Two New Codes for Diabetic Food Ulcer Treatment

CPT will come up new codes in 2011. The new codes are G0440 and G0441

As we go into the new year, the talk that's doing the rounds most among the coding community is the Cpt Code changes. CPT will come up with over 200 new codes with the purpose of helping you code more accurately. These changes will have an affect on several categories, and podiatry is no exception.

For podiatry, there are two new codes to report diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity.

The new codes are G0440 (Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less) and G0441 (…each additional 25 sq cm) that'll put an end to the confusion providers put forth the different global periods for two tissue cultured skin substitute codes.

To cite an instance, a patient presents to the office with a history of diabetes and neuropathy. For the past six weeks, he has been treated for an ulcer with minimal results from standard conservative care. An exam shows an ulcer under the fifth metatarsal head. The ulcer measures one cm in diameter and shows necrotic tissue at the base. The podiatrist carried out a debridement, sharply removing it with scalpel and picking up at the skin margins and necrotic tissue. There's no exposure of the muscle or bone. If the podiatrist prepared for an application of Dermagraft or Appligraft, placing the substance in sterile normal fashion and then bandaging in standard fashion, you would use G0440.

For further details on this and to get all updates on how the CPT code changes (http://www.supercoder.com/cpt-codes) are affecting your specialty, sign up for a medical coding guide like Supercoder!

Congress Goes Ahead With One-Year Medicare Pay Fix

President Obama passed a bill that will freeze medical pay at present levels for another 12 months.

The new legislation helps you avoid the scheduled 25 percent drop in Medicare pay for the new year.

The up and down ride of conversion factor changes for 2011 has come to a conclusion thanks to a Senate Finance Committee bill that'll freeze Medicare pay at present levels for another 12 months.

The House of Representatives passed the Medicare and Medicaid Extenders Act of 2010 on December 9 and the Senate voted on it the day before. The bill will do away with the 25 percent cut that medical practices were going to face from January 1. President Obama made it official on December 15, 2010 when he signed the year-long delay into law.

Doctors cheered the news that they will not have to wait for the new Congress and Senate members to take their seats prior to finding out whether a payment fix would take place.

The bill passed as a bipartisan effort, and the Senate Finance Committee noted that it'll cost $14.9 billion over 10 years to implement the physician pay fix. It'll be funded by making minor adjustments to the Affordable Care Act, the health care legislation that President Obama signed into law last March.

Last-minute fix is a welcome sight, however not forever

The US Senate passed a quick, 1-month extension of the present SGR formula on November 18 in a first step to avoid the 23 percent payment cut physicians were facing on December 1. The House of Representatives had already recessed for Thanksgiving at that point and took up the one month fix when they returned on November 29.

While many are pleased that the Senate has acted swiftly on the pending payment cut, one remains sceptical about another round of short term fixes. One hopes that the ultimate result of this Congressional session will be a fix of atleast one year. This extended period must then be followed by a strong bipartisan commitment from Congress to work with the physician community to lastly replace the badly flawed SGR formula with a new update mechanism that works. The frequent disruptions and delayed payments caused by the present formula and Congress' inability to fix it except for short periods are simply not fair to our members who have payrolls and other practice management expenses.

Check whether ACF applies

Some pain management coders also code for anesthesia procedures, which means you have a second CF to consider: the anesthesia conversion factor, or ACF.

The 2011 national ACF will remain at $21.5696. Check your specific area; but then as anesthesia reimbursement changes from state to state and even within regions of the same state.

For more on the latest Medicare updates, sign up for a medical coding guide like Supercoder.com

CPT 2011 Provides Revised Debridement Code Guidelines Latest CPT comes to your rescue with revised debridement code guidelines that explain how to cho

Latest CPT comes to your rescue with revised debridement code guidelines that explain how to choose between the two code groups.

Not sure when to go for a debridement code and an active wound code? Well, the latest CPT comes to your rescue with revised debridement code guidelines that explain how to choose between the two code groups.

According to Chad Rubin, MD, FACS, American College of Surgeons AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member with Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member, ""Depth is the only documentation item you need to determine the proper code."

Active wound care (which has a 0 day global period) is for active wound care of the skin, dermis, or epidermis. For deeper wound care, go for debridement codes in the proper location.

For instance: Codes 11040 and 11041 have been shown the door this time. The parenthetical note under the codes' deletion reads, "For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598."

The codes are then revised to mirror the change. For example, 11042 removes "Skin, and" and adds after subcutaneous tissue "includes epidermis and dermis, if performed."

Code 97597's revision involves "mainly rewording to make clear how active wound care is separate from integumentary wound care."

The latest CPT code set includes guidelines that indicate two requirements for active wound care management. These guidelines focus on:

Intent: "Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing."

For further information on when to choose a debridement code and an active wound code as well as on the latest CPT changes (http://www.supercoder.com/cpt-codes), sign up for a medical coding guide like Supercoder!

HCPCS 2011 Brings new Options for Lymph Cancer Drugs

HCPCS 2011: C codes are appropriate only for Hospital Outpatient Prospective Payment System claims.

When all other treatments have failed, take a look at these drugs

You'll have three new J codes for leukemia and lymphoma treatments available for use in January, 2011.

J9302 answers call for Arzerra Code

If you provide Arzerra injections, you should take note of new code J9302 (Injection, ofatumumab, 10 mg). Oncologists normally use the medication to treat chronic lymphocytic leukemia in adults who haven't responded well to fludarabine or alemtuzumab.

As the suffix -mab in ofatumumab points to, this medication is a monoclonal antibody.

Remember: Earlier, hospitals had a C code available for this agent, C9260 (Injection, ofatumumab, 10 mg). However this code makes an exit in the latest HCPCS code sets. (Note that C codes are appropriate only for Hospital Outpatient Prospective Payment System claims.)

Train eyes on J9307 for Folotyn

One more new J code for 2011 is J9307 (Injection, pralatrexate, 1 mg), which is just right for Folotyn.

Oncologists normally use this folate analogue metabolic inhibitor to kill cancer cells in patients with peripher al T-cell lymphoma that hasn't responded to other medications or has returned.

HCPCS 2011 also axes the C code available to hospitals for this drug, C9259 (Injection, pralatrexate, 1 mg).

Flip to J9315 for Romidepsin

If your documentation shows your practice supplied Istodax, you have J9315 (Injection, romidepsin, 1 mg) at your service in the new year. The drug is a histone deacetylase inhibitor that slows the growth of cancer cells. It is intended for use in patients with cutaneous T-cell lymphoma who have been treated earlier with another drug.

In 2010, hospitals use C9265 (Injection, romidepsin, 1 mg) for this drug, however HCPCS 2011 deletes this code.

CPT 2011 Asks for CMS re-Examination of Time as Averages or Thresholds

CPT 2011: The doctor must have spent a time closest to the chosen code, according to CPT Assistant

All that fine green print on time in your E/M CPT 2011 manual comes down to one thing: you can round to the closest time code. However, that advice from CPT contradicts Medicare's threshold time guideline.

CPT treats times as averages

CPT 2011 indicates that you can use the code closest to the documented time. That piece of advice is nothing new. In choosing time, the doctor must have spent a time closest to the chosen code, according to CPT Assistant, Aug. 2004.

Your documented time must be equal to or cross the average time given to bill that level. For a 35-minutes spent on a medically necessary counseling-dominated visit is a 99214, according to CPT you could report 99215.

Medicare has considered times thresholds

Medicare has always considered the times indicated in CPT's code descriptors to represent minimums. The doctor would choose the lower code (for example 99214… physicians typically spend 25 minutes face-to-face with the patient and/or family …) unless the time was greater or equal to the higher-level code's required time (such as 40 minutes for 99215).

Will Medicare alter its position?

When questioned on whether Medicare would change the allotments from thresholds to averages at the CPT® and RBRVS 2011 Annual Symposium, medical directors were hesitant to give a definitive answer. "I do not want to say one way either 'yes' or 'no' at this juncture," said E/M expert Deborah Patterson, MD, clinical medical director for Trailblazer Health Enterprises, LLC in Dallas.

For more on CPT 2011 , sign up for a medical coding guide like Supercoder!

Maneuver the Medicare Opt-Out Process in Three Easy Steps

Medicare: You can find samples of the form online at specialty association Websites and even some Medicare carrier Websites.

If you've decided that 2011 is the year your practice's going to scrap Medicare, follow this plan to see to it that you do not miss any important components when you are boosting your no-Medicare plan.

Notify Medicare that you are opting out

First, file an affidavit with your Medicare contractors informing them that your physician is opting out. If you're already a participating provider, states CMS, “To opt out of Medicare, a participating doctor must first terminate his or her Medicare Part B participation pact."

Tool: You can find samples of the form online at specialty association Websites and even some Medicare carrier Websites. For example, you can get National Government Service's form at www.ngsmedicare.com/pdf/medicareoptoutaffidavit.pdf.

Create a patient contract

If your practice decided to opt out of Medicare, however your providers plan to see Medicare patients, you will need solid patient contracts. “The provider has to have a written ‘private contract' with each Medicare beneficiary to whom the provider provides any service, except in a life-threatening emergency.

This contract, among other things, inform your patients that you're no longer part of Medicare and therefore, neither they nor the provider will get any reimbursement from Medicare. You'll be able to treat patients with Medicare coverage just like before, however you won't bill Medicare for the services. In its place, you'll bill any secondary or supplementary insurance the patient may have, or bill the patient directly. For instance, Medigap insurance will not pay you money if you're opted out since Medigap pays only secondary to Medicare payment.

Point to remember: Medicare has various requirements for what it considers an acceptable private contract. Be wary that the contracts have to be made available to CMS upon request, even long after the two-year opt-out period expires.

Set up internal processes to avoid claim errors

Finally, implement procedures within your office to ensure that:

You never file a Medicare claim

You don't provide the info to your patient to file a Medicare claim

Rule breaker: Two exceptions to this are emergency or urgent care, and providing covered services that Medicare would consider unnecessary.

Do not miss: Set up reminder notices either electronically or on a paper calendar so that you know when the two-year optout period expires. If you decide to opt out again, you will need to fill out another affidavit.

For more on this, and for more medical coding updates, sign up for a medical coding guide like Supercoder!

Axe 90658 for Medicare Patients In Favor Of Just-In Q Codes

Medical Coding: Medicare will no longer pay you money for 90658 with effect from January 1, 2011.

The new year brings changes to flu vaccines and counseling codes.

Your vaccine coding in 2011 will be on its toes, thanks to changes in codes and administration reporting. Two more updates every family physician should know involve new Q codes for some Medicare flu vaccines and expanded ages for adolescent vaccine counseling.

Nix 90658 for Medicare patients

CMS has come up with New HCPCS codes and payment allowances to replace 90658. Medicare will no longer pay you money for 90658 with effect from January 1, 2011. As such, select from the new codes instead, based on the specific product: Q2035, Q2036, Q2037, Q2038, Q2039.

Timing: Codes Q2035-Q2039 went into effect on October 1, 2010. When filing claims for DOS from October 1 until December 31, 2010: bill Medicare immediately with 90658, or hold the claim until January 1, 2011 and file with the proper Q code.

Explanation: Medicare pays for influenza vaccine based on 95 percent of the average wholesale price. The products normally classifiable to 90658 have widely varying AWPs. If Medicare continued paying for all of them under a single code, they could be overpaying some and underpaying others, relatively.

Consequence: Medicare assigns different Q codes to each individual product starting January 1, 2011 to account for variances in manufacturing prices. "This should actually ensure that physicians are paid well for products that might have significant differences.

Report 90460, +90461 through age 18

You will be able to use medicine series vaccine administration with counseling codes on older patients and when a nurse provides the counseling, thanks to CPT 2011.

As counseling for adolescents can involve as much as counseling on vaccine for younger children, the American Academy of Pediatrics recommended that the age limitation on the vaccine administration with counseling codes be raised. New codes extend vaccine administration with counseling to patients through 18 years of age.

Benefit from RN/LPN counseling and still get the reimbursements

Busy practices will be excited at being able to use their registered nurses (RN) or licensed practicing nurses (LPN) to capture the higher RVUs some private payers associate with the vaccine administration with counseling codes. The just-in vaccine administation code with counseling code descriptor expands who can provide the vaccine counseling described in the deleted immunization administration with vaccine counseling codes (90465-90468). CPT 2010 vaccine administration with counseling codes 90465-90468 limited the counselor role to a doctor and, subject to state scope of practice laws, nurse practitioner (NP) or physician assistant (PA).

Final say: Remember the just-in administration codes 90460 and 90461 are per vaccine/toxoid component. That means if your doctor provides counseling and administration for a combination, you will report 90460 for the first component and 90461 for each additional component. In the MMR example, you would use 90460 once and 90461 twice. Before 2011, you'd report only a single vaccine administration code for a combination vaccine, irresespective of the number of components in the vaccine.