AMA, CMS discuss preventive care, a new modifier

by: Charles Fiegl Nov 12, 2010

DecisionHealth's Laura Evans sent along some reports from the AMA's CPT and RBRVS 2011 Annual Symposium in Chicago. We'll have a complete story with her coverage in a future issue of Part B News, but here are just a few highlights:

You won't need to append modifier 25 (significant, separately identifiable E/M service) to the new annual wellness visit codes if billed with covered screening tests. However, if you bill a wellness visit exam with a separately identifiable E/M, you'll need to attach 25 to the E/M.
CPT unveiled a new modifier: 33. The new modifier will be appended to new preventive services, according to Peter Hollmann, MD, AMA CPT Editorial Panel Vice Chair.
The new subsequent observation codes (99224-99226) are designed to be reported by both the physician who initiates observation care and any other doctor who evaluates the patient, said Dr. Hollmann. For the non-initiating doctors, the AMA thinks you should report the subsequent observation codes for Medicare and the office consult codes for non-Medicare payers. It's not clear how Medicare will handle these services, and CMS officials were not being forthcoming. Medicare priced the subsequent observation codes at 75% of the fee for subsequent hospital care, according to Kenneth Simon MD, CMS Senior Medical Officer. Medicare policy currently directs physicians who didn't initiate observation care to use the office/outpatient E/M codes when evaluating a patient in observation.

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