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Issue #102 - June 4, 2008 
AAPC EdgeBlast
CPT® 2009: 50 Changes for E/M Alone
The American Medical Association (AMA) recently pulled a corner of the sheet hiding the planned changes to 2009 CPT® codes for its resellers. The anticipated numbers of new, revised, and deleted codes for each section are below. Most noteworthy are the biggest changes to evaluation and management (E/M) codes in more than a decade. The 50 changes to E/M are only part of the expected 519 additions, changes, and deletions. They're significant compared to recent years and will come on the heel of the many proposed changes to ICD-9-CM announcement.

EdgeBlast will keep you apprised as we learn more.

Section  New  Revised  Deleted
Anesthesia  2 2 0
E/M 17 18 15
Surgery  36 58 9
Radiology  4 1 6
Path & Lab  7 17 1
Medicine  67 20 37
Category II  147 10 2
Category III  14 7 22
========================================
Total  294 133 92

HCPCS Level II Hearings Agenda:
the Word is Out

The Centers for Medicare and Medicaid Services (CMS) just finished several days of public hearings on changes to the Healthcare Common Procedure Coding System (HCPCS Level II). Agendas for the meeting addressed requests and CMS' preliminary coding decisions with an overview of Medicare pricing and payment methodology.

Code sections covered were those that impacted reimbursement through durable medical equipment (DME) rules usually reimbursed through Medicare administrative contractors (MACs). Several days were dedicated to meetings on the classes of supplies:

Supplies

  • Orthotics and prosthetics
  • Drugs, biologicals, and radiopharmaceuticals
  • Durable Medical Equipment

Suppliers and manufacturers presented new and existing products to the HCPCS Committee and representatives from other federal groups and contractors. Some wanted new codes. Others wanted changes to existing codes. Some presenters wanted their products added to existing codes. Some simply wanted to clarify decisions already made.

The public meetings are an opportunity for the public to contribute to HCPCS Level II code set modification requests. Final decisions are subject to change and released in November.

Find Quarterly Updates to CCI Edits
On July 1, quarterly updates to Correct Coding Initiative (CCI) edits go into effect for physicians who submit claims to Medicare carriers and A/B Medicare administrative contractors (A/B MACs).

Version 14.2 of CCI edits include all previous versions and updates from Jan. 1 to the present and are organized into two tables:

  • Column 1/Column 2 Correct Coding Edits
  • Mutually Exclusive Code (MEC) Edits

Find information about CCI, including the current CCI and MEC edits.

View the official change request (CR) 6045 issued to carriers and A/B MACs.

2008 DMEPOS Fee Schedule Updates
Change request (CR) 6022 provides the quarterly update to the July 2008 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedules which implements new codes' fee schedule amounts and revises fee schedule amounts for existing codes with calculated errors. CR 6022 affects providers and suppliers submitting claims to Medicare contractors for DMEPOS for Medicare beneficiaries.

Changes to HCPCS Level II include:
  • Codes A5083, E0856, E2228, E2227, E2397, L3927, L7611–L7614, L7621, and L7622 were added to these fee schedule amounts and were paid on a local fee schedule basis effective Jan. 1.
  • The fee schedule amounts for codes L3905, L3806, and L3808 are revised to correct fee schedule calculation errors, and the revised fee schedule amounts will be added to the fee schedule.
  • Code K0672 Addition to Lower Extremity Orthosis, Removable Soft Interface, All Components, Replacement Only, Each was added to the HCPCS Level II file effective April 1.
  • The fee schedule amounts for code E0461 Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g. mask) were inadvertently dropped from the January DMEPOS fee schedule file, and it was revised to add the E0461 fee schedule amounts.

Notify billing staff of these changes.

The DMEPOS fee schedule's update process is located in chapter 23, section 60 of the Medicare Claims Processing Manual.

Other DMEPOS fee schedule information.

AMA Board Member Fears
RAC and ICD-10's Impact on Small Practices

William Dolan, American Medical Association (AMA) board member and a practicing orthopaedic surgeon from Rochester, N. Y., testified to CMS regulations and programs' impact on small health care providers, stating, "Approximately 75 percent of physician practices are composed of fewer than eight physicians. For the majority of these small physician practices, including mine, burdensome regulations can take valuable time away from patient care. We believe this is particularly true with regard to the Recovery Audit Contractor (RAC) program and the ICD-10 implementation." When talking about RACs, he asked CMS to act on the following:

  • Consult with the AMA on RAC/physician communications
  • Preclude RACs from reviewing claims from the past twelve months
  • Not permit RACs to review evaluation and management (E/M) services or medical necessity determinations billing issues
  • Limit the number of medical records requested from individual physicians
  • Encourage the pursuit of underpayments as well as overpayments by requiring RACs to accept case files from providers for underpayment reviews

He concluded his testimonial with, "The AMA looks forward to working closely with the Small Business Committee to ensure that physician practices, especially the smaller practices, like my own, are able to manage the RAC audit process and prepare for the ICD-10 transition without compromising the delivery of health care."

Go to the Medical News Today website for the story.

CMS Advisory Opinion to Link EHRs and Physicians
CMS, in an advisory opinion, said a hospital system's proposal to pay for customized software to help communicate between its electronic health record (EHR) system and affiliated physicians' EHR software may be a permitted compensation under physician referral laws.
The proposal may not be prohibited because the hospital ensured that the software is used solely to communicate results of tests and procedures furnished by the hospital, and would only allow physicians to perform functions they already perform at the hospital.

Read more about the CMS advisory opinion.

Coding Tips
Take a Closer Look at New Orthopaedic Procedures.
The inclusion of several orthopaedic procedures to the ambulatory surgery center (ASC)-approved list brings with it the opportunity for additional reimbursement.

Telephone and Online Services: How Much Is Your Practice Losing? As background, CPT® 1995 introduced three codes to enable physicians to charge for telephone management services.

Coding Consult: Six Top Coding Tips
The experts share their favorite coding pearls.

Call for EdgeBlast Writers
Do you have timely coding news, coding tips, or coding expertise you'd like to include in the EdgeBlast? If so, email them to michelle.dick@aapc.com. We'll give you credit for any articles we use.



Medical News
Control Personal Medical Data with Google Health
Google has launched Google Health for securely gathering, storing, and downloading personal medical data online. You can privately control to and with whom you wish to share your health information.

ACP Creates Foundation for
Universal Affordable Health Insurance

American College of Physicians (ACP) released the framework for policies that enable all Americans access to affordable health insurance coverage.

30 Communities Partake in EHR Project
More than 30 communities have applied for an electronic health records (EHR) demonstration project with Medicare incentive payments for physician practices. The project is to help reduce medical errors and improve the quality of care for an estimated 3.6 million Americans.

Over 60? CDC Says Get Shingles Vaccination
The success of the chickenpox vaccine has led to an increase in shingles. The United States Centers for Disease Control and Prevention (CDC) recommends older adults get the shingles vaccine, especially if it runs in your family.

Judge Blocks Attempt to Implement Medicaid Rule
Federal Judge James Robertson of the United States District Court "slapped down" an attempt by the Bush administration to impose a Medicaid regulation that would reduce Medicaid payments to safety net hospitals and clinics.

Congratulations to Cynthia Norling, CCS-P, CPC-H
On May 25, Cynthia Norling, CCS-P, CPC-H, coding educator and research coordinator for PrimeWest Health, was recognized by Cambridge Who's Who for showing dedication, leadership and excellence in information management.

Coding Job Links
AAPC Job Database

AAPC Employment Forums

Test Yourself Online
The Test Yourself questions can be accessed online at www.aapc.com/testyourself/. Once you go there and take the test, you can automatically grade your answers, correct any mistakes, and have your CEUs automatically added to your CEU Tracker for submission.

Featured Items
CPT® 2009: 50 Changes
HCPCS Lvl II Hearings
CCI Quarterly Edits
DMEPOS Schedule Updates
AMA Board Member Fears
CMS Advisory Opinion
Coding Tips
Call for EB Writers
Medical News
Coding Job Links
Test Yourself Online


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CPT® codes Copyright 2007 American Medical Association. All Rights Reserved. CPT® is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.