NEW CODES from CMS

On August 12th, 2010, posted in: Industry News by

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CMS recently announced several new codes:

  • G0429 Dermal filler injection for the treatment of facial lipodystrophy syndrome (LDS)
  • Q2026 Injection, Radiesse, 0.1 ml
  • Q2027 Injection, Sculptra, 0.1 ml
  • G0428 Collagen meniscus implant procedure for filling meniscal defects (e.g. collagen scaffold, Menaflex) – NOT covered by Medicare- per transmittal 1977 – if you do this, get an ABN signed, we will bill it, receive the denial and you in turn can bill the patient.

Physical Therapy in Physician Offices
The Medicare Payment Advisory Commission at their last meeting in July suggests a big crackdown on physician-owned physical therapy services. MedPac recently released a report recommending that Congress exclude physical therapy services from the STARK law exception that allows physicians to self refer patients for ancillary services in which they have a financial relationship, according to a press release from the American Physical Therapy Association.

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Emerging Technology Codes

On August 12th, 2010, posted in: Industry News by

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The AMA released four new transforaminal codes in January and one plasma injection code on July 1st. These codes should be reported. By reporting these codes, data is collected on these procedures which will help the CPT committee determine if a Category I code will be assigned.

The new codes are:

  • 0228T Injection(s) anesthetic agent and/or steroid, transforaminal epidural, with US guidance, cervical or thoracic; single level
  • 0229T each additional level
  • 0230T Injection, transforaminal epidural with US guidance, lumbar or sacral; single level
  • 0231T each additional level
  • 0232T Injection platelet rich plasma, any tissue, including imaging guidance, harvesting and preparation when performed.

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IBC authorization requirements

On August 12th, 2010, posted in: Industry News, Tips by

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Effective October 1, 2010, all NaviNet network providers must submit authorization requests through NaviNet. The following authorization must be done through the system:

  • Medical/surgical procedures
  • Cardiac rehab
  • Chemotherapy/infusion
  • DME
  • Emergency hospital admission notification
  • Home health
    • Dietitian
    • Home health aide
    • Occupational therapy
    • Physical therapy
    • Skilled nursing
    • Social work
    • Speech therapy
  • Home infusion
  • Outpatient speech therapy
  • Pulmonary rehab
  • Sleep studies

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Front Desk Card Check Alert

On August 12th, 2010, posted in: Tips by

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IBC no longer offers Security 65. Any patient that presents with this card does not have valid insurance. The new insurance is called Medigapsecurity-Plan A, B, C, F and N . This name and the plan the individual choose will be indicated on the right hand side of the card. Please ask the patient for updated information.

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Kyphoplasty/Vertebroplasty

On August 12th, 2010, posted in: Tips by

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You can report imaging for needle positioning and injection assessment during kypholasty or vertebroplasty with a ‘26’ modifier if you are personally performing the guidance. Make sure it is clearly indicated in your operative report and state the type of guidance you use – CT or Fluoroscopy.

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NEW FLU CODES for this flu season

On August 12th, 2010, posted in: Tips by

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  • 315.35 childhood onset fluency disorder
  • 488.01 flu due to identified avian flu virus w/pneumonia
  • 488.02 flu due to identified avian flu w/other respiratory manifestations
  • 488.09 flu due to identified avian flu w/ other manifestations
  • 488.11 flu due to identified novel H1N1 flu w/pneumonia
  • 488.12 flu due to identified novel H1N1 w/other respiratory manifestations
  • 488.19 flu due to identified novel H1N1 w/other manifestations
  • 784.52 flu disorder in conditions classified elsewhere

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CMS has proposed to cut physical therapy payments next year. In the proposal, CMS would apply the reduction to ‘always therapy’ codes (list attached- provided by Orthopedic Pink Sheet).

The agency reason that when multiple therapy services are billed in the same session “duplicate clinical labor and supplies are included in the practice expense RVU of the services furnished.” CMS is proposing to pay 100% for the highest RVU code and reduce the additional codes by 50%.

On the Ortho side (and all others), if CMS adopts its proposed Medicare fee schedule reduction, if Congress fails to fix the SGR, December 1st could bring approximately a 23% reduction with an additional 6.1% cut on January 1, 2011, bringing the total reduction to nearly 30%.

As example, the cut would have a significant impact on individual codes. 99214 would pay $49.00 next year compared to $67.00 now. 99214 would pay $72.43, compared to this year $100. (Amounts not adjusted geographically).

A total hip will pay $1,005.00 according to CMS, compared to $1,408; total knee $1,074 compared to $1,505.

In the proposed rule, CMS estimates next year’s conversion factor could be $26.6574, more than $10 less than the current rate of $36.8729.

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E-Scribe Reminder

On August 12th, 2010, posted in: Tips by

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Remember to report, on your fee ticket, every time you use your electronic e-prescribing. There may be a bonus for doing so. You must report at least 50% of the Medicare scripts via e-scribe to potentially qualify for the bonus. If the “G” code is not on your form – write ‘E-Rx’ somewhere on the form and we will report the “G” code with the claim.

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PQRI

On August 12th, 2010, posted in: Industry News by

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Earning a Medicare quality bonus might get easier in 2011. CMS plans to lower the claims-based criteria to 50% of eligible patient encounters from the current standard of 80%. Although that is good news, the bad news is that they also want to lower the incentive payment to 1% . The reduction is part of a long-term transition from incentives to participate in PQRI to penalties that kick in for 2015 and beyond for failure to participate. Starting 2015, failure to report will result in a 1.5% pay reduction.

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Highmark Blue Shield is now making EFT (electronic fund transfers) mandatory. We will start the change in enrollment process, for those of you who are not yet enrolled, within the next few weeks and will inform you when this change will occur. Once activated, you will no longer receive paper checks or EOBs. EOBs will be downloaded in our office and the EFT will go directly into your bank. We suggest you check bank balance daily to reconcile EFT deposits.

Meaningful use Requirements – finalized – what your EMR must do to benefit from incentive bonus

The EHR incentive program eventually will pay out $27 billion over the next couple of years. How much of that money your practice takes in will depend on when you start meeting meaningful use requirements and whether you qualify for Medicare or Medicaid incentives. Failing to demonstrate meaningful use by the end of 2014 means decreased Medicare payments in 2015.

Your bonus will be equal to 75% of your Medicare allowable charges for services provided during the year. Each eligible provider in you practice can earn up to a maximum of $44,000 over five years starting in 2011. No bonus will be paid after 2016. Bonus is issued per physician and is considered income and can be signed over to the group. Incentives are paid on an individual reporting basis.

There are 15 meaningful use core objectives and measures your EMR must meet. A list of the measures, can be found on the Federal Register website http://www.gpoaccess.gov/fr/.   Please contact your EMR vendor and question their readiness.

After meeting the core requirements, you will also have to meet 5 elements from the ‘menu’ set listing which the Federal Register published. To read the fact sheet on the final rule, visit:
www.cms.gov/apps/media/fact_sheets.asp

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