2005 CPT Coding & Payment Update

1. Steven A. Adams, CPC, CPC-H, COA 2005 CPT Coding & Payment Update http://www.coderscentral.com/beauty.htm

2. 2005 RVU Update, Reimbursements & NPI update Deductible, Venipuncture and Injection Changes ASP vs. AWP New Codes for Preventive Services Incentive Payments - PSA’s & HPSA’s New Appendix in CPT CPT changes by Specialty Topics

3. Ever Feel Like This?

4. 2005 Changes 171 new codes 61 revised codes 46 deletions 1.5 Increase in Reimbursement The Conversion Factor (CF) for 2005 will be 37.8975 up from 37.3374 in 2004.

5. 2005 Changes ICD-9-CM has more than 800 changes in the tabular section alone http://www.instacode.com/news-2005-changes.htm

6. ICD-9 Updates • Starting in 2005, the AMA will publish ICD-9 Codes on: • October 1 and • April 1

7. Avoiding trouble is largely a matter of knowing the rules & remembering your audience.

8. CPT What you did Here Are The Rules ICD-9 Why you did it

9. Here’s Your Audience Criminal Justice Field Accountants Biologists “Most individuals do not have training in the health care field.” CMS and OIG

10. Payment Reform Continues in 2005 The lovely thing about being 40 is that you can appreciate 25 year old men more. Colleen McCullough 36-41

11. Worthless Information?

12. Atlanta, Georgia Rest of Georgia

13. Specialty Reimbursements Physician’s Fee Schedule

14. Effective 5/23/2005 Medicare Will Begin A: NPI

15. Deductible, Venipuncture and Injection Changes Whatever women do they must do twice as well as men to be thought half as good. Luckily, this is not difficult. Charlotte Whitton

16. Effective 1/1/05 Medicare Deductible is: $110

17. Effective 1/1/05 Medicare No Longer Accepts G0001

18. Effective 1/1/05 Medicare No Longer Accepts 90782

19. New Medicare Injection Codes http://www.communityoncology.org/documents/ReimbursementActionCenter/Q_and_A_Final_12-8-04.pdf 43-47

20. New Medicare Injection Reimbursement *Indicates an additional payment for anti-neoplastic drug use

21. Monoclonal antibody agents or other biological response modifiers: Chemotherapy http://www.medicare.bcbsmt.com/Assets/Downloads/PDF/2005_drug_admin_coding_revisions.pdf

22. A series of 12 new “G” codes have been developed for a pilot project: Any office-based physician or nonphysician practitioner operating within the state scope of practice laws who takes care of and administers chemotherapy to oncology patients in an office setting Is eligible to participate. Payment is $130 dollars per encounter. Chemotherapy Assessment Codes G9021-G9032 LACK OF ENERGY G9029 G9030 G9031 G9032 NAUSEA G9021 G9022 G9023 G9024 PAIN G9025 G9026 G9027 G9028 17-18 www.cms.hhs.gov/Manuals/pm_trans/R12DEMO.pdf

23. ASP vs. AWP My husband and I didn’t sign a pre-nuptial agreement. We signed a mutual suicide pact. Rosanne Barr 13-14

24. ASP - Manufacturers submits data to CMS quarterly showing their production costs. CMS multiplies this cost times 6% and pays us. For all drugs not on a cost or a PPS basis. Drug Reimbursement Average Wholesale Price Average Sales Price • AWP - Took the wholesales price and CMS averaged them out and paid us 95%. If you dispense drugs - you’d better monitor your reimbursements

25. Change to Specialties

26. 2005Preventive Medicine Services Nine out of ten people like chocolate. The tenth person always lies.. --John Q. Tullius 9-12

27. Initial Preventive Physical Exam EKG Pelvic examination Pap - obtain Occult Blood Flu vaccine Pneumonia vaccine Hepatitis vaccine Colonoscopy patient at high risk G0344 $100.84 G0366 $ 28.35 G0101 $ 39.09 Q0091 $ 42.14 G0107 $ 4.49 G0008 $ 18.66 G0009 $ 8.66 G0010 $ 8.66 G0105 $401.85

28. Colonoscopy screening exam Prostate exam DM self-management Bone Mass Measurement (DEXA) Mammogram Glaucoma screening Medical NT for DM/Renal Cardiovascular screening Diabetes screening G0121 $401.85 G0102 $ 22.37 G0108 $ 34.18 76075 $147.89 76092 $ 89.93 G0117 $ 46.86 97802 $ 19.50 15 min. 80061 $ 18.72 82947 $ 5.48

29. Initial Preventive Physical Exam G0344 - $100.84 G0366 - $28.35 • Comprehensive Medical & Social History • Determine Potential Risk Factors/Depression • Review Functional Ability and Level of Safety • Must Examine Height, Weight, BP and Visual Acuity • Examine Other Areas Deemed As Appropriate • Perform an ECG • Conduct necessary Education, Counseling & Referrals as Appropriate

30. Initial Preventive Physical Exam • Pneumococcal, Influenza and Hepatitis Vaccine • Screening Mammogram • Prostate Screening • Colorectal Cancer Screening • Diabetes Outpatient Self-Management Training • Bone Mass Measurement • Glaucoma Screening • Medical Nutrition Therapy Services • Cardiovascular & DM Screening Tests

31. Initial Preventive Physical Exam • Cannot be billed by Midwifes • Can be billed by PA, NP, or CNS • Cannot bill a prostate exam • Medicare still to decide what to do about ECG • No comment on billing a pap and/or pelvic at same time • Following comment on split billing: • Can bill with a 99202 or 99212 if medically necessary Only covered in first 6 months of Coverage

32. Are You Eligible for an Incentive? • I love women, They’re the best thing ever created. If they want to be like men and come down to our level, that’s fine. • Mel Gibson 12-13

33. PSA - Physician Scarcity Areas (Primary & Specialty) Incentive Payments PSA - 5% HPSA - 10% When in doubt call Medicare - Follow instructions Ratio of primary care physicians to Medicare beneficiaries - Ends 12/31/07 HPSA - Health Professional Shortage Area (Primary/Mental) Still determined by county health department in conjunction with CMS www.cms.hhs.gov/providers/bonuspayment/

34. Endometrial Cryoablation and Essure My wife and I were happy for ten years. Then we met. Rodney Dangerfield

35. Malignancy In life, it’s not who you know that’s important, it’s how your wife found out. Joey Adams

36. New Appendix F & G & H & I The 50-50-90 rule as it applies to women: Anytime you have a 50-50 chance of getting something right with a woman, there’s a 90% probability you’ll get it wrong. Andy Rooney

37. Codes exempt from 63 modifier F

38. Codes which include conscious sedation G

39. Performance Measurement Index H

40. Genetic Testing Code Modifiers I

41. Specific CPT Changes by Specialty Men are like dogs because they keep coming back. Ladies are like cats, because if you yell at a cat just one time…they’re gone. Lenny Bruce

42. Pediatrics • Inpatient Pediatric Critical Care • 99293 – now reads 29 days through 24 months • 99294 – now reads 29 days through 24 months • 99295 – now reads 28 days or less • 99296 – now reads 28 days or less

43. Pediatrics - Immunizations • 90465 – Immunization under 8 - injection • +90466 - each additional • 90467 – Immunizations under 8 oral or nasal • +90468 - each additional • Vaccine Code: • 90656 – Influenza virus vaccine, split virus, preservative free 3 years and above

44. Dermatology / General Surgery / OBGYNIntegumentary • 11004 – Debridement of skin for necrotizing soft tissue infection; external genitalia • 11005 - abdominal wall • 11006 - external genitalia, perineum and abdominal wall • +11008 – Removal of prosthetic material or mesh for necrotizing soft tissue

45. Wound Care • 97597 – Removal of devitalized tissue; selective debridement 20 square centimeters or less • 97598 - greater than 20 square centimeters • 97605 – Negative pressure wound therapy; 50 square centimeters or less • 97606 – total wound greater than 50 square centimeters 97601 is deleted - selective debridement

46. General Surgery Breast Code • Some new codes for placement of radiotherapy in the breast were created: • 19296 – Placement of radiotherapy afterloading • +19297 - concurrent with partial mastectomy • 19298 – a conscious sedation code

47. Orthopedic SurgeryMusculoskeletal • For orthopedic surgeons doing knee surgery – two new graft codes have been created • 27412 - Autologous chondrocyte implantation • 27415 – Osteochondral allograft, knee, open • Thee new knee arthroscopy codes have been created • 29866 – osteochondral autograft • 29867 – osteochondral allograft • 29868 – meniscal transplantation

48. ENT / PulmonologyRespiratory • If your surgeon is doing Laryngoscopy of vocal cords, two new direct laryngoscopy codes, with operating microscope: • 31545 – Submucosal removal of non-neoplastic lesions of vocal cord reconstruction with local tissue flaps • 31546 – Submucosal removal of non-neoplastic lesions of vocal cord reconstruction with grafts

49. ENT / PulmonologyRespiratory • If your doctor is doing a bronchoscopic procedure using Endobronchial Ultrasound (EBUS) they can now use the following “add-on code” • +31620 - EBUS during bronchoscopic intervention • The following new codes have also been added to the Bronchoscopy section of CPT: • 31636 – Placement of bronchial stent(s) • +31637 – each additional bronchus stent • 31638 – with revision of tracheal or bronchial stent

50. PulmonologyRespiratory • A new code now exists for the: • 32019 - Insertion of indwelling tunneled pleural catheter with cuff PulmonologyDiagnostic • 94452 – High altitude simulation test (HAST) • 94453 - with supplemental oxygen titration