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25% payment reduction PC services for advance diagnostic imaging

  1. #1
    Default 25% (PC) payment reduction for advance diagnostic imaging
    Medical Coding Books
    How is everyone handeling the 25 percent payment reduction to the professional interpretation of advanced diagnostic imaging services for multiple imaging studies administered to the same patient, by physicians, on the same day?

    I have heard it suggested that it applies to exams performed during the same session so applying a 59 would indicate separate times and override the payment reduction. Has anyone else heard this?

    What is your practices approach to this reduction?
    Last edited by chembree; 12-22-2011 at 07:21 AM. Reason: update info

  2. Default
    Have you found any information about applying a 59 to override the payment reduction? We were wondering if this was able to be done or if a 51 has to be applied.

    How did your practice decide to handle multiple imaging studies?

  3. #3
    Default
    This is how I see it:
    The 25% reduction would apply to the less expensive procedure, but would cut across modalities. For example, if a patient receives an MRI of the brain and a CT of the chest on the same day, the reimbursement for the CT of the chest would be decreased by 25%. The procedure with the highest PC and TC payments would be paid in full-the PC payment for each subsequent procedure furnished to the same patient, by the same physician, in the same session, on the same day will be reduced by 25%. Not sure if a modifier will help.

  4. #4
    Location
    Alexandria, LA
    Posts
    518
    Default
    Quote Originally Posted by chembree View Post
    How is everyone handeling the 25 percent payment reduction to the professional interpretation of advanced diagnostic imaging services for multiple imaging studies administered to the same patient, by physicians, on the same day?

    I have heard it suggested that it applies to exams performed during the same session so applying a 59 would indicate separate times and override the payment reduction. Has anyone else heard this?

    What is your practices approach to this reduction?
    The reduction applies to interpretations at the same session, by the same doctor - regardless of when the technical was actually done. 59 will over-ride the adjustment, but your documentation should be very clear when the interps were done and why they were done at diferent sessions. CMS is watching for overuse of 59 to bypass, and will be checking to make sure that exams that should have been interpreted together are not separated just to get the full payment for each.

  5. #5
    Default
    Quote Originally Posted by donnajrichmond View Post
    The reduction applies to interpretations at the same session, by the same doctor - regardless of when the technical was actually done. 59 will over-ride the adjustment, but your documentation should be very clear when the interps were done and why they were done at diferent sessions. CMS is watching for overuse of 59 to bypass, and will be checking to make sure that exams that should have been interpreted together are not separated just to get the full payment for each.

    This is the exact information that we were given. I am still working with our physicians to have times dictated with in our reports. We want make sure we have proper documentation to support the 59.

  6. #6
    Location
    Alexandria, LA
    Posts
    518
    Default
    Quote Originally Posted by chembree View Post
    This is the exact information that we were given. I am still working with our physicians to have times dictated with in our reports. We want make sure we have proper documentation to support the 59.
    If it helps - show them the OIG review of diagnostic imaging in the ED. Part of what OIG complained about to CMS was that the suggested ACR Documentation guidelines are not being used, and that includes time of dictation. OIG is looking at this, and they suggested that CMS do the same. CMS said that they will begin enforcing documentation requirements. Whether that will be these or not is still up in the air, but it's a good bet that this type of thing will be part of whatever is finalized.

    Here is just a bit of that report:
    Percentage of Interpretation and Reports for X-Rays That Did Not Follow Suggested Practice Guidelines
    Time examination performed
    48.5
    Time report dictated
    24.8
    Date report dictated
    18.3
    Referring physician
    14.9
    Date/time report transcribed
    9.9


    Percentage of Interpretation and Reports for CTs and MRIs That Did Not Follow Suggested Practice Guidelines
    Time examination performed
    45.4
    Time report dictated
    26.8
    Date report dictated
    18.0
    Date/time report transcribed
    12.9
    Referring physician
    9.8

    You can find the full report at: http://oig.hhs.gov/oei/reports/oei-07-09-00450.pdf

  7. #7
    Default
    Quote Originally Posted by donnajrichmond View Post
    If it helps - show them the OIG review of diagnostic imaging in the ED. Part of what OIG complained about to CMS was that the suggested ACR Documentation guidelines are not being used, and that includes time of dictation. OIG is looking at this, and they suggested that CMS do the same. CMS said that they will begin enforcing documentation requirements. Whether that will be these or not is still up in the air, but it's a good bet that this type of thing will be part of whatever is finalized.

    Here is just a bit of that report:
    Percentage of Interpretation and Reports for X-Rays That Did Not Follow Suggested Practice Guidelines
    Time examination performed
    48.5
    Time report dictated
    24.8
    Date report dictated
    18.3
    Referring physician
    14.9
    Date/time report transcribed
    9.9


    Percentage of Interpretation and Reports for CTs and MRIs That Did Not Follow Suggested Practice Guidelines
    Time examination performed
    45.4
    Time report dictated
    26.8
    Date report dictated
    18.0
    Date/time report transcribed
    12.9
    Referring physician
    9.8

    You can find the full report at: http://oig.hhs.gov/oei/reports/oei-07-09-00450.pdf
    Great info.

    Thanks,
    Christy Hembree,CPC

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