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Get Ready for Some Big Changes

Many of the changes are significant and will impact the way that you practice and how you bill for services.
Edited by John Rumpakis, O.D., M.B.A., Clinical Coding Editor

1/15/2010

The scent of change is in the air. While many despise the New Year, others embrace ushering in the new and sweeping away the old. Resolutions are abundant—follow-through isn’t. No matter which side of the line you fall, one thing is for sure: 2010 is here, and so are changes from the Centers for Medicare & Medicaid Services (CMS) and to the Current Procedural Terminology (CPT) codes.

Many of the changes are very significant and will impact the way that many of you practice.

Consultant Codes Are Cut
The first item on the list—and likely the most significant—is CMS’s recent decision to eliminate the Consult Codes from coverage. This fall, CMS alerted physicians and non-physician practitioners that effective January 1, 2010, the CPT consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment.

For Medicare services provided on or after January 1, 2010, physicians and non-physician practitioners should code a patient evaluation and management (E/M) visit with E/M codes that represent where the visit occurs and that identify the complexity of the service performed. (For specific details, go to: www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf).

Keep in mind that the effective date for this change was January 1, 2010. So, by the time you read this column, you may have already improperly billed CMS for services rendered and have had claims denied.

Physician Fee Schedule Fix
The next big change coming is what is going to happen with the Physician Fee Schedule calculations for 2010 and beyond.

In late December, President Obama signed a temporary stay of the 21.2% CMS fee reduction that was slated to take place January 1. The current (2009) CMS conversion factor of 36.0846 will remain in force until March 1, 2010.

Congress is anticipated to fix the ongoing problem with the CMS Physician Fee Schedule in early 2010.

Avoid an Audit
Last but not least, audits are on the rise—and eye care professionals are not going unnoticed. In its recent Semiannual Report to Congress, the Office of Inspector General (OIG) announced a reported savings and expected recovery of $20.97 billion for 2009 as a result of audits, investigations and evaluations the agency conducted last year. Among the OIG’s most touted accomplishments during the semiannual period between April 1 and September 30 are several cases involving Medicare fraud, waste or abuse.

Within the semiannual report, the OIG highlighted a “Nationwide Review of Evaluation and Management Services Included in Eye and Ocular Adnexa Global Surgery Fees.” (To see the report, go to: http://oig.hhs.gov/oas/reports/region5/50700077.asp.)

Specifically, the OIG estimated that in 2005 Medicare paid $97.6 million for E/M services that were included in eye global surgery fees but not provided during the global surgery periods.

According to the OIG, the global surgery fees did not reflect the number of E/M services provided to beneficiaries because CMS had not adjusted or recently adjusted the relative value units for most of the sampled surgeries.

By adjusting the estimated number of E/M services within eye global surgery fees to reflect the number of E/M services actually provided, the OIG says CMS could have reduced payments by as much as $97.6 million

So here we go, ready or not, blazing into 2010. Keep tuned in to “Coding Abstract” to get the latest from our great team of contributors throughout the year. Best wishes for a prosperous 2010!

Please send your comments to CodingAbstract@gmail.com.



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