If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.
The change: In the past, you could collect for tobacco cessation counseling for a patient with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare recognized practitioner who can work with them to help them stop using tobacco.”
“For too long, many tobacco users with Medicare coverage were denied access to evidencebased tobacco cessation counseling,” said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. “Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence.”
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The new tobacco cessation counseling…
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 Medicaid Extenders Act of 2010 today and the Senate voted on it yesterday, so now it goes to President Obama’s desk for his signature. The bill will eliminate the 25 percent cut that medical practices were going to face effective January 1.
Physicians cheered the news that they won’t have to wait for the new Congress and Senate members to take their seats before determining whether a payment fix would take place. “The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year,” said AMA president Cecil B. Wilson, MD, in a statement today. “Stopping the steep 25 percent Medicare cut…
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 an incomplete colonoscopy. If the gastroenterologist could not get beyond the splenic flexure for reasons including poor prep, he is supposed to report 45378 with modifier 52, according to CPT 2010. CMS policy, however,
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 physician administered a vaccine with preservatives to a patient over the age of three. Medicare will no longer pay for claims with 90658 “effective for claims with dates of service on or after Jan. 1, 2011,” according to MLN Matters article MM7234.
Instead, you’ll have to bill based on the specific brand-name flu vaccine that the physician administers using the following new HCPCS level II codes:
- Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; Afluria
- Q2036 – Flulaval
- Q2037 – Fluvirin
- Q2038 – Fluzone
- Q2039 – Not otherwise specified.
Important: Don’t start submitting the new codes just yet. The…
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 two HCPCS level II codes to represent the new annual wellness visits, as follows:
G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit
G0439 – Annual wellness visit; includes a personalized prevention plan of service (PPPS); subsequent visit
Medicare crosswalked the RVUs of 2.43 from new patient office visit code 99204 to G0438, and the RVUs of 1.50 from established patient office visit code 99214 to G0439.
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 only 1 diagnosis for both CPT codes. We are getting denials for the injection. Can we attach modifier 25 to 99211 or should we consider 99211 included in the injection?
Answer: You may report 99211 and 95115/95117. There is no National Correct Coding Initiative edit on the codes.
You, however, should not use 99211 every time you are giving an allergy injection. Providers may bill for a nurse-only 99211 when dealing with clinical issues surrounding allergy injection administration, according to a Joint Council of Allergy, Asthma and Immunology (JCAAI) member letter.
The nurse must document the medically necessary E/M service that she…
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
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 the 23 percent Medicare Physician Fee Schedule conversion factor cut that practices have feared since January was once again kicked to the curb by Congress.
On Nov. 18, the Senate voted to halt the Medicare physician pay cut for one month, and the House returned from Thanksgiving break on Nov. 29, at which point they also voted to freeze Medicare pay through the end of 2010.
Medicare pay is set to drop 25 percent effective Jan. 1, 2011, and the current legislation does not change that.
Stay informed on 2011 payments with weekly updates from by Torrey Kim, CPC, CGSC.
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
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. House of Representatives resumes sessions on Nov. 29, at which time members are expected to pass the 31-day period extension. The month will buy members time to work on reform and budgetary constraints and potenetially pass a 12-month payment cut reprieve.