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Issue #104 - July 2, 2008 
AAPC EdgeBlast
Congress Fails to Delay 10.6 Percent Cuts; CMS Waits
A House-passed bill (HR 6331) to delay the 10.6 percent reduction in payment for Medicare services under the Medicare physician fee schedule (MPFS) failed in the Senate by one vote last week, according to CongressDaily. The reduction in payment was effective yesterday, July 1. Although the payment cut was originally scheduled to be effective on Jan. 1, Congress postponed the implementation of the cut until July 1.

But there is reason to hope. The Centers for Medicare & Medicaid Services (CMS) announced it will direct its contractors to hold the processing of all physician and non-physician claims for services on or after July 1 for at least 10 days. This will allow more time for Congress to pass necessary legislation to forestall the deep reimbursement. The week of July 7 is the soonest Congress, which will be returning from the Independence Day holiday, can consider the legislation necessary to prevent the cut from taking place.

CMS hopes to avoid a situation where claims are submitted, paid at the lower rate, and then Congress passes legislation to repeal the cut retroactive to July 1. See Medical News Today for details. Listen to a NPR audio clip to hear the story.

CMS J2 AB/MAC Award Protested
A protest filed with the Government Accountability Office (GAO) against the Jurisdiction 2 (J2) award of the Part A/Part B Medicare administrative contractor (AB/MAC) to National Heritage Insurance Corporation (NHIC) under the Competition in Contracting Act (CICA) has delayed implementation of that change.

CMS awarded the seventh and eighth contracts for a A/B MAC. CMS selected NHIC to be the A/B MAC for J2, comprised of Alaska, Idaho, Oregon, and Washington. Pinnacle Business Solutions, Inc. (PBSI) was awarded the A/B MAC for Jurisdiction 7 (J7), comprised of Arkansas, Louisiana, and Mississippi. A total of 15 A/B MACs will be awarded by 2011 to fulfill requirements of the Medicare Contracting Reform provisions of the Medicare Modernization Act of 2003 (MMA).

 More information can be found on the Medicare Contracting Reform Web page and in the What’s New area of the CMS Web site.

Find Your LCD Info at Trailblazer
By Penny Sparks, CPC

Local Coverage Determinations (LCD) carrier-established medical policies was posted to the new TrailBlazer Web site June 13th. The redesigned LCD Web page allows providers to:

  • Select either Part A or Part B, and then the applicable state.
  • Click Search to display a listing of the LCDs. You may also enter a term or code in the search field.

TrailBlazer has a new Medicare Part B form to request a reopening or clerical error on a claim, effective in June.
J4 LCDs are active for:

  • March 1 - New Mexico Part B; Oklahoma Part A and Part B
  • March 21 - Colorado Part B

June 13 - Colorado and New Mexico Part A; Texas Part A and Part B

Critical Changes to Critical Code
ByTracie Luke, CPC

Effective July 1, Change Release (CR) 5993 revises the Medicare Claims Processing Manual chapter 12 (Physicians/Non-physician Practitioners), section 30.6.12. (Critical Care Visits and Neonatal Intensive Care Codes (99291-99292)). CR 5993 replaces previous critical care payment policy language and adds general Medicare evaluation and management (E/M) payment policies for critical care services.

CR 5993:
  • Explains the definition of, and how to bill for, critical care services, and includes the American Medical Association (AMA) CPT® definitions of critical care and critical care services. Physicians should consult the AMA CPT® Manual for applicable codes and guidance for critical care services provided to neonates, infants, and children.
  • Adds a new CPT® code for 2008 (36591 Collection of blood specimen from a completely implantable venous access device) replacing code 36540. Code 36591 identifies a bundled vascular access procedure when performed with a critical care service.

Here are links related to the story:
CR 5993
MLN Matter 5993
PBSI Medicare Services

New Waived Tests Under CLIA
CR6060 amends CR 5913 to add 24 new CLIA waived tests approved by the Food and Drug Administration (FDA) under Clinical Laboratory Improvement Amendments of 1988 (CLIA). To view the latest tests in table format, go to MLN Matters article MM6060.

New waived CPT®/HCPCS Level I code(s) are:

  • 84550QW Uric acid; blood is assigned for the uric acid test performed using the abaxis piccolo blood chemistry analyzer (general chemistry 13 panel){whole blood} and the abaxis piccolo xpress chemistry analyzer (general chemistry 13 panel){whole blood}; and
  • 82330QW, 82374QW, 82435QW, 84132QW, and 84295QW are assigned for the ionized calcium, carbon dioxide, chloride, potassium, and sodium tests performed using the Abbott i-STAT Chem8+ cartridge {whole blood}.

See MLN matter article MM5913 for the previously released assigned CPT®/HCPCS Level I and II codes for waived tests.

Coding Tips
Fluoroscopic Guidance in Pain Management
By Penny Sparks, CPC

Billing fluoroscopic guidance in pain management can be confusing for billing staff. Fluoroscopy is an X-ray procedure used for localization of needle placement and to visualize the patient's anatomy.

To confirm needle placement, the fluoroscope is used as a guidance tool for needle placement. The biller should use 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction for most of the common nerve block procedures such as paravertebral facet joint nerve or sacroiliac joint, epidural, transforaminal epidural, paravertebral facet joint, subarachnoid and including neurolytic agent destruction. Note: According to the CPT®, code 77003 is per spinal region (cervical, thoracic, lumbar, or sacral). Do not bill per level. Modifier 59 Distinct procedural service can be used to identify a separate guidance/localization procedure performed in different spinal regions.

Use 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) for fluoroscopic guidance for needle placement for non-spinal procedures. An example would be when a physician performs a major joint injection for a shoulder, knee or hip.

Use 76000 Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 and 71034 (eg, cardiac fluoroscopy) and 76001 Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy) when the physician uses fluoroscope to provide diagnostic images.

Medical News
CMS Requires Nursing Homes to Install Sprinkler Systems
CMS announced long term care facilities such as nursing homes are required to protect their residents by installing sprinkler systems throughout their building to continue serving Medicare and Medicaid beneficiaries.

EHR Program Starts
Medicare launched a pilot program to prompt doctors to computerize their offices. Electronic health records (EHRs) may address modern medical care issues, but is the issue of patient privacy at stake and the cost of computerization too high?

Listen to the NPR news audio clip.

Coding Job Links
AAPC Job Database

AAPC Employment Forums

Test Yourself Online
The Test Yourself questions can be accessed online at 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
Congress Fails to Delay
LCD Info at Trailblazer
Critical Changes to Code
Waived Tests Under CLIA
Coding Tips
Medical News
Coding Job Links
Test Yourself Online

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