Jen Godreau, BA, CPC, CPMA, CPEDCContent Director, SuperCoder.com
The Coding Institute, LLCNov. 23, 2010
Symposium Facts1. Dr. Hollmann
missed his calling as a comedian.
2. Chicago can be warm in November.
3. Joe’s Crab Shack is the place to be for seafood.
MPFS Ups & DownsDates Type Percent
June 2010 –Nov. 2010 2.2
Dec. 1, 2010 23.0
Jan. 1, 2011 2.51
Conversion Factor: $25.5217
-- Marc HartsteinDeputy Director
Hospital and Ambulatory Policy GroupCenter for Medicare
“Medicare Physician Payment Schedule 2011 Changes and Beyond”
Nov. 10, 2010
-- 2011 Medicare Physician Fee Schedule Final Rule
MEI Increases Office Space PayMedicare Economic Index (MEI)
2000 base %
2006 base %
Physician work
52.466 48.266
Practice expense
43.669 47.439
Malpractice
3.865 4.295Medicare increased the cost share weight for
office rent to 12.2 percent from a
proposed 8.4 percent.
Therapy Cap Uncertainty
2010 Therapy Cap: $18602011 Therapy Cap: $1870
Expiration: Dec. 31, 2010.
Will GPCI Be Extended?1.5 work GPCI
Alaska
1.o PE GPCI states:MontanaWyomingNorth DakotaNevadaSouth Dakota
G Codes Created for Tissue-Cultured Skin SubstituteCurrent Codes New Codes
Application
Skin Repair
Global Day Period
Apiligraf 15430, 15431
90
Dermagraft 15360, 15361, 15365, 15366
30
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)
G0441 ( … each additional 25 sq cm)
CRP Code Wins Payable Status
Good News Bad NewsStatus changed from
bundled to activeWork RVU: 0.75
Medicare will not pay for CRP performed by an audiologist because CRP is a therapeutic code. Medicare restricts payments for audiologists to audiological diagnostic tests.
95992 (Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day)
CPT Considers Times as Averages“In selecting time, the physician
must have spent a
time closest to the code selected.”-- CPT Assistant 2004
“If coding by time,pick the closest typical time.”
-- Peter Hollmann, MD“E/M, Vaccines and Time Based Codes”
CPT and RBRVS 2011 Annual Symposium
Thresholds Vs. AveragesFollowing CPT Assistant’s closest time code rule,
time breakdowns for office visits include:
Code CPT descriptor indicates physicians typically spend this many minutes face-to-face with the patient and/or family
CPT Assistant indicates to use when counseling/coordination of care dominates face-to-face office time totaling this many minutes
99212 10 10-12.5
99213 15 12.6-20.5
99214 25 20.6-32.5
99215 40 32.6 or more
Will Medicare Change Its Rule?
“I don’t want to sayone way either ‘Yes’ or
‘No’at this time.”
-- E/M expert Deborah Patterson, MDClinical Medical Director
Trailblazer Health Enterprises, LLC
Dallas
Vaccine Administration RehaulCPT 2011 deletes per vaccine administration
codes 90465-90467.90471-90474 (Immunization
administration ...) codes remain.The new codes are based on the number of
components.
Vaccine Administration Base CodeAssign one code for each vaccine’s initial
component:90460 (Immunization administration through
18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component)
Definition: A component refers to theantigen in a vaccine that prevents disease caused by one organism.
Each Additional ComponentFor each additional vaccine component,
report :+90461 (Immunization administration through
18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure))
Always report +90461 in addition to 90460.Bill the add-on code, plus the number of units
that represents the number of components.
ExampleA pediatrician counsels a mother on vaccine
risks and benefits prior to giving the patient Pediarix (90723), which has five components: DTaP-HepB-IPV. Diphtheria, tetanus toxoids, acellular pertussis, Hepatitis B and inactivated polio virus each count as one component. For the vaccine administration with counseling on the components included in Pediarix, you should report:
90460+90461 x 4.
Extended Observation
Code Interval History
Exam MDM Presenting Problem
Time (min)
Proposed RVU
Accepted RVU
99224
Problem focused
Problem focused
straightforward or of low complexity
stable, recovering, or improving
15 0.76 0.54
99225
expanded problem focused
expanded problem focused
moderate patient is responding inadequately to therapy or has developed a minor complication
25 1.39 0.96
99226
detailed detailed high unstable or has developed a significant complication or a significant new problem.
35 2.00 1.44
Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components:
11042-11047 Vs. 97597-97602(11040, 11041 have
been deleted)(For debridement of
skin, i.e. epidermis and/or dermis only, see 97597, 97598)
11042: Debridement, skin andskin and subcutaneous tissue [includes epidermis and dermis, if performed); first 20 sq cm or less
Active wound care of the skin, dermis, or epidermis.
0 day global periodIntent: “Active wound
care procedures are performed to remove devitalized and/or necrotic tissue and promote healing.”
Contact: Direct patient contact is required.
Sentinel Lymph Node Mapping
Includes injection of nonradioactive dye, when performed
For the injection of a radioisotope, use 38792.
38900 (Intraoperative identification [e.g., mapping] of sentinel lymph node[s] includes injection of non-radioactive dye, when performed [List separately in addition to code for primary procedure])
Photodynamic Therapy 96570 and 96571.If the pulmonologist performs 96570 for less
than 23 minutes, report modifier 52.For each increment after the first 30, you
have to get to the 8th minute for each interval.
Sleep StudiesTypes of Home Sleep Studies
Study Description CPT 2009 CPT 2010 CPT 2011
Type II Comprehensive portable polysomnography (min 7 channels)
G0398 95806 95806
Type III Modified portable sleep apnea testing (min 4 channels)
G0399 0203T 95800
Type IV Continuous single or dual bioparameters (min 3 channels per NCD CPAP for OSA)
G0400 0204T 95801
Pain Points1. Include imaging guidance in
64479-644842. Code paravertebral facet joint
blocks (64490-64495) bilaterally if the physician injects two sides at the same level.
3. Do not report the insertion 64555 in addition to new code 64566 for programming.
Amniotic Membrane CodesCode Membrane Placed
65578 on the ocular surface
65779 with suturing
65780 multiple layers
66999 using tissue glue
SCODI Also By Location92135 is deleted92133 (Scanning computerized ophthalmic
diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve)
92134 (… retina)92132 (Scanning computerized ophthalmic
diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral)
Nasal/Sinus DilationCode Location
31295 dilation of the maxillary sinus ostium, which can often be accessed transnasally or through the canine fossa if there’s been a previous puncture
31296 dilation of sinus ostium, in which the otolaryngologist does not remove tissue
31297 sphenoid sinus ostium is dilated
“These codes are for dilation of sinus ostium.”Do not use them if the otolaryngologist removes tissue.
Instead use the appropriate sinus endoscopy code, such as 31267 or 31276.
-- Richard W. Waguspeck, MD, FACSThe Triological Society, AMA CPT Advisory Committee Member
698012010 2011Labyrinothotomy, with or
without cyrosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs (single or multiple perfusions); transcanal
90 day global periodIncluded all required
infusions performed on the initial and subsequent days of treatment for 90 global days.
Labyrinothotomy, with perfusion of vestibuloactive drug(s); transcanal
0 day global periodCan now code per
injection on separate day.
Motility, Monitoring91117 -- Colon motility (manometric) study,
minimum 6 hours continuous recording [includes provocation tests, e.g., meal, intracolonic balloon distension, pharmacologic agents, if performed), with interpretation and report
91034 -- Esophagus, gastroesophageal reflux test, with nasal catheter pH electrode(s) placement, recording, analysis and interpretation
91035 -- … with mucosal attached telemetry pH electrode placment, recording, analysis and interpretation
FAQsYou can only bill the study once even if it’s
done for more than 48 hours.If the catheter is placed in an ASC, the center
cannot be involved in the staffing, physician work, or equipment. The office has to provide all those items and bill for them.
If the gastroenterologist does an office endoscopy for abnormalities and then places the capsule on same day, you may bill both the study 93015 and the scope with modifier 59 (43235-59).
Incomplete ColonoscopyWhen performing an endoscopy on a patient
who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope beyond the splenic flexure, due to unforeseen circumstances, report the colonoscopy code with modifier 53 and appropriate documentation.
Uniform method: Aligns CPT with Medicare.
Combined Abdomen Pelvis CTStand Alone Code 74150
CT AbdomenWO Contrast
74160CT AbdomenW Contrast
74170CT AbdomenWO/W Contrast
72192CT PelvisWO Contrast
74176 74178 74178
72193CT PelvisW Contrast
74178 74177 74178
72194CT PelvisWO/W Contrast
74178 74178 74178
Device Monitoring code deletionsintroductory language changescode revisions93224 – External WearableWearable electrocardiocraphic
rhythm derived monitoring for 24 hours rhythm derived monitoring for 24 hours recording up to 48 hours by continuous original original waveform waveform rhythm recording and storage, with , with visual superimposition scanningvisual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation
For codes 93224-93227, when a continuous is less than 12 hours, use modifier 52.
Cardiac CatheterizationThe new noncongenital studies include:Most injection procedure servicesImaging supervisionInterpretation and report.
Left heath catheterization includes left ventriculography (injection procedure, supervision, interpretation and report) when performed
Table of Catheterization Codes
New Hip Arthroscopy Codes Code Describes Treats
29914 arthroscopy with femoroplasty
cam lesion
29915 arthroscopy with acetabloplasty,
pincer lesion, a new disease
The treatment grinds away the excess lesions.
29916 analagous to a labral repair at the shoulder or knee
sports injuries
Get up-to-date on the latest coding changes from the comfort of your desk at
www.audioeducator.com!
ResourcesCPT® and RBRVS 2011 Annual Symposium;
Nov. 10-12, 2010, Chicago.2011 CPT Professional Edition; American
Medical Association.
Ensuring reimbursement. Insuring coders.Ensuring reimbursement. Insuring coders.
Questions
Jen Godreau, Content Director, Supercoder.comFamily Practice, Pediatrics, Otolaryngology:
www.supercoder.com/forum/