Steven A. Adams, CPC, CPC-H, COA

1. Steven A. Adams, CPC, CPC-H, COA Doing It Right The First Time (a managers look into the world of coding)

2. When It Is Too Late… practice-management.org sadams@magmutual.com

3. Discussion Points • Medicare Payment Reform • Future Documentation/Coding Solutions • New Modifier Rules (August 2006) • New Consultation Rules (January 2006) • E and M Coding Profiles & Audits • New Codes for 2006 • Preventive Services for 2006

4. Result of Payment Reform “How long can you afford to live?”

5. Premiums & Deductibles 2007 • 1. Part A Premium: $410 (paid by about 1 percent of beneficiaries) • 2. Part A deductible: $992 • Part B standard premium: $93.50 • Part B deductible: $131

6. Good News for 2007 The proposed notice includes substantial increases for “evaluation and management” services, that is, time and effort that physicians spend with patients in evaluating their condition, and advising and assisting them in managing their health. The changes reflect the recommendations of the Relative Value Update Committee (RUC) of the American Medical Association. “It’s time to increase Medicare’s payment rates for physicians to spend time with their patients,” said CMS Administrator Mark McClellan, M.D., Ph.D. “We expect that improved payments for evaluation and management services will result in better outcomes, because physicians will get financial support for giving patients the help they need to manage illnesses more effectively.” The proposed notice will appear in the June 29 Federal Register. Comments will be accepted until August 21, 2006.

7. Impact of Change

8. Bad News for 2007 Without congressional intervention, Medicare will cut physician payment by 5.1 percent in 2007; unchecked by congressional action, the cuts will continue for the next eight years for a 40 percent reduction overall.

9. Future Documentation & Coding Solutions

10. Superbill 2

11. Finding CPT/ICD-9 meistermed.com Tracking Pt Info: Pocketmed.org Patientkeeper.com E&M Auditing Tool Statcoder.com Future Solutions Documentation Management Srssoft.com FP ICD-9 codes http://www.aafp.org/online/en/home/publications/journals/fpm/icd9/icd9changes.html

12. Consultation Changes

13. Medicare Transmittal 788(1/17/06) • Consultation Versus Visit - Pay for a consultation when criteria is met: • …opinion is requested by another physician or NPP • …need for consultation is documented in note • …written report is provided to referring physician A transfer of care occurs when a physician or NPP requests that another physician or NPP take over the responsibility for managing the patients’ complete care for the condition and does not expect to continue treating or caring for the patient for that condition.

14. Medicare Transmittal 788 • Consultation for Preoperative Clearance - Pay for the appropriate consultation code for a pre-operative consultation for a new or established patient performed by any physician at the request of a surgeon, as long as all of the requirements for billing the consultation codes are met.

15. Covered Diagnosis • The following are covered dx’s to use when billing for preoperative services: • V72.81 Pre-operative cardiovascular examination • V72.82 Pre-operative respiratory examination

16. Medicare Transmittal 788 • Postoperative Care – If the surgeon asks a physician or NPP who had been treating the patient …to take responsibility for the management of an aspect of the patient’s condition during the postoperative period, the physician or NPP may not bill a consultation because the surgeon is not asking for an opinion or advice. The physician or NPP would bill a subsequent hospital code in the inpatient setting.

17. Modifier Changes

18. Medicare Transmittal 954(8/20/06) • Modifier Transmittal – Outlines proper use of: • …25 modifier with global period codes only (minor) • …different diagnosis code is NOT required • …carriers shall not search old files for errors When you bill a procedure code with a global period with the –25 modifier, make sure the E&M is truly a separate and identifiable note – They want to see two notes.

19. Productivity Reports certcdc.com/certproviderportal/default.aspx

20. Outpatient Visit New / Consults 99201 - 99245 “Requires All Three Key Elements”

21. 3

28. Outpatient Visit Established Patient 99211 - 99215 “Requires Two of Three Key Elements” 3

29. 3

34. Inpatient/Outpatient Visits Initial & Subsequent Patient Encounters 99217 - 99239 3 / 19

35. See Forms To Remember The Correct Codes 99221 - $66 99222 - $110 99223 - $152 99231 - $33 99232 - $54 99233 - $77 99238 - $68 99239 - $93 2,13 14

36. Hospitals Work on Calendar Days not HOURS - See Form For Correct Coding 99234 - $131 99235 - $173 99236 - $216 99218 - $65 99219 - $108 99220 - $152 99217 - $68 3 17

37. Major Code Changes for 2006! - See Form For Proper Coding 99301 - $64 99302 - $85 99303 - $105 99311 - $32 99312 - $54 99313 - $77 18

38. Preventive Services

39. Initial Preventive Physical Exam EKG Pelvic examination Pap - obtain Occult Blood Flu vaccine Pneumonia vaccine Hepatitis vaccine Colonoscopy patient at high risk Colonoscopy screening exam Prostate exam DM self-management Bone Mass Measurement (DEXA) Mammogram Smoking Cessation 3-10 minutes Smoking Cessation > 10 minutes Cardiovascular screening Diabetes screening 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 G0121 $401.85 G0102 $ 22.37 G0108 $ 34.18 76075 $147.89 76092 $ 89.93 G0375 $ 13.20 G0376 $ 26.03 80061 $ 18.72 82947 $ 5.48

40. Vaccines

41. G0101 - Breast and pelvic Q0091 - Pap smear G0107 - Occult Blood V76.51 CA screen of colon V76.2 CA screen of Cervix V76.47 CA screen of Vagina V76.49 Woman without Cervix V15.89 High risk Cervical CA Medicare Information G0101 - $39.09 Q0091 - $42.14 G0107 - $ 4.49 22 - 23

42. G0179 - Home Health Recertification - $70 G0180 - Home Health Certification - $80 G0181 – Home Health Agency – >30 Min - $115 G0182 – Hospice Care – >30 Minutes - $125 Medicare Information 24 -25

43. G0372 – Physician service required to establish and document the need for a power mobility device - $22 Can be billed with E&M (25 modifier) Need for PMD documented in the chart Written Rx for PMD Provide medical record to supplier within 30 days PMD 24 -25

44. Tobacco Cessation 30

45. New Codes - 2006

46. 90780 - Infusion 90781 - each hour 90782 - Therapeutic 90788 - Antibiotic 90760 - IV Hydration 90761 - each hour 90765 - IV Therapy 90766 - each hour 90772 - IM Injection 90772 - IM Injection New Injection Codes 2006

47. Occult Blood (guaiac) 82270 - 3 cards/triple card • 82271 - other sources • 82272 - single specimen Hemoglobin 83036 - A1C • 83037 - A1C by FDA device Common Code Changes

48. Discussion Points • Medicare Payment Reform • Future Documentation/Coding Solutions • New Modifier Rules (August 2006) • New Consultation Rules (January 2006) • E and M Coding Profiles & Audits • New Codes for 2006 • Preventive Services for 2006

49. Remember: If all else fails, destroy the evidence, find a new job, and blame your failures on someone else. Steven Adams

50. Questions practice-management.org sadams@magmutual.com