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/