Operating Room Microscope

On November 4th, 2010, posted in: Tips by

Medicare doesn’t reimburse for the use of the operating room microscope often; in fact, there are very few codes that allow the addition of the CPT code 69990 on the claim. However, for the procedures that still allow the reporting and payment of the scope, you need to remember to document the use clearly in the body of your report.

Consider documenting in a separate line and clearly indicate the reason for the use. The effort is well worth it – the reimbursement is about $215.00. The codes that would apply for our client population are:

64840 through 64858
64861 though 64870 and
64885 through 64898

The remaining codes are for use in cranial surgery and currently do not apply to any of our clients.

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Smoking Cessation – coding changes

On November 4th, 2010, posted in: Industry News by

CMS has changed its coverage policy for smoking cessation. Codes 99406 (3-10 minutes) and 99407 (more than 10 minutes counseling) may still be reported for patients that present with a tobacco related illness or disease.

If the tobacco use is preventing healing or you are just counseling the patient to quit, between now and December 31, 2010, we will report code 99199 – with a diagnosis of 305.1 – non-dependent tobacco use disorder or V15.82 – history of tobacco use , you must decide on which code is most appropriate. The service may be provided by a physician or a qualified mid-level provider.

On January 1, 2011 the codes change for asymptomatic patients, please add these codes to your superbill:

G0436 smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes of counseling – up to 10 minutes or

G0437 smoking and tobacco cessations counseling visit for the asymptomatic patient greater than 10 minutes, intensive counseling

CMS says you should use 305.1 or V15.82 when reporting the “G” code(s). And remember, document the time spent. You can bill these services up to 8 times per year in addition to your E/M code. For the remainder of 2010, this service may be subject to co-insurance and deductible amounts.

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Some significant CPT changes for 2011

On November 4th, 2010, posted in: Industry News by

Cardiac cath – codes for left, right and combined heart catheterization (including 93501, 93510, and 93511, 93514 and 93524-93529) have been deleted, along with catheterization imaging codes 93555 and 93556. The replacement codes are 93451 and 93464, which bundle imaging into catheterization.

Arthrodesis and cervical fusion – until now, you could previously bill 22554 and 63075 for anterior cervical discectomy and interbody fusion at the same level in the same encounter. In 2011 you will report a new code, 22551, by itself, with add-on code 22552 for each additional interspace.

Transforaminal epidurals – fluoroscopic and ultrasound guidance codes billed alongside 64479-64484 will be bundled into the injection. The procedures cannot be performed without guidance, but you won’t be paid.

Category III codes have been established for transforaminal injection that include ultrasound guidance.

0228T Injection cervical or thoracic; single level, with ultrasound guidance
0230T Injection lumbar or sacral; single level, with ultrasound guidance

If you are performing injections with ultrasound, the category III codes must be reported beginning now. The changes took place October 1, 2010. Note, there are some carriers that will still want the old codes and claims will be adjusted per carrier requirements. All claims to Medicare must be reported with the “T” codes.

RVU’s are not assigned to the “T” codes; therefore payment will vary carrier to carrier.

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On November 4th, 2010, posted in: Industry News by

The tobacco measure may no longer be an option for you after this year. Measure 114 and 115 (preventative care advising smokers and tobacco user to quit) are set to be deleted for the 2011 PQRI program. However, CMS will still pay for smoking cessation counseling.

You still may report measure 124, G8447, use of CCHIT EMR or G8448, use of non-CCHIT certified EMR on claims when billing a valid patient encounter. Internal medicine and family practice physicians still have the broadest range of codes to choose from as the reporting denominator/numerator for specialty practices are often hard to meet.

The 2011 PQRI program notes will be published after the fee scheduled is finalized. Remember the bonus drops from 2% to 1% of your Medicare payments.

We will keep you updated and if you should wish to begin reporting in 2011, please contact us and we will give you any information we have on the subject. One option to receive the bonus is to report through a registry. Go to: www.cms.gov/PQRI – go to “how to get started” and scroll to the bottom – go to link for qualified registries for 2010 PQRI reporting. This is a PDF file and will list the registries. When you report through a registry, there is more work entailed on your end, but you don’t have to report as many times. There is a cost and that may vary from registry to registry. This may be a better option than the claim by claim reporting. In fact, you still have time to report for 2010 through a registry and receive your bonus.

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On November 4th, 2010, posted in: Tips by

Those of you who have not received an E-scribe bonus (you will see the amount on your end of month report), still have time to earn a bonus for 2010 if you have the capability of reporting through a qualified hand held system or your EMR.

The code G8553, at least one prescription was created during the encounter and was transmitted electronically using a qualified system, can be reported a total of 25 times (visits) (for 2010) in order to earn the 2% bonus on your total Medicare payments.

Medicare is using the data collected throughout 2010 to determine if Medicare will apply penalties in 2012 and 2013 for not using E-scribe.

There are several options on the market for you, including free e-prescribing systems such as one offered by the National ePrescribing Patient Safety Initiative at www.nationalerx.com.

Remember, you can only report the e-scribe code during an eligible encounter which basically translates to a billable office visit. Prescriptions reported during a post-operative period with no billable encounter do not qualify.

You will not be eligible if less than 10% of your Medicare reimbursement comes from these codes, nor will you be eligible for an e-scribe bonus when you earn an EHR incentive Program bonus under the Medicare program.

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Each of the following scenarios will tell you whether or not a prescription counts as e-scribing under CMS’s rules. The scenarios are based on CMS policy governing the program and the questions that were asked during a recent CMS teleconference.

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On July 1, 2010 Medicare started paying less for certain imaging procedures when performed in the same imaging session due to a provision in the new health care act.

The TC portion of the claim is affected, not the professional component, and only when Medicare considers the scans to be in a contiguous imaging family and they are performed together.

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The US Department of HHS announced July 1, 2010 the establishment of a new Pre-existing Condition Insurance Plan that offers coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health conditions.

This plan will provide a new health coverage option for Americans who have been uninsured for at least 6 months, have been unable to get health coverage because of a medical condition and are a US citizen or are residing in the US legally.

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Medically necessary reasons that support this scope include but are not limited to:

  • Macroglossia preventing mirror exam
  • Gag reflex preventing mirror exam
  • Patient unable to cooperate to allow mirror exam due to age or mental condition
  • Hoarseness, dysphasia, aspiration not clearly evaluated by indirect laryngoscopy
  • Lesion identified by mirror exam needing further evaluation
  • Anterior commissure not completely visualized by mirror exam
  • Aspiration suspected that cannot be evaluated by mirror exam
  • Evaluation of the larynx and immediate subglottis in patients for tracheal decannulation
  • Acute airway obstruction

Remember, using a mirror, 31505 to perform an exam of the throat, oropharynx, etc. is part of the E/M service based on 1997 E/M guidelines.

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  • Visual Excess Cerumen impairs the exam of clinically significant portions of the external auditory canal, tympanic membrane or middle ear condition.
  • Qualitative Extremely hard, dry, irritative Cerumen causing symptoms such as pain, itching and/or hearing loss occur
  • Inflammatory Associated with foul odor, infection or dermatitis
  • Quantitative Obstructive, copious Cerumen that requires a physician skill to remove with magnification and multiple instrumentations.

Removal by lavage, cotton swab, drops or spoon is not paid separately.

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