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.

The two men leading the National Commission on Fiscal Responsibility and Reform released a draft document outlining their thoughts on cutting the national deficit and improving the federal budget. The 50-page document dedicates six pages to the Medicare program in a section titled Mandatory Budget Options.

The preliminary report represents the co-chairmen's ideas and not the consensus of the whole commission. However, physician practices should take note of where the commission might be headed when it comes to Medicare reimbursement issues. The commissioners want to fix the flawed Medicare payment formula that uses the sustainable growth rate (SGR) mechanism. But, the fix would be paid for.

I spoke to two members of Congress, in the House of Representatives, about the major legislative issues affecting you and your peers. That really boils down to just two issues: the looming Medicare physician pay cut and the future of the health reform law, which one side wants to uphold and the other repeal.

While Republican Rep. Michael Burgess (Texas) and Democratic Rep. Diana DeGette (Colorado) both agree that the 23% cut must be stopped, they hold opposite views on the health reform law.

Here are edited transcripts of my conversations with them, over phone and email (read more about interviews with House Republicans and Democrats) ...

CMS quietly released a fact sheet on Part B premiums and deductibles for 2011 a couple days after Election Day and the release of the 2011 Medicare Physician Fee Schedule. Both rates will be going up next year.

The Part B deductible will be $162, a 4.5% increase from the $155 deductible in 2010.

The standard premium will be $115.40, a 4.4% increase from the 2010 rate. Premiums are increasing "because of growth in the use of services like outpatient hospital care, home health and physician-administered drugs," CMS says. "In addition, the premium accounts for a likely Congressional action to avert a precipitous decrease in physician  payments, which the Administration supports, and has occurred every year since 2003. The Administration is committed to permanent reform of the physician payment formula."

Patients who currently have the Social Security Administration withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2011, CMS says. So, a majority of Medicare patients will continue to pay $96.40, which has remained unchanged since 2008.

Preventing the 23% cut slated for Dec. 1 must be a top priority for HHS, Secretary Kathleen Sebelius said in remarks at the annual meeting of the Association of American Medical Colleges (AAMC). The importance of stopping the cuts comes from the top, as President Obama himself stressed to Sebelius at a Cabinet meeting last week, Sebelius said.

"The single biggest step we can take to strengthen Medicare for seniors and disabled Americans is to make sure these disruptive cuts don't take effect," she said (read more about Obama and the pay fix) ...