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PIPAC Monthly News BriefPublished January 2004On-Line Version -- The following articles are taken from our January 2004 monthly news brief. Click on the headlines below to jump to that story. For More Information Contact: Kimberly
Fullmer - Marketing & Communications Manager The AMA Revamps, Refines Codes In CPT 2004 Update Mark Your Calendars for the 9th Annual PIPAC/RIPAC MeetingCBO Releases Report on Malpractice Reforms The AMA Revamps, Refines Codes In CPT 2004 Update Back to TopThe American Medical Association (AMA) made numerous changes to CPT codes in the 2004 manual. Although the official implementation date for the codes is January 1, 2004, many payors, including Medicare, provides a grace period until April 1 for claims to reflect any of the changes. In the “Medicine” section of CPT 2004, the AMA clarifies that code 99050 should be assigned for services provided after posted office hours in addition to basic service. This revised language indicates that the code should be reported, for instance, when a physician’s practice is normally closed on a Wednesday afternoon. However, a patient requests a 3 p.m. appointment and opens the office to see the patient. Influenza virus vaccine code 90659 is deleted from CPT 2004 because the influenza whole-virus vaccine is no longer manufactured. Instead, you should report one of the revised split virus codes for children 6-35 months of age or for individuals 3 years of age and above with codes 90657 and 90658, respectively. New influenza virus code 90655 describes the preservative free vaccine for children 6-35 months of age. The AMA eliminated starred procedures, which were listed with asterisks to designate codes that describe the surgical procedure only. As such, you should eliminate any starred procedures from your charge slips. Detailed instruction notes were added before skin biopsy codes 11100 and 11101 and the “separate procedure.” (Code 11100 describes a single lesion; code 11101 describes each additional lesion.) As such, you may report a skin biopsy code whether the biopsy is performed alone or with another unrelated or distinct skin procedure. For instance, if the physician biopsies a lesion on the patient’s hand and excises a benign lesion on the patient’s arm, both the lesion excision on the arm (11400) and the unrelated skin biopsy (11100) could both be reported with modifier –59, indicating that the biopsy occurred on a separate site from the lesion excision. If you struggle with reporting tendon sheath injections, the AMA has once again revised the codes in code range 20550-20552 in an attempt to clarify how the services should be reported. CPT code 20550 now describes a single tendon sheath, or ligament, injection or aponeurosis. Code 20551, which is indented under it, describes a single tendon origin or insertion. Code 20552, which is now a main code and not indented under 20550, describes single or multiple injection points into one or two muscles. Consult your 2004 CPT manual for additional changes (additions, revisions or deletions) to CPT codes that you routinely use in your practice. For More Information Contact: Kimberly
Fullmer - Health Care Policy Manager Mark Your Calendars for the 9th Annual PIPAC/RIPAC Meeting Back to TopOur annual meeting will be held at the Stonewall Resort in Roanoke, West Virginia on May 1 and 2. The educational and business functions of this meeting will take place in the morning hours to allow our attendees the opportunity to participate in sponsored golf outings and other activities during the afternoon on both days. We are currently working on the agenda and the sessions to be presented at the meeting. Based on feedback we received on a recent survey, information on the following topics will be presented: 2004 coding update; NCCI edit update/bundling policies; Medicare update; payor/provider updates; practice profitability analysis; legislative update; CME presentations (end-of-life); malpractice and messenger model/antitrust issues. We urge you to make additional suggestions related to topics you would like you or your practice staff would be interested in. The final agenda and registration forms will be distributed once all presentations are made final. For More Information Contact:
Steve Nordeck, RN - Education
Manager Medicare Part B Notes… Back to TopVaccine Coding, Payment Update The following CPT/HCPCS codes must be used appropriately when submitting claims to Medicare for influenza and pneumococcal vaccines and their administration. CPT/HCPCS Payment as of Oct. 1, 2003 90657 $4.01 90658 $9.95 90659 (Not produced for 2003 flu season.) G0008 $6.76 G0009 $6.76 For dates of service on or before September 30, 2003, the following ICD-9-CM codes should be assigned: V04.8 and V03.82 Codes V04.81 and V03.82 should be used for dates of service on or after September 30, 2003. Tracking Reimbursement Updates Keep in mind that reimbursement amounts for flu and pneumonia vaccines and their administration are updated quarterly by the Centers for Medicare and Medicaid Services (CMS). To access the current Medicare reimbursement rates for West Virginia, go to the Web site at http://www.PalmettoGBA.com: go to Providers, Part B Carrier, West Virginia, Fee Schedules, and choose the appropriate year. Facts About ICD-9-CM Coding The ICD-9-CM codes for each year expire on September 30. The “expired” ICD-9-CM codes can still be used for services performed from October-December of the year, as long as the service is reported to Medicare before the end of the year. This is the “grace” period. For any claim submitted to Medicare on or after January 1, the “expired” codes can be used only for services that were performed from January through September of the previous year. For any claim submitted to Medicare on January 1 or after, claims with dates of service October through December must be submitted to Medicare with “new” (not expired) codes. HCPCS Update CMS has announced that there will be a grace period for submitting codes/ modifiers that are deleted in the 2004 HCPCS update. Claims submitted with codes/modifiers deleted in the 2004 update that are received prior to April 1, 2004, for dates of service January 1, 2004 through March 31, 2004, will be paid based on updated 2004 amounts. Claims received after March 31, 2004, with codes and modifiers that were deleted in the 2004 HCPCS update will be rejected. For More Information Contact: Kimberly
Fullmer - Health Care Policy Manager CBO Releases Report on Malpractice Reforms Back to TopA report issued by the Congressional Budget Office (CBO) on January 8, 2004, asserts that even if medical liability premiums are lowered as a result of limitations on tort liability, the direct impact on health care spending will be minimal. The CBO states that malpractice costs account for less than two percent of all spending. The CBO also contends that savings from reducing the practice of defensive medicine will also produce little health care savings. CBO does not refute evidence by other studies that show that medical liability premiums are lower in states with tort reform. In fact, the CBO has estimated in the report that medical liability reform legislation similar to that passed in the House (H.R. 5) would lower premiums nationwide by an average of 25-30 percent. For More Information Contact: Kimberly
Fullmer - Health Care Policy Manager |
Content of this page was last modified: Thursday, 22 July 2004 |
