Part B Insider (Multispecialty) Coding Alert
Eye Surgeons Win Boost as CMS Reviews RVUs
PDF
Good news for physicians billing for voice prosthetics and eye surgery codes. The good news CPT 92597 (evaluate and fit voice prosthetic) will now be covered by Medicare as of last March 1. CMS admits it wrongly gave this code a status indicator of I (non-covered) and an RVU of 2.84. In fact, the code should have a status indicator of A (active) and an RVU of 2.53, CMS admits. This should spell payment of around $93 instead of the $104.40 it would have reimbursed had it been covered previously. The bad news Three other codes went from active to C for carrier pricing, however: 93315 (transesoph echo-cong card anom), 95951 (monitor cerebral seiz-cable) and G0125 (PET imag rgn/whole body). These three codes had their RVUs drop from 7.57, 8.63 and 57.30, respectively, to zero.
The quarterly housekeeping for physician coding yielded a few winners and losers. In the May 30 Federal Register (Vol. 68, No. 104, pp. 32400-32405), the Centers for Medicare and Medicaid Services boosted reimbursement for a handful of codes and ended coverage for a number of others.
CMS boosted facility and non-facility RVUs for half a dozen codes: 53853 (prostatic water thermotherapy) and eye surgery codes 66710 (destruction of ciliary body), 66720 (destruction of ciliary body), 66761 (revision of iris), 66762 (revision of iris) and 66770 (removal of inner eye lesion). For example, 53853 will now reimburse about $1634 in the nonfacility setting, up from $1567 previously. (See chart for details.)
CMS said it wrongly assigned status code A to CPT code 67221 (ocular photodynamic ther), which should instead have status code R, for restricted or carrier discretion. It corrected CPT code 90723 from X to I, both of which indicate non-covered codes.
CMS says it erred in assigning RVUs to four other codes that Medicare never covers: G0219, G0219-26, G0255 and G0255-26. CMS also wrongly assigned an RVU to a new emerging technology code, 0020T, and erroneously created new codes to go with it, G0279 and G0280. CMS also clarified that it will no longer recognize code 0019T for Medicare purposes.
CMS corrected the global periods for five codes. CPT codes 33224, 77789, 77789-26 and 77789-TC should all have a global period of "XXX," while CPT code 58550 should have a 90-day global period.
CMS also made adjustments to dozens of PE-RVUs, most of them increases of a few pennies. CMS makes a number of housekeeping corrections, including removing codes P2031 and P7001 from a list of clinical lab codes and adding speech pathology code 92597 to a list of designated health services. 
Part B Insider (Multispecialty) Coding Alert
- Physician Payments:
Congressmen Call For Drug-Free Physician Growth Rate
Physicians are getting shafted because drug expenses make their payments look as if they're growing [...] - MEDICARE OVERHAUL:
Physicians, Brace Yourselves for Medicare Reform
A Medicare reform plan could pass as soon as this summer, but you're not likely [...] - Medicare Prescription Drugs:
SENATE FINANCE PRODUCES BIPARTISAN Rx PLAN
Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and ranking Democrat Max Baucus (D-Mont.) unveiled a [...] - Medicare Private Plans:
Nudging Patients Into Private Health Plans
Physicians may still have to deal with preferred provider organizations, but it won't be in [...] - Payment Revisions:
Eye Surgeons Win Boost as CMS Reviews RVUs
Good news for physicians billing for voice prosthetics and eye surgery codes.
The quarterly housekeeping [...] - Drugs:
Jan. 1 Could Be D-Day for Drug Payments
Oncologists and others who dispense medications under Medicare could be under the gun in a [...] - OIG Excludes 200 per Month
Heads up, physicians. The HHS Office of Inspector General is out for blood.
In its [...] - Studies & Surveys:
Emergency Care Costs Doctors $4.2 Billion a Year
Think it's just emergency department physicians who suffer from unreimbursed emergency care? You're off your [...] - Coverage:
ICD COVERAGE EXPANDS - BUT ONLY SLIGHTLY
Healthcare providers will soon be able to bill Medicare for implantable cardioverter defibrillators in more [...] - REIMBURSEMENT:
New Guidelines Mean Broader Application of Deep Brain Stimulation Codes
New guidelines from the Centers for Medicare & Medicaid Services have allowed for broader use [...] - Don't Forget to Charge for Programming
Following implantation of a DBS unit, the surgeon (or a neurologist) must test the device [...] - Coding:
Add Prolonged Services to Applicable E/M Only
If you're billing for prolonged service codes 99354-99357, you should be careful to avoid adding [...] - Legislation:
SENATORS AGREE ON GENERIC DRUG BILL
A bipartisan compromise announced June 5 means the Senate is again likely to pass legislation [...] - Coverage:
Beneficiary Rage Leads to Likely Coverage
Taking the Centers for Medicare & Medicaid Services to court proved a worthwhile strategy for [...] - Reimbursement:
An ED Visit and a Hospital Admission on the Same Day? Earn Proper Payment
How can you code for optimal reimbursement if the surgeon sees a patient in the [...] - Coding:
Can't Decide Between -51 and -59? Here's How to Choose
Physicians, coders and payers alike often have trouble distinguishing between modifiers -59 (Distinct procedural service) [...] - Physician Notes:
Radiologist-Hospital JV Clears Anti-Kickback Hurdles
The fact that radiologists don't typically order the tests they perform allowed an otherwise potentially [...]