You won’t face the same nail-biting payment woes in 2011 as you did this year, thanks to a Senate Finance Committee bill that will freeze Medicare pay at current levels for another 12 months. The House of Representatives passed the Medicare and M...
Question: I’m receiving contradictory guidance on which modifier to use when a gastroenterologist does an incomplete colonoscopy. Should I use modifier 52 or 53? Answer: CPT 2011 ends the days of arguing over whether to use modifier 52 or 53 for ...
Get ready to change your flu vaccine product code 90658 to one of four Q codes. For 2010, report 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) to signify that your physici...
Medicare beneficiaries will be thrilled that Medicare will cover annual well checks. The Center for Medicare introduces a new benefit of wellness visits for beneficiaries annually, except during the year of their Welcome to Medicare exam. You’ll use ...
Question: If a nurse has to check vitals to make sure an allergy injection is the correct quantity or if she has to educate the patient about the administration or side effects of the injections, we’ve been billing 99211 with 95115 or 95117. There is...
These terms nail down your diabetic retinopathy imaging code choice.
In CPT® 2011 in the place of your old familiar SCODI code, you’ll find three area specific codes. Check out these tips on finding the correct code for imaging as well as DR services.
Code 92135 is being split into three more specific codes. The scanning computerized ophthalmic diagnostic imaging or SCODI code got used a lot in 2010 and was a high volume code. CPT 2011 deletes the code. Pick the new code based on the particular area the imaging is performed on as follows:
| Area | CPT 2011 Code | Descriptor |
| Front of the eye | 92132 | Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral |
| Optic nerve | 92133 | Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve |
| Retina | 92134 | Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina |
92227 Vs. 92228: Look at DR Status
Diabetic retinopathy is the leading cause of blindness. Yet early detection makes the condition correctable 95 percent of the time. Imaging retina center technicians can easily look at a photo and read it. The ophthalmologist can then determine if the patient has DR, the stage it’s in, and the proper course of treatment.
Equate the term “Detection” that’s in new diabetic retinopathy imaging code 92227 (Remote imaging for detection of retinal diseases [e.g., retinopathy in a patient with diabetes] with analysis and report under physician supervision, unilateral or bilateral]) with “screening” for diabetic retinopathy. “Use this...
Medicare Physician Fee Schedule rate won’t be cut 23 percent. Although the government appeared poised to take a big bite out of your next Medicare Part B payments, you now have another month before you need to worry about losing pay. That’s because...
Pediatricians who were thrilled with CPT 2011’s move to paying vaccines per component got a setback from Medicare’s rejection of the recommended RVUs for new vaccine administration codes 90460 and 90461.
The Relative Update Committe recommended that the 2011 Medicare Physician Fee Schedule and Resource Based Relative Value Scale assign 0.20 practice expense (PE) RVUs to 90460 and 0.16 PE RVUs to 90461. But CMS disagreed with the proposal. “We disagree with the recommendations and will maintain 0.17 RVUs for code 90460 and 0.15 RVUs for code 90461 since these codes would be billed on a per toxoid basis,” said Kenneth Simon, MD, MBA, Senior Medical Officer, Center for Medicare and AMA CPT Editorial Panel Member, in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT® and RBRVS 2011 Annual Symposium on Nov. 10, 2010.
The increased PEs represent an increase in RVUs from the 2010 values for comparable codes 90465/90467 and 90466/90468. The RUC requested the increase in value due to increased time for patient education. Since the new codes are valued per component, CMS felt no increase was warranted.
CMS assigned RVUs to 90460 and 90461 by crosswalking them with the values of the noncounseling vaccine administration codes 90471 and 90472. This means that new code 90460 has the same RVUs as 90471, and each unit of 90461 has the same RVUs as 90472.
The work and total RVUs for the codes include:
| Code | PE RVU RUC Proposed | PE RVU MPFS Accepted | Total RVUs |
| 90460 | 0.20 | 0.17 | 0.59 |
| 90461 | 0.16 | 0.15 | 0.3 |
| 90465 | <td width="203"
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Physicians could feel a little looser on their spending thanks to a hold on the 2011 Medicare Physician Fee Schedule cut. On Nov. 18, the U.S. Senate unanimously consented to halt the Medicare planned conversion factor cut for a 31-day period. The U.S...
A major insurer will now pay for turbinate fracture in addition to septoplasty. Thanks to advocacy from the American Academy of Otolaryngology–Head and Neck Surgeons (AAO-HNS), Aetna has overturned its coverage position on 30520 and 30930 billed on t...
When reporting diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity for a Medicare beneficiary in 2011, you’ll use two temporary G codes. Providers were concerned about the different global periods for two t...
Revascularization, heart catheterization, and more all have new looks in CPT 2011. Here’s an overview of what you can expect. • 37220-37235: Endovascular revascularization, open or percutaneous The codes in this range are distinguished by the vesse...
All that fine green print on time in your E/M CPT 2011 manual boils down to one thing: you can round to the closest time code. But that advice from CPT contradicts Medicare’s threshold time guideline. CPT Treats Times as Averages CPT 2011 indicates...
You’ll soon capture counseling per disease.
For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed fair, but CPT 2011 lets you capture that extra counseling work.
Although multiple component vaccines require counseling on each disease, physicians have only been able to capture counseling for vaccine administration once per administration. CPT 2011 solves the problem with new immunization administration with counseling codes that you’ll code per vaccine component.
CPT 2011 deletes 90465-90468 (Immunization administration younger than 8 years of age … when the physician counsels the patient/family … per day). Codes 90471-90474 (Immunization administration …) remain.
Use 90460 as Vaccine Administration With Counseling Base Code
No more looking at administration route when choosing which immunization administration with counseling code. For vaccine administration, you’ll assign one code for each vaccine’s initial component:
Definition: A component refers to the antigen in a vaccine that prevents disease caused by one organism.
CPT streamlines your coding of the vaccine counseling codes by giving you one universal base code. The code includes “any route of administration.” You no longer have to choose a different code based on whether the code is intramuscular/subcutaneous or oral/intranasal.
Step 2: Report Second Vaccine Component With +90461
Coders can breathe a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. CPT 2011 gives you only one vaccine administration with counseling base code (90460). For each additional vaccine component, you report the same add on code:
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Denials for mismatched CPT and ICD-9 codes cost practices thousands of dollars every year. SuperCoder.com will soon help you ensure your links are correct helping you further reduce your denials rate. Plus, more code details and pictures will improve y...
You can sit back and enjoy the fall foliage spectacle — SuperCoder.com’s got your ICD-9-CM 2011, National Correct Coding Initiative 16.3, and October Medicare Physician Fee Schedule medical coding updates covered. Go ahead and search for th...