CPT® 2005: Prepare Now For New Backbench Transplant Preparation Codes (September 2004)
This sneak peek puts you a step aheadTime is running out! With just over three months to go before the new CPT codes take effect on Jan. 1, coders are eagerly collecting every hint as to the nature of the new codes.Luckily, coding experts have learned many of the new codes. They caution that the new codes are provisional and subject to change, so you shouldn’t consider any of them official until you receive your [...]
Legislation: Neurosurgeons Gain Victory In Senate Committee (September 2004)
But language won’t have any reimbursement impact, say oncologistsNeurosurgeons who feel as though radiologists are improperly billing for stereotactic neurosurgery recently scored an important point on Capitol Hill. The Centers for Medicare & Medicaid Services should move cobalt 60 stereotactic neurosurgery from the radiation therapy section to the neurosurgery section of the Ambulatory Procedure Classification system for outpatient procedures, Senators insisted. The language in the Senate Committee Report accompanying S. 2810, the appropriations bill for [...]
Senators Push For Oral Cancer Coverage Sooner Than 2006 (September 2004)
The Senate report also urged CMS to address the “unintended consequences” of current reimbursement policies that don’t cover oral anti-cancer therapies under Medicare Part B. Medicare only covers cancer drugs that a physician administers, which bars access to some potent therapies.But cancer providers and oncology societies express puzzlement about this language in the Senate report, because the Medicare Part D prescription drug program that takes effect next year will cover oral medications.
CPT® 2005: Confused About How To Bill For APBI? Help Is Here! (September 2004)
New codes could end APBI reimbursement woesMany carriers issued Local Coverage Determinations for Accelerated Partial Breast Irradiation last summer (see PBI, Vol. 5, No. 26, p. 196), but there was no way to bill for a huge part of these procedures. All that should change in the new year.Experts expect three new codes to come out in January for breast catheter placement for radiation therapy after a lumpectomy. APBI targets part of the breast after [...]
Local Papers Warn Of Cancer Patient Exodus To Hospitals (September 2004)
Cuts to cancer drug payments next year could force Euclid, OH oncologist David Fishman to cover $400,000 worth of drug costs out of pocket, he told Crain’s Cleveland Business. And local oncologists predicted a mass exodus of patients back to the hospital in interviews with the Baton Rouge, LA Advocate.According to the Crain’s article, roughly 80 percent of chemotherapy treatments now happen in a physician’s office, but this situation may change drastically next January. Fishman [...]
Shared Visits: Save The ‘Shared Visits’ Rule For The Hospital Ward (September 2004)
Don’t try to combine NPP/physician visits in the office settingSome things are better not shared, like syringes, Justin Timberlake impersonations - and office visits.Providers are often tempted to use the shared visits rule in the office setting. But while you’re allowed to bill for a shared visit under certain limited circumstances, you won’t find the rule very useful in the office, according to experts. The Centers for Medicare & Medicaid Services introduced shared visits in [...]
The Centers for Medicare & Medicaid Services clarifies in Change Request 3460, dated Sept. 17, that another member of the same physician group can supervise a non-physician practitioner who is following the plan of care of a physician who isn’t present. The supervising physician must bill under the same group PIN as the other physician, and must have signed a form 855R reassigning his/her right to bill to the group. You should identify the supervising [...]
New Codes: No More Unlisted Codes For Laparoscopic (September 2004)
The days of blind billing have passed you byThe wait is over for laparoscopic gastric bypass codes. Many providers have been struggling to bill for laparoscopic “stomach stapling” and other procedures using an unlisted code (see PBI, Vol. 5, no. 12, p. 83). But CPT 2005 apparently includes two codes (43644-43645) for laparoscopic gastric restrictive procedures using roux-en-y gastroenterostomy and small intestine reconstruction respectively. It also includes another new gastric bypass code, 43845 (Gastric restrictive [...]
Start Organizing Dementia PET Clinical Trials Now (September 2004)
The Centers for Medicare & Medicaid Services budged an inch or so on the issue of covering positron emission tomography for suspected Alzheimer’s disease. CMS still is sticking to last summer’s limited draft coverage decision that only covers PET when the physician has narrowed the diagnosis down to just Alzheimer’s or fronto-temporal dementia. Physicians argued that it would be hard for most doctors to feel confident about eliminating all other diagnoses (see PBI, Vol. 5, [...]
Part B Coding Coach: Don’t Let Burn Coding Singe Your Reimbursement (September 2004)
Keep your burn coding cool with these 7 expert stepsConfused by the number of burn coding options? You’re not alone.With some diagnoses there is clearly one code series to choose from - but that’s not the case with burns. ICD-9-CM lists codes for both burn location (940-947) and percentage of body burned (948). And unlike some simpler diagnoses, burn codes require fourth and fifth digits to specify the degree and exact location of a patient’s [...]
