August 25, 2006

NYSRS HEALTH INSURANCE, COMPENSATION & CAC REPORT 

MEDICARE UPDATE

PAYMENT CAP FOR TC IN 2007!!!

Proposed Major Decrease in 2007 for OFFICE-BASED Technical Component (TC) ----- 145 procedures.

·       Will NOT affect Professional Component (PC)

·       CMS proposes to calculate the cap by “comparing the national average technical payments for physician in-office procedures with the national average prices paid to the hospital outpatient departments.”

·       The geographic adjustment will then be applied to the lower figure.

·       If more than one imaging study is done on contiguous parts, a 25% decrease will be applied prior to the cap.

·       The ACR is supporting legislation that would delay implementation by two years.

·       Examples –          

o      70553-TC – MRI brain w & wo IV- $876.46<$513.48

o      70496-TC -  CTA head - $424.83<$302.85

o      75635-TC – CTA abdomen - $619.62<$302.85

o      71010-TC -  Chest x-ray - $28.04<$25.18

(Part B News, Volume 20, No. 33, August 21, 2006, pp. 1-8)

(Interventional Procedure Coder’s Pink Sheet, Volume 2, No. 8, August, 2006)

2007 PRACTICE EXPENSE REVISION –CONTRAST

CMS proposes to remove contrast media from calculation of practice expenses because contrast media can be separately billed.

(Part B News, Volume 20, No. 32, August 14, 2006, p. 4)

2007 – Colon CA SCREENING Deductibles Waived

No deductibles for colon cancer screening in 2007 --- Including BE’s

Part B – No deductibles or coinsurance for Codes G106, G0120, G0121

(Part B News, Volume 20, No. 30, July 31, 2006, p. 3)

DEXA TARGETED

“The work involved with code 76075 is more mechanical and less intense” according to CMS.  CMS plans to follow the RUC proposal to decrease the RVUs from 0.30 to 0.20.

 (Part B News, Volume 20, No. 25, June 26, 2006, p. 4)

COMPLETE ABDOMINAL ULTRASOUND RULES

To get paid for a COMPLETE abdominal ultrasound, examine and document that you have examined “. . . the liver, gall bladder, common bile duct, pancreas, spleen, kidneys and the upper abdominal aorta and inferior vena cava including any demonstrated abnormality.”  In the absence of such documentation, use code 76705, limited exam.  If all of the required elements are not visible, the report should indicate why, e.g. previous removal of one kidney, obscured by bowel gas, to be in compliance with the documentation rules for a Complete exam.

(Radiology Coding Alert, Volume 8, No. 7, July 2006,  p. 56)

TRANSVAGINAL US – PELVIC US ON SAME DAY

According to the Radiology Coding Alert, “NCCI deleted an edit that bundled 76830 (Ultrasound, transvaginal) into 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete). . . . . “You should not need to use modifier 59 (Distinct procedural service) to report 76830 separately from 76856. . .”  If you are receiving denials from Medicare on the basis of this, you should consider challenging.  For more information, see the reference material cited.

(Radiology Coding Alert, Volume 8, No. 6, June 2006,  p. 41)

FOLLOW-UP URINARY PROCEDURES CODES

50394- injection procedure for pyelography (e.g. nephrostogram, etc)

74225- supervision & interpretation for nephrostogram, loopogram, etc

50398- replacing urinary tract tubes, stents, etc. with contrast monitoring

75984- supervision & interpretation with 50398 for GU,GI, Abscess

50389- removal of nephrostomy tube with fluoroscopic guidance

(Interventional Procedure Coder’s Pink Sheet, Volume 2, No. 5, p 5, May, 2006)

*For more detailed information, recommend review of the source information, cited above.

Home Page Information:

http://www.ghimedicare.com/

http://www.umd.nycpic.com/

http://www.gao.gov

Coding 

Upstate Medicare - http://www.umd.nycpic.com/billtips.html#ICD-9-CM  and then select, ICD-9-CM Coding for Diagnostic Tests

Respectfully submitted,

Arthur J. Segal, M.D., F.A.C.R.

Chairman, Medical Insurance and Compensation Committee / NYSRS CAC Representative