Jen Godreau, BA, CPC, CPMA, CPEDC

Content Director, SuperCoder.com

The Coding Institute, LLC
Nov. 23, 2010
Symposium Facts
1. Dr. Hollmann missed
his calling as a
comedian.

2. Chicago can be warm

in November.

3. Joe’s Crab Shack is the

place to be for seafood.
MPFS Ups & Downs
Dates Type Percent
June 2010 –Nov. 2010 2.2
Dec. 1, 2010 23.0
Jan. 1, 2011 2.51

Conversion Factor: $25.5217

-- Marc Hartstein
Deputy Director
Hospital and Ambulatory Policy Group
Center for Medicare
“Medicare Physician Payment Schedule 2011 Changes and Beyond”
Nov. 10, 2010

-- 2011 Medicare Physician Fee Schedule Final Rule

MEI Increases Office Space Pay
Medicare 2000 2006 base
Economic base % %
Index
(MEI)
Physician 52.466 48.266
work
Practice 43.669 47.439
expense
Malpractice 3.865 4.295
Medicare increased the cost
share weight for office rent
to 12.2 percent from a
proposed 8.4 percent.
Therapy Cap Uncertainty
2010 Therapy Cap: $1860
2011 Therapy Cap: $1870

Expiration: Dec. 31, 2010.

Will GPCI Be Extended?
1.o PE GPCI states: 1.5 work GPCI
Montana Alaska
Wyoming
North Dakota
Nevada
South Dakota
G Codes Created for Tissue-
Cultured Skin Substitute
Current Codes New Codes
Application Skin Global Day G0440 (Application of tissue
Repair Period cultured allogeneic skin
Apiligraf 15430, 90 substitute or dermal
15431 substitute; for use on lower
Dermagraft 15360, 30 limb, includes the site
15361,
preparation and debridement
15365,
15366 if performed; first 25 sq cm or
less)
G0441 ( … each additional 25
sq cm)
CRP Code Wins Payable Status
95992 (Canalith repositioning procedure[s] [e.g., Epley
maneuver, Semont maneuver], per day)
Good News Bad News
Status changed from bundled Medicare will not pay for
to active CRP performed by an
Work RVU: 0.75 audiologist because CRP is a
therapeutic code. Medicare
restricts payments for
audiologists to audiological
diagnostic tests.
CPT Considers Times as Averages
“In selecting time, the physician
must have spent a
time closest to the code selected.”
-- CPT Assistant 2004

“If coding by time,

pick the closest typical time.”
-- Peter Hollmann, MD
“E/M, Vaccines and Time Based Codes”
CPT and RBRVS 2011 Annual Symposium
Thresholds Vs. Averages
Following CPT Assistant’s closest time code rule, time
breakdowns for office visits include:
Code CPT descriptor indicates physicians CPT Assistant indicates to use
typically spend this many minutes when counseling/coordination of
face-to-face with the patient and/or care dominates face-to-face office
family time totaling this many minutes

99212 10 10-12.5

99213 15 12.6-20.5

99214 25 20.6-32.5

99215 40 32.6 or more

Will Medicare Change Its Rule?

“I don’t want to say

one way either ‘Yes’ or ‘No’
at this time.”
-- E/M expert Deborah Patterson, MD
Clinical Medical Director
Trailblazer Health Enterprises, LLC
Dallas
Vaccine Administration Rehaul
CPT 2011 deletes per vaccine administration codes
90465-90467.
90471-90474 (Immunization administration ...) codes
remain.
The new codes are based on the number of
components.
Vaccine Administration Base Code
Assign one code for each vaccine’s initial component:
90460 (Immunization administration through 18 years
of age via any route of administration, with counseling
by physician or other qualified health care professional;
first vaccine/toxoid component)

Definition: A component refers to the

antigen in a vaccine that prevents disease
caused by one organism.
Each Additional Component
For each additional vaccine component, report :
+90461 (Immunization administration through 18
years of age via any route of administration, with
counseling by physician or other qualified health care
professional; each additional vaccine/toxoid
component (List separately in addition to code for
primary procedure))
Always report +90461 in addition to 90460.
Bill the add-on code, plus the number of units that
represents the number of components.
Example
A pediatrician counsels a mother on vaccine risks and
benefits prior to giving the patient Pediarix (90723),
which has five components: DTaP-HepB-IPV.
Diphtheria, tetanus toxoids, acellular pertussis,
Hepatitis B and inactivated polio virus each count as
one component. For the vaccine administration with
counseling on the components included in Pediarix,
you should report:
90460
+90461 x 4.
Extended Observation
Subsequent observation care, per day, for the evaluation and management of a
patient, which requires at least 2 of these 3 key components:
Code Interval History Exam MDM Presenting Time Proposed Accepted
Problem (min) RVU RVU
99224 Problem focused Problem straightforward stable, recovering, 15 0.76 0.54
focused or of low or improving
complexity
99225 expanded problem expanded moderate patient is 25 1.39 0.96
focused problem responding
focused inadequately to
therapy or has
developed a minor
complication
99226 detailed detailed high unstable or has 35 2.00 1.44
developed a
significant
complication or a
significant new
problem.
11042-11047 Vs. 97597-97602
(11040, 11041 have been
deleted)
(For debridement of skin,
i.e. epidermis and/or
dermis only, see 97597,
97598)
11042: Debridement, skin
and subcutaneous tissue
[includes epidermis and
dermis, if performed); first
20 sq cm or less
Active wound care of the
skin, dermis, or epidermis.
0 day global period
Intent: “Active wound care
procedures are performed
to remove devitalized
and/or necrotic tissue and
promote healing.”
Contact: Direct patient
contact is required.
Sentinel Lymph Node Mapping
38900 (Intraoperative identification [e.g., mapping] of sentinel lymph node[s]
includes injection of non-radioactive dye, when performed [List separately in
addition to code for primary procedure])

Includes injection of nonradioactive dye, when

performed
For the injection of a radioisotope, use 38792.
Photodynamic Therapy
96570 and 96571.
If the pulmonologist performs 96570 for less than 23
minutes, report modifier 52.
For each increment after the first 30, you have to get
to the 8th minute for each interval.
Sleep Studies
Types of Home Sleep Study Description CPT 2009 CPT 2010 CPT 2011
Studies
Type II Comprehensive portable G0398 95806 95806
polysomnography (min
7 channels)
Type III Modified portable sleep G0399 0203T 95800
apnea testing (min 4
channels)
Type IV Continuous single or G0400 0204T 95801
dual bioparameters (min
3 channels per NCD
CPAP for OSA)
Pain Points
1. Include imaging guidance in 64479-
64484
2. Code paravertebral facet joint
blocks (64490-64495) bilaterally if
the physician injects two sides at the
same level.
3. Do not report the insertion 64555 in
addition to new code 64566 for
programming.
Amniotic Membrane Codes
Code Membrane Placed
65578 on the ocular surface
65779 with suturing

65780 multiple layers

66999 using tissue glue

SCODI Also By Location
92135 is deleted
92133 (Scanning computerized ophthalmic diagnostic
imaging, posterior segment, with interpretation and
report, unilateral or bilateral; optic nerve)
92134 (… retina)
92132 (Scanning computerized ophthalmic diagnostic
imaging, anterior segment, with interpretation and
report, unilateral or bilateral)
Nasal/Sinus Dilation
Code Location
31295 dilation of the maxillary sinus ostium, which can often be accessed
transnasally or through the canine fossa if there’s been a previous
puncture
31296 dilation of sinus ostium, in which the otolaryngologist does not
remove tissue
31297 sphenoid sinus ostium is dilated

“These codes are for dilation of sinus ostium.”

Do not use them if the otolaryngologist removes tissue. Instead use
the appropriate sinus endoscopy code, such as 31267 or 31276.

-- Richard W. Waguspeck, MD, FACS

The Triological Society, AMA CPT Advisory Committee Member
69801
2010 2011
Labyrinothotomy, with or Labyrinothotomy, with
without cyrosurgery including perfusion of vestibuloactive
other nonexcisional drug(s); transcanal
destructive procedures or
perfusion of vestibuloactive 0 day global period
drugs (single or multiple Can now code per injection
perfusions); transcanal on separate day.
90 day global period
Included all required
infusions performed on the
initial and subsequent days of
treatment for 90 global days.
Motility, Monitoring
91117 -- Colon motility (manometric) study, minimum
6 hours continuous recording [includes provocation
tests, e.g., meal, intracolonic balloon distension,
pharmacologic agents, if performed), with
interpretation and report
91034 -- Esophagus, gastroesophageal reflux test, with
nasal catheter pH electrode(s) placement, recording,
analysis and interpretation
91035 -- … with mucosal attached telemetry pH
electrode placment, recording, analysis and
interpretation
FAQs
You can only bill the study once even if it’s done for
more than 48 hours.
If the catheter is placed in an ASC, the center cannot
be involved in the staffing, physician work, or
equipment. The office has to provide all those items
and bill for them.
If the gastroenterologist does an office endoscopy for
abnormalities and then places the capsule on same
day, you may bill both the study 93015 and the scope
with modifier 59 (43235-59).
Incomplete Colonoscopy
When performing an endoscopy on a patient who is
scheduled and prepared for a total colonoscopy, if the
physician is unable to advance the colonoscope
beyond the splenic flexure, due to unforeseen
circumstances, report the colonoscopy code with
modifier 53 and appropriate documentation.

Uniform method: Aligns CPT

with Medicare.
Combined Abdomen Pelvis CT
Stand Alone Code 74150 74160 74170
CT Abdomen CT Abdomen CT Abdomen
WO Contrast W Contrast WO/W Contrast

72192 74176 74178 74178

CT Pelvis
WO Contrast
72193 74178 74177 74178
CT Pelvis
W Contrast
72194 74178 74178 74178
CT Pelvis
WO/W Contrast
Device Monitoring
code deletions
introductory language changes
code revisions
93224 – External Wearable electrocardiocraphic
rhythm derived monitoring for 24 hours recording up
to 48 hours by continuous original waveform rhythm
recording and storage, with visual superimposition
scanning;
scanning includes recording, scanning analysis with
report, physician review and interpretation
For codes 93224-93227, when a continuous is less
than 12 hours, use modifier 52.
Cardiac Catheterization
The new noncongenital studies include:
Most injection procedure services
Imaging supervision
Interpretation and report.

Left heath catheterization includes left

ventriculography (injection procedure, supervision,
interpretation and report) when performed
Table of Catheterization Codes
New Hip Arthroscopy Codes
Code Describes Treats
29914 arthroscopy with cam lesion
femoroplasty
29915 arthroscopy with pincer lesion, a The treatment
acetabloplasty, new disease grinds away the
excess lesions.
29916 analagous to a sports injuries
labral repair at the
shoulder or knee
Get up-to-date on the latest coding changes from the
comfort of your desk at www.audioeducator.com!
Resources
CPT® and RBRVS 2011 Annual Symposium; Nov. 10-12,
2010, Chicago.
2011 CPT Professional Edition; American Medical
Association.
Ensuring reimbursement. Insuring coders.

Questions

Jen Godreau, Content Director, Supercoder.com

Family Practice, Pediatrics, Otolaryngology
:
www.supercoder.com/forum/