guide your Ucler Reporting

Ask yourself few questions about the excision and debridement services, you will have an easier time selecting the right code.

When your dermatologist carries out a decubitus ulcer excision or debridement, you will have to choose from about 25 possible codes. If you ask yourself the following four questions about the excision and debridement services, you will have an easier time selecting the right code.

Was the wound closed? If yes, by what method?

In some instances, the dermatologist may debride the ulcer and allow the wound to stay open to heal.

On the other hand, the dermatologist may excise the ulcer, clear all infection, and close the wound.

The difference: You shouldn’t distinguish debridement from excision by the ulcer’s removal but, rather, by what the documentation specifies. For instance, documentation for an ulcer removal may read, “The skin was cut in elliptical fashion around the lesion, and the dermatologist excised and sent the lesion to pathology. The dermatolgist closed the wound with 4-0 sutures in a layered fashion (or packed open to drain and heal by secondary intention)." It’s difficult to tell the difference sometimes (both methods are ways of clearing infection); as such you should determine your coding on what the dermatologist describes in the documentation.

Where was the ulcer?

With the nine ICD-9 codes for decubitus ulcers (707.00-707.09), you may have many codes to select from, specific to the ulcer’s location on the body:

707.00 -- Pressure ulcer; unspecified site

707.01 -- elbow

707.02 -- upper back

707.03 -- lower back

707.04 -- hip

707.05 -- buttock

707.06 -- ankle

707.07 -- heel

707.09 -- other site.

How deep was the debridement?

You can report debridement (11040-11044) based on three different skin levels, which are partial thickness, full thickness or subcutaneous – or as deep as muscle or even bone. For instance, 11044 (Debridement; skin, subcutaneous tissue, muscle, and bone) describes a debridement that involves chipping off pieces of diseased bone to help rid the wound of infection.

A partial thickness debridement includes the epidermis and part of the dermis; however some dermal cells are left. The physician normally carries out these procedures using a scalpel or scissors, depending on the situation.

Besides the ulcer, was anything else excised?

In some cases, with coccygeal pressure sores the dermatologist may remove the coccyx to do away with irritation and prevent the ulcer from recurring. The dermatologist may also excise bony prominences as a pressure sore at the same time.

Was anything else excised besides the ulcer?

In some instances, with coccygeal pressure sores the dermatologist may remove the coccyx to eliminate irritation and prevent the ulcer from recurring. The dermatologist may also excise bony prominences at the same time as a pressure sore.

Source URL :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/ulcer-treatments-70700-70709-basics-4-questions-guide-your-ulcer-reporting-article

Fee Schedule Establishes Coverage for Annual Wellness Visits for Medicare Patients

The Fee Schedule establishes coverage for annual wellness visits for Medicare patients.

The new Fee Schedule incorporates several provisions of the Affordable Care Act of 2010 that was passed in March.

New coverage: The Fee Schedule(http://www.supercoder.com/coding-tools/fee-schedules) establishes coverage for annual wellness visits for Medicare patients.

The rule that was issued on November 3 is a key step toward improving the health status of Medicare beneficiaries by providing coverage for annual wellness visit that'll allow a physician and patient to develop closer ties to improve the patient's long term health.

Change: If your doctor carries out a procedure that meets CMS's description of an annual wellness visit, don't report a code from CPT's preventive medicine section to your Part B carrier, the Final Rule indicates. CMS doesn't pay for preventive medicine services billed under 99381-99397. Instead, report one of the following newly-established HCPCS codes that'll be effective from January 1, 2011:

G0438 -- Annual wellness visit; includes a personalized prevention plan of service, first visit

G0439 -- Annual wellness visit; includes a personalized prevention plan of service, subsequent visit

CMS has assigned 2.43 physician work RVUs to G0438 and 1.50 work RVUs to G0439. Beneficiaries who have been enrolled in Part B for 12 months will be eligible for an initial preventive physical exam (also known as an IPPE, which is billed with G0402). After the 12 months of Part B coverage on or after January 1, 2011 beneficiaries would be eligible for an annual wellness visit as described by the new G codes, assuming that patient has not had an IPPE within the preceding 12-month period, states the Fee Schedule.

Take a Look at Your Cardiac Cath Injection Coding Options In 2011

Start easing your practice into the CPT 2011 changes that'll be in effect on the first day of the year.

As you gear up to step into the New Year, you should start easing your practice into the CPT 2011 changes that'll be in effect on the first day of the year. Begin your preparations with this preview of some of the new and revised descriptors that may have an impact on your cardiology coding.

Gear up for cardiac cath coding overhaul

CPT 2011 brings major code changes for cardiac catheterization codes. One aspect of that change is that many of the new injection codes appear to be add-on codes. It'll be interesting to see what the fee schedule has allowed for these services to really get a hang of how it'll affect the cardiology practices in the coming year.

We will go into more details on the correct use of the new codes once the AMA has released details; however you can get a hint of what's to come by looking at the new injection procedure codes. Note that these codes include both (1) the injection procedure during cardiac cath and (2) imaging supervision, interpretation, and report:

93563

93564

93565

93566

93567

93568

Deletion alert: As a result of these additions, reports indicate that CPT 2011 will delete 2010 codes 93539-93545 and 93555-93556.

Rely on more to come for coronary angiography options

You may also think why the just-in injection procedure codes for coronary angiography (93563-93564) specify "congenital heart catheterization". It appears you will have other options for non-congenital cases.

This is because another one of the major changes you can expect is the addition of a new, eight-code family, 93454-93461. The codes in the family differ based on whether you are reporting additional imaging or heart catheterization services carried out at the same session.

For other cardiac cath codes and the entire CPT code list(http://www.supercoder.com/cpt-codes), sign up for a medical coding guide like Supercoder!

Family Physicians likely to See Some Gains

Family Physicians: Congress voted to not only stave off a 21 percent cut to your Medicare pay, but to increase the conversion factor by 2.2 percent.

As everyone knows, the Congress voted to not only stave off a 21 percent cut to your Medicare pay, but to increase the conversion factor by 2.2 percent. However that vote only kept the cuts at bay through November 30.

With effect from December 1, your Medicare pay is likely to come down by over 23 percent, unless Congress intervenes to reverse the cuts. To add to it all, the 2011 payments are due to drop even further with effect from January 1, and medical practices are facing a perfect storm of payment nightmares.

Some practices will bear the brunt and face additional cuts. Affected groups include radiology, urology, oncology/hematology, pathology, and emergency medicine. But family physicians have better news to face thanks to the government seeking to give primary care practices boosts in the coming year.

Family medicine practices expect a two percent gain in Medicare allowed charges next year based on an ongoing transition in Medicare's practice expense RVUs, according to one impact table in the final rule. Internists and pediatricians should anticipate a one percent boost in their Medicare allowed charges, as per the same table.

Other practices that'll see their pay go up will be hand surgeons, who will watch their Medicare allowed charges increase on average by four percent. The following specialists will also see gains in the coming year: neurologists (2 percent), otolaryngologists (3 percent), dermatologists (4 percent), plastic surgeons (3percent), and colorectal surgeons (3 percent).

For more on the Fee Schedule, sign up for a medical coding guide like Supercoder!