Proposed Rule 2012: 29.5 Percent Cut in Physician Payment Rates Likely

With physician pay cut looming large, right now you need to have a lasting (Sustainable Growth Rate) SGR fix to do away with this problem for good.

If the 2012 Medicare payment rates proposed in the Centers for Medicare & Medicaid fee schedule becomes final, physician practices could be taking yet another hit. Physician practices can expect a 29.5 percent payment cut for covered services, According to CMS' July 1 release.

According to the release, total projects under the Medicare Physician Fee Schedule (MPFS) in CY 2012 will be to the tune of $80 billion.

A brief background: The release further informs that the proposed rule threatens to bring down payment rates based on the SGR formula. But then the cuts have been avoided every time except in the year 2002. In fact, last year, it took three different legislations to prevent the cuts, informs the release.

Consequences: Said Dr. Donald M. Berwick, CMS Administrator in the release, "This payment cut would have serious consequences and we cannot and will not allow it to happen."

In the proposed rule, the agency is significantly expanding the potentially misvalued code initiative, the release notes.

Strong efforts are required to assess Medicare's fee schedule to see to it that it's paying right and ensuring that Medicare beneficiaries remain to have access to vital services like primary care services, the release cites.

Among other changes, the agency is also proposing to expand its multiple procedure payment reduction to the professional interpretation of advance imaging services.

ICD-9 2012 Update: 173.0-173.9 Get Specific Next Year with New Fifth Digits

Expanded diagnosis code sets will allow coders to classify whether skin cancer is basal, squamous, or unspecified.

On October 1, dermatology coders will be able to more accurately report the location of carcinomas and other neoplasms of the skin.

The Centers for Medicare & Medicaid Service (CMS) has released its proposed changes to ICD-9 2012, and they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that will specify whether the malignant neoplasm is basal cell, squamous cell, or unspecified.

Example: Now, dermatology coders would report 173.0 (Other malignant neoplasm of skin of lip) for any non-melanoma malignant neoplasm of the lip. But when ICD-9 2012 becomes effective on October 1, 2011, coders can choose from:

173.00 -- Unspecified malignant neoplasm of skin of lip

173.01 -- Basal cell carcinoma of skin of lip

173.02 -- Squamous cell carcinoma of skin of lip

173.09 -- Other specified malignant neoplasm of skin of lip. Additionally, in October, 173.0 will become an invalid diagnosis code.
The changes in the other skin cancer categories follow this pattern, with the fifth digit of "0" referring to an unspecified malignant neoplasm, "1" denoting a basal cell cancer, "2" referring to a squamous cell carcinoma," and "9" describing another specified malignant neoplasm.

The new, revised, and invalid codes have been approved by the by the ICD-9-CM Coordination and Maintenance Committee and were published in the Federal Register on May 5, 2011. After the new codes take effect on Oct. 1, CMS will only add new ICD-9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

Get Staff Up to Speed on Changes

With only a few months before implementation, the time to act is now, says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas.

"Coders will have to maker sure their systems are updated with the new codes," she notes. "Training will have to be done for all the staff."

Good idea: "This is a great example of when to have a lunch and learn session for all providers and other clinical staff that may be assigning diagnosis codes," Biffle suggests. Source URL :-

New ICD-10 Coding Conventions You Should Be Aware Of

Here are a few things you need to keep in mind as you make the transition from ICD-9 to ICD-10.

Excludes may include two different things
When you switch to ICD-10, one key change you'll see is 'excludes' will be of two types. Initially, this might seem like more burden to your coding work; however, this will only ease your work by getting rid of one of ICD-9's mistakes.

'X' or "X?" in your code listing? Well, this is here to help you
When you get hold of your ICD-10 manual, you will notice certain codes that include an 'X' or an "X?" in them – however don't assume that it's a printing error as it is there to assist you.

Whether left side or right side was treated while dealing with some anatomic areas
Worried about your ICD-10 manual ( Source "http://www.supercoder.com/icd-10/") being thicker than the ICD-9 book? Don't be. Because much of the book's additions are owing to the fact that many codes will require you to denote whether the left side or right side was treated while dealing with certain anatomic areas – it could be eyes, ears, hands, hands, feet, ovaries, and the like.

Right now, when you report acute atopic conjunctivitis, you use 372.05. In some rare examples, when insurers want to figure out which eye was affected, you add the RT or LT modifiers. When you make the transition, you will not only signify the specific type of conjunctivitis by reporting the most spot on diagnosis code, but will also have to specify which eye was affected. As such, depending on the eye infected, an acute atopic conjunctivitis diagnosis could track to one of these codes: H10.10, H10.11, H10.12 and H10.13.

A/R process: Tips to get your Practice its Deserved Reimbursements

Here are some medical billing tips to refine your accounts receivable (A/R) process swiftly and easily to bring in the money more efficiently. For the uninitiated, AR is the money that is owed to the practice.

Don't be a code it, bill it and forget it company - keep a tab on each claim you send out

Don't follow the footsteps of other companies who don't take any step to bring in the money. Ensure that someone in your practice monitors closely all the claims you submit. Enquire whether the insurance company received the claim or try to find out whether the patient paid her copay portion of the bill. Also, make it a point to follow up early; doing so can save you time. If it gets delayed, find out why.

Follow up if you get unpaid and denied claim

Every practice meets with unpaid and denied claim. The best way to ensure your practice is among dollars is to follow up on denials and appeal as the situation demands. Review your explanations of benefits (EOB), focusing on your denials. You can pick up a lot of information from your EOBs such as how quickly insurers are paying you, whether your fee schedule is enough, whether coders are doing their job properly, why insurance companies are denying your claims and if you are being paid as per your contracted rates.

You should update your A/R process

You need to produce a variety of reports to help you evaluate your A/R process. You can invest in a good management system and learn all of its capabilities. You should pay special attention to the reporting abilities of the system you use to ensure you get the data you need to manage your practice's A/R. It could be the practice's gross collection rate, net collection rate and average days in A/R for claims. After this, you can use this information to assess the efficiency of your practice's A/R management.

Source Code :- http://www.supercoder.com

ICD-9 codes 2012: A new Saddle Embolus Code Likely

Here's a refresher on some of the ICD-9 codes that you might have to use starting October 1.

ICD-9 2012 goes into effect on October 1 this year. As such, you need to be all geared up for the changes. Here are some proposed changes you need to be aware of.

Saddle embolus code: This time you may get to use a new saddle embolus code 415.13. For the uninitiated, a saddle embolus is where you have a very large blood clot that dislodges and then goes through the blood stream and lands in a big division of an artery.

NCHS proposes that the diagnosis gets its own code

This code came to the fore after National Center for Health Statistics (NCHS) realized that there is no ICD-9 index entry pointing to a proper pulmonary saddle embolus choice. Presently, ICD-9 does link the term 'saddle embolus' to the aorta. If you look under 2011 code 444.0, you will see 'saddle embolus' in the inclusion list. However this year's ICD-9 code changes will take that connection a step further. You can anticipate 444.0 to expand to provide more spot on coding: 444.01 (Saddle embolus of abdominal aorta) and 444.09 (Other arterial embolism and thrombosis of abdominal aorta).

Source URl :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/icd-9-2012-74731-promises-new-option-for-pulmonary-artery-disorders-107260-article

Apart from this, ICD-9 2012 intends to add V12.55 to provide a unique code for this part of the patient's history. What's more, you can even expect ICD-9 2012 to expand 747.3 to a range of five-digit codes: 747.31, 747.32 and 747.39. 747.31, the first proposed code refers to coarctation and atresia, both of which currently fall under 747.3.

Apart from these, as a radiology coder, you also need to watch out for expansion of cystostomy complication coding options. The proposal expands 596.8 into a new range of five digit codes.

Also anticipate: To add to it all, 997.5 and 996.39 might also undergo changes.

ICD-10 Preparation: Not Planning to Transition to ICD-10 as of Oct. 1, 2013? You Might Be Liable to Face Millions in Fines, CMS Reps Say

Plus: CMS officials are considering how to handle dates of service that span the pre- and post-ICD-10 implementation dates.

If you think the ICD-10 codes won't apply to your Medicare claims as of Oct. 1, 2013, CMS has news for you—not only will your claims be denied if you continue to submit ICD-9 codes to Medicare after that date, but you could face fines. CMS representatives shed light on this and several other issues during the agency's May 18 "ICD-10 National Provider Teleconference," and we've broken down the five FAQs that best apply to Part B practices.

Question 1: How will CMS handle claims that span from before Oct. 1, 2013 through dates after Oct. 1, 2013? Should the practitioner use ICD-9 or ICD-10 codes for these claims?

Answer: CMS is mulling how to handle this situation, but hasn't yet arrived at a firm decision. "We are getting very close to finalizing our decision for all claim types, including professional claims, supplier claims, and the various types of institutional claims," said CMS's Sarah Shirey-Losso during the call. "Some claims will continue to use the discharge date, some will use the ‘from' date, and some may be required to be split," she said.

Stay tuned: CMS is currently working on a final decision, which the agency will issue in a "Change Request" document this summer.

Date of service issue: If, however, you submit a claim for a single date of service, you'll submit ICD-9 codes for dates of service through Sept. 30, 2013, and ICD-10 codes for dates of service Oct. 1, 2013 and thereafter. For instance: If you send in a claim on Oct. 15, 2013, but the date of service is Sept. 1, 2013, you'll still use ICD-9 codes.

Question 2: Will workers' compensation insurers still use ICD-9, even after the rest of the industry transitions to ICD-10 after Oct. 1, 2013?

Answer: The answer to that is unclear, but CMS has heard murmurs that workers' comp. insurers will switch over to ICD-10.

"We've heard anecdotally that even though they're not required to transition to ICD-10, that many of them are planning to, just because it's more practical to do so and they see that it's the way the rest of the industry is going," said CMS's Denise Buenning, MsM, during the call.

Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-not-planning-to-transition-to-icd-10-as-of-oct-1-2013-you-might-be-liable-to-face-millions-in-fines-cms-reps-say-106761-article

Closures: 12001 or 13100? Consider More Than Layers to Code Correct Closure Level

Follow our tips to dig deeper and find the differences between 'simple,' 'intermediate,' and 'complex.'

All closures aren't created equal; one of the nuances of coding these procedures is knowing how to distinguish one type from another. Read on for our experts' advice on how to assess the three closure levels and assign the best codes.

Remember 'Simple' Doesn't Mean 'Easy'

A simple repair involves primarily the dermis and epidermis. It might involve subcutaneous tissues, but not deep layers.

Draw the line: How do you know when a closure might involve subcutaneous layers but is still considered a simple repair? Your provider's documentation is the key. The difference is whether the wound is closed in layers or just a single layer, experts note. The provider might decide to include the subcutaneous layer in the closure but does so by bringing the needle through the dermis into the subcutaneous and back. That results in a single-layer closure rather than closing the subcutaneous layer first and then the dermis/epidermis second in separate closure techniques.

But "simple" doesn't mean the repair is something anyone could do. Simple repairs involve one-layer closure, which helps set them apart from a standard E/M procedure. Simple repair also includes "local anesthesia, and chemical or electrocauterization of wounds not closed," says Dilsia Santiago, CCS, CCS-P, a coder in Reading, Pa.

For example, if your dermatologist uses adhesive strips to close a laceration, consider it an E/M service that you'll report with the best-fitting choice from CPT codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient). Most Steri-strip applications are done by nursing staff; but even if the physician applies them, they're included in the E/M service .

If, however, your dermatologist uses sutures, staples, or tissue adhesives to close the laceration, consider it a separate procedure. Choose your code from 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, eternal genitalia, trunk and/or extremities [including hands and feet]) or 12011-12018 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes), based on the lesion's location and size.

Measuring tip: For excision of soft tissue tumors, measure the longest dimension of an oblong mass, according to John P. Heiner, MD, professor at University of Wisconsin Hospital and Clinics in Madison.

Medicare exception: Guidelines change when your physician performs a single-layer laceration repair on a Medicare patient. You'll report G0168 (Wound closure utilizing tissue adhesive[s] only) instead of reporting standard CPT codes. If your physician uses sutures instead of tissue adhesive for Medicare patients, turn back to the standard suture/repair codes.

Source URL :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/closures-12001-or-13100-consider-more-than-layers-to-code-correct-closure-level-article


Jerry Salley, CPC, has over six years' experience writing about coding, focusing especially on ophthalmology coding with The Coding Institute's Ophthalmology Coding Alert . He has also written about optometry, gastroenterology, dermatology, audiology, and urology coding, as well as Joint Commission accreditation, healthcare human resources, and behavioral healthcare reimbursement issues. A graduate of Furman University, Jerry is a certified professional coder through the American Academy of Professional Coders.