7/25/2019 How Will Changes to the Physician Fee Schedule Affect
Your Practice.docx
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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713,
Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
[email protected]
How Will Changes to the Physician Fee Schedule
Affect Your Practice?
By Susan Dooley
Did you remember to check the Medicare Physician Fee Schedule
Database (MPFSDB) for July? CMS
implements the changes on July 5, 2016, but some of the changes
will be effective back to Jan. 1, 2016.
Check Out Key Changes in July Update
CMS requires Medicare Administrative Contractors (MACs) to amend
payment files to conform with theJuly changes. Note that MACs will
not search their files to retract payment for claims already paid,
nor
will they retroactively pay claims. However, they will adjust
claims that are brought to their attention.
We talked yesterday about some of the new CPT Category III codes
added to the MPFS. Next week
well go over changes to HCPCS codes and to National Correct
Coding Initiatives (CCI) edits. But today,
lets focus on the CPT Category I codes affected by the 2016 MPFS
changes.
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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713,
Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
[email protected]
Review Ways the Fee Schedule Changes Payment for These Codes
The MPFS adjusts the following CPT codes by adding one of
several indicators that affect
reimbursement for these services. The codes official descriptors
are unchanged.
+10036, Placement of soft tissue localization device(s) (eg,
clip, metallic pellet, wire/needle,
radioactive seeds), percutaneous, including imaging guidance;
each additional lesion
Multiple Surgery Indicator = 0
Note that Medicares multiple procedure rule allows payment of a
reduced amount for subsequent
procedures performed during the same session. The indicator
digit listed in the Physician Fee Schedules
Multiple Procedure column tells the amount that the
reimbursement is reduced. Heres what Chapter
1 of the National Correct Coding Initiative (NCCI) Policy Manual
tells us about indicator 0: 0=No
payment adjustment rules for multiple procedures apply. This
means that reporting multiple instances
of +10036 will not result in reduced or no reimbursement for the
additional instances.
37188, Percutaneous transluminal mechanical thrombectomy,
vein(s), including intraprocedural
pharmacological thrombolytic injections and fluoroscopic
guidance, repeat treatment on
subsequent day during course of thrombolytic therapy
Multiple Surgery Indicator = 0
This means that for 37188, no payment adjustment for multiple
procedures applies to this code.
45346, Sigmoidoscopy, flexible; with ablation of tumor(s),
polyp(s), or other lesion(s) (includes
pre- and post-dilation and guide wire passage, when
performed)
Endo Base Code = 45330
The endo base code rule is similar to the multiple procedure
rule, in that it affects the reporting of two
or more endoscopic procedures. CPT and CMS classify endoscopic
procedure codes by family. Each
family is made up of related services with a parent code
consisting of an endoscopic base code,representing the most basic
version of that endoscopic service. The base code for 45346 is
45330, a
flexible sigmoidoscopy with or without collection of specimens.
This means that if a gastroenterologist
performs diagnostic sigmoidoscopy (45330), and finds lesions
that require ablation, you can only report
45346. This is because the ablation procedure includes the work
of the diagnostic sigmoidoscopy
procedure.
+61651, Endovascular intracranial prolonged administration of
pharmacologic agent(s) other
than for thrombolysis, arterial, including catheter placement,
diagnostic angiography, and
imaging guidance; each additional vascular territory (List
separately in addition to code for
primary procedure)
Multiple Surgery Indicator = 0
As noted above, a Multiple Surgery Indicator of 0 tells us that
no payment adjustment for multiple
procedures applies to this code.
65855, Trabeculoplasty by laser surgery
Bilateral Indicator = 1
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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713,
Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
[email protected]
Bilateral indicators identify which procedures can be billed as
bilateral. A bilateral indicator of 0 means
the criteria doesnt apply. An indicator of 1 means the procedure
is Conditional Bilateral. This means
that if you report 65855 with modifier 50 to indicate a
bilateral procedure, Medicare will reimburse at
150 percent of the allowed amount.
69209, Removal impacted cerumen using irrigation/lavage,
unilateral
PC/TC indicator = 3
This indicator 3 designates 69209 as a technical component only
code, which is a standalone code
describing the technical component (that is, staff and equipment
costs) of this diagnostic test.
What About You?
Do you think these changes will have a big effect on your
practice?Please let us know.
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Contact Us:
Name: Sam Nair
Title: Associate Director
Email:[email protected]
Direct: 704 303 8150
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC
27713
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