Cpt 2011 coding updates


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Cpt 2011 coding updates

  1. 1. Jen Godreau, BA, CPC, CPMA, CPEDC Content Director, SuperCoder.com The Coding Institute, LLC Nov. 23, 2010
  2. 2. Symposium Facts <ul><li>Dr. Hollmann missed his calling as a comedian. </li></ul><ul><li>Chicago can be warm in November. </li></ul><ul><li>Joe’s Crab Shack is the place to be for seafood. </li></ul>
  3. 3. MPFS Ups & Downs Conversion Factor: $25.5217 -- Marc Hartstein Deputy Director Hospital and Ambulatory Policy Group Center for Medicare “ Medicare Physician Payment Schedule 2011 Changes and Beyond” Nov. 10, 2010 -- 2011 Medicare Physician Fee Schedule Final Rule Dates Type Percent June 2010 –Nov. 2010 2.2 Dec. 1, 2010 23.0 Jan. 1, 2011 2.51
  4. 4. MEI Increases Office Space Pay Medicare Economic Index (MEI) 2000 base % 2006 base % Physician work 52.466 48.266 Practice expense 43.669 47.439 Malpractice 3.865 4.295 Medicare increased the cost share weight for office rent to 12.2 percent from a proposed 8.4 percent.
  5. 5. Therapy Cap Uncertainty <ul><li>2010 Therapy Cap: $1860 </li></ul><ul><li>2011 Therapy Cap: $1870 </li></ul><ul><li>Expiration: Dec. 31, 2010. </li></ul>
  6. 6. Will GPCI Be Extended? <ul><li>1.5 work GPCI </li></ul><ul><ul><li>Alaska </li></ul></ul><ul><li>1.o PE GPCI states: </li></ul><ul><ul><li>Montana </li></ul></ul><ul><ul><li>Wyoming </li></ul></ul><ul><ul><li>North Dakota </li></ul></ul><ul><ul><li>Nevada </li></ul></ul><ul><ul><li>South Dakota </li></ul></ul>
  7. 7. G Codes Created for Tissue-Cultured Skin Substitute <ul><li>Current Codes </li></ul><ul><li>New Codes </li></ul><ul><li>G0440 ( Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less ) </li></ul><ul><li>G0441 ( … each additional 25 sq cm ) </li></ul>Application Skin Repair Global Day Period Apiligraf 15430, 15431 90 Dermagraft 15360, 15361, 15365, 15366 30
  8. 8. CRP Code Wins Payable Status <ul><li>Good News </li></ul><ul><li>Bad News </li></ul><ul><li>Status changed from bundled to active </li></ul><ul><li>Work RVU: 0.75 </li></ul><ul><li>Medicare will not pay for CRP performed by an audiologist because CRP is a therapeutic code. Medicare restricts payments for audiologists to audiological diagnostic tests. </li></ul>95992 ( Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day )
  9. 9. CPT Considers Times as Averages <ul><li>“ In selecting time, the physician </li></ul><ul><li>must have spent a </li></ul><ul><li>time closest to the code selected .” </li></ul><ul><li>-- CPT Assistant 2004 </li></ul><ul><li>“ If coding by time, </li></ul><ul><li>pick the closest typical time .” </li></ul><ul><li>-- Peter Hollmann, MD </li></ul><ul><li>“ E/M, Vaccines and Time Based Codes” </li></ul><ul><li>CPT and RBRVS 2011 Annual Symposium </li></ul>
  10. 10. Thresholds Vs. Averages <ul><li>Following CPT Assistant’s closest time code rule, time breakdowns for office visits include: </li></ul>Code CPT descriptor indicates physicians typically spend this many minutes face-to-face with the patient and/or family CPT Assistant indicates to use when counseling/coordination of care dominates face-to-face office time totaling this many minutes 99212 10 10-12.5 99213 15 12.6-20.5 99214 25 20.6-32.5 99215 40 32.6 or more
  11. 11. Will Medicare Change Its Rule? <ul><li>“ I do n’t want to say </li></ul><ul><li>one way either ‘Yes’ or ‘No ’ </li></ul><ul><li>at this time.” </li></ul><ul><li>-- E/M expert Deborah Patterson, MD </li></ul><ul><li>Clinical Medical Director </li></ul><ul><li>Trailblazer Health Enterprises, LLC </li></ul><ul><li>Dallas </li></ul>
  12. 12. Vaccine Administration Rehaul <ul><li>CPT 2011 deletes per vaccine administration codes 90465-90467. </li></ul><ul><li>90471-90474 ( Immunization administration ...) codes remain. </li></ul><ul><li>The new codes are based on the number of components. </li></ul>
  13. 13. Vaccine Administration Base Code <ul><li>Assign one code for each vaccine’s initial component: </li></ul><ul><li>90460 ( Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component ) </li></ul>Definition: A component refers to the antigen in a vaccine that prevents disease caused by one organism.
  14. 14. Each Additional Component <ul><li>For each additional vaccine component, report : </li></ul><ul><li>+90461 ( Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure) ) </li></ul><ul><li>Always report +90461 in addition to 90460. </li></ul><ul><li>Bill the add-on code, plus the number of units that represents the number of components. </li></ul>
  15. 15. Example <ul><li>A pediatrician counsels a mother on vaccine risks and benefits prior to giving the patient Pediarix (90723), which has five components: DTaP-HepB-IPV. Diphtheria, tetanus toxoids, acellular pertussis, Hepatitis B and inactivated polio virus each count as one component. For the vaccine administration with counseling on the components included in Pediarix, you should report: </li></ul><ul><li>90460 </li></ul><ul><li>+90461 x 4. </li></ul>
  16. 16. Extended Observation Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Code Interval History Exam MDM Presenting Problem Time (min) Proposed RVU Accepted RVU 99224 Problem focused Problem focused straightforward or of low complexity stable, recovering, or improving 15 0.76 0.54 99225 expanded problem focused expanded problem focused moderate patient is responding inadequately to therapy or has developed a minor complication 25 1.39 0.96 99226 detailed detailed high unstable or has developed a significant complication or a significant new problem. 35 2.00 1.44
  17. 17. 11042-11047 Vs. 97597-97602 <ul><li>(11040, 11041 have been deleted) </li></ul><ul><li>(For debridement of skin, i.e. epidermis and/or dermis only, see 97597, 97598) </li></ul><ul><li>11042: Debridement, skin and subcutaneous tissue [includes epidermis and dermis, if performed); first 20 sq cm or less </li></ul><ul><li>Active wound care of the skin, dermis, or epidermis. </li></ul><ul><li>0 day global period </li></ul><ul><li>Intent: “Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing.” </li></ul><ul><li>Contact: Direct patient contact is required. </li></ul>
  18. 18. Sentinel Lymph Node Mapping <ul><li>Includes injection of nonradioactive dye, when performed </li></ul><ul><li>For the injection of a radioisotope, use 38792. </li></ul>38900 ( Intraoperative identification [e.g., mapping] of sentinel lymph node[s] includes injection of non-radioactive dye, when performed [List separately in addition to code for primary procedure] )
  19. 19. Photodynamic Therapy <ul><li>96570 and 96571. </li></ul><ul><li>If the pulmonologist performs 96570 for less than 23 minutes, report modifier 52. </li></ul><ul><li>For each increment after the first 30, you have to get to the 8 th minute for each interval. </li></ul>
  20. 20. Sleep Studies Types of Home Sleep Studies Study Description CPT 2009 CPT 2010 CPT 2011 Type II Comprehensive portable polysomnography (min 7 channels) G0398 95806 95806 Type III Modified portable sleep apnea testing (min 4 channels) G0399 0203T 95800 Type IV Continuous single or dual bioparameters (min 3 channels per NCD CPAP for OSA) G0400 0204T 95801
  21. 21. Pain Points <ul><li>Include imaging guidance in 64479-64484 </li></ul><ul><li>Code paravertebral facet joint blocks (64490-64495) bilaterally if the physician injects two sides at the same level. </li></ul><ul><li>Do not report the insertion 64555 in addition to new code 64566 for programming. </li></ul>
  22. 22. Amniotic Membrane Codes Code Membrane Placed 65578 on the ocular surface 65779 with suturing 65780 multiple layers 66999 using tissue glue
  23. 23. SCODI Also By Location <ul><li>92135 is deleted </li></ul><ul><li>92133 ( Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve ) </li></ul><ul><li>92134 (… retina ) </li></ul><ul><li>92132 ( Scanning computerized ophthalmic diagnostic imaging, anterior segment , with interpretation and report, unilateral or bilateral ) </li></ul>
  24. 24. Nasal/Sinus Dilation “ These codes are for dilation of sinus ostium.” Do not use them if the otolaryngologist removes tissue. Instead use the appropriate sinus endoscopy code, such as 31267 or 31276. -- Richard W. Waguspeck, MD, FACS The Triological Society, AMA CPT Advisory Committee Member Code Location 31295 dilation of the maxillary sinus ostium, which can often be accessed transnasally or through the canine fossa if there’s been a previous puncture 31296 dilation of sinus ostium, in which the otolaryngologist does not remove tissue 31297 sphenoid sinus ostium is dilated
  25. 25. 69801 <ul><li>2010 </li></ul><ul><li>2011 </li></ul><ul><li>Labyrinothotomy, with or without cyrosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs (single or multiple perfusions); transcanal </li></ul><ul><li>90 day global period </li></ul><ul><li>Included all required infusions performed on the initial and subsequent days of treatment for 90 global days. </li></ul><ul><li>Labyrinothotomy, with perfusion of vestibuloactive drug(s); transcanal </li></ul><ul><li>0 day global period </li></ul><ul><li>Can now code per injection on separate day. </li></ul>
  26. 26. Motility, Monitoring <ul><li>91117 -- Colon motility (manometric) study, minimum 6 hours continuous recording [includes provocation tests, e.g., meal, intracolonic balloon distension, pharmacologic agents, if performed), with interpretation and report </li></ul><ul><li>91034 -- Esophagus, gastroesophageal reflux test, with nasal catheter pH electrode(s) placement, recording, analysis and interpretation </li></ul><ul><li>91035 -- … with mucosal attached telemetry pH electrode placment, recording, analysis and interpretation </li></ul>
  27. 27. FAQs <ul><li>You can only bill the study once even if it’s done for more than 48 hours. </li></ul><ul><li>If the catheter is placed in an ASC, the center cannot be involved in the staffing, physician work, or equipment. The office has to provide all those items and bill for them. </li></ul><ul><li>If the gastroenterologist does an office endoscopy for abnormalities and then places the capsule on same day, you may bill both the study 93015 and the scope with modifier 59 (43235-59). </li></ul>
  28. 28. Incomplete Colonoscopy <ul><li>When performing an endoscopy on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope beyond the splenic flexure, due to unforeseen circumstances, report the colonoscopy code with modifier 53 and appropriate documentation. </li></ul>Uniform method: Aligns CPT with Medicare.
  29. 29. Combined Abdomen Pelvis CT Stand Alone Code 74150 CT Abdomen WO Contrast 74160 CT Abdomen W Contrast 74170 CT Abdomen WO/W Contrast 72192 CT Pelvis WO Contrast 74176 74178 74178 72193 CT Pelvis W Contrast 74178 74177 74178 72194 CT Pelvis WO/W Contrast 74178 74178 74178
  30. 30. Device Monitoring <ul><li>code deletions </li></ul><ul><li>introductory language changes </li></ul><ul><li>code revisions </li></ul><ul><li>93224 – External Wearable electrocardiocraphic rhythm derived monitoring for 24 hours recording up to 48 hours by continuous original waveform rhythm recording and storage , with visual superimposition scanning ; includes recording, scanning analysis with report, physician review and interpretation </li></ul><ul><li>For codes 93224-93227, when a continuous is less than 12 hours, use modifier 52. </li></ul>
  31. 31. Cardiac Catheterization <ul><li>The new noncongenital studies include: </li></ul><ul><li>Most injection procedure services </li></ul><ul><li>Imaging supervision </li></ul><ul><li>Interpretation and report. </li></ul><ul><li>Left heath catheterization includes left ventriculography (injection procedure, supervision, interpretation and report) when performed </li></ul>
  32. 32. Table of Catheterization Codes
  33. 33. New Hip Arthroscopy Codes Code Describes Treats 29914 arthroscopy with femoroplasty cam lesion 29915 arthroscopy with acetabloplasty, pincer lesion, a new disease The treatment grinds away the excess lesions. 29916 analagous to a labral repair at the shoulder or knee sports injuries
  34. 34. Get up-to-date on the latest coding changes from the comfort of your desk at www.audioeducator.com!
  35. 35. Resources <ul><li>CPT® and RBRVS 2011 Annual Symposium; Nov. 10-12, 2010, Chicago. </li></ul><ul><li>2011 CPT Professional Edition; American Medical Association. </li></ul>
  36. 36. Ensuring reimbursement. Insuring coders. <ul><li>Questions </li></ul><ul><li>Jen Godreau , Content Director, Supercoder.com </li></ul><ul><li>Family Practice, Pediatrics, Otolaryngology </li></ul><ul><li>: </li></ul><ul><li>www.supercoder.com/forum/ </li></ul>
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