Cardiology Coding Alert

Question:  Yes, I was wondering if the bell curves that were mentioned that CMS does for each specialty, are they available on their website or somewhere we can get those to compare our practice to those?

Answer:  They are, they do not show it as a bell curve and I cannot even think of the site right now, but I could try to get it for you and relay it to you, or you could call Medicare.  They do have each code and each specialty listed for every single CPT code.  So if you take the numbers, they will say like 99201:33,000, 99202:50,000.  You can take those numbers and transform it yourself and make your own bell curves.  In other words, you will make your bell curve according to their stats and then all you have to do is take your production report, the production analysis for the end of the year - it would be better for the whole year - and provider B (your doctor) and log how many he did 99201, 99202, 99203, 99204, 99205 and put that on a bell curve and then just compare them and you will see exactly how your physician compares to the norms.

Comments:  Okay, thank you very much. Question:  Hi, I have a question, we understand the concept of when you would utilize modifier 25 with your E/M level in addition to a surgical procedure that is performed.  My question is, I understand according to CMS rules when you would apply the modifier 25 versus the modifier 57 having to do with the minor and the major surgical procedures. However, we have had some information saying that of course CPT does not recognize minor and major surgical procedures, so would there be any information out there to designate if it is not a Medicare or Medicaid patient,  whether we should be appending the modifier 25 or the modifier 57, just for decision for surgery when there are no other problems or diagnoses?

Answer:  Right, the difference is you use modifier 57 when the surgical procedure has a 90-day global.  So it is mostly your surgical procedures that would be in the hospital and of course you know what that is too.  If your decision was made for surgery the same or next day - so you had somebody come in, they were in really bad shape, you admitted them and you did surgery today or tomorrow.  You would use modifier 57. Question:  Right and I understand that and according to CMS rules, they recognize the minor and the major with 0-10 days for minor and 90-day global follow-up for major.

Answer:  Right. Question:  But we have received some information that according to CPT guidelines, [...]