Surgical code not required for anesthesia claims. An article in the October 24 issue of Part B News listed that a surgical code is required on all anesthesia claims. HIPAA 5010 regulations allow anesthesiologists to include the surgical code on the anesthesia claims but doing so is not a requirement, according to the American Society of Anesthesiologists (ASA) which released guidance on the matter after the article’s publication.

Your peers increasingly think of Medicare’s annual wellness visit (AWV) as a patient data-gathering and education visit, especially with the new health risk assessment (HRA) requirement. Because no physical exam is required and much of the AWV is collecting patient health information, your non-physician practitioners (NPPs) play a bigger role than physicians.

You and your peers rake in a lot of extra revenue by billing your non-physician practitioners’ (NPP) services incident-to with Medicare. But you could be taking in even more money by letting your NPPs bill under their national provider identifier despite the 15% lower reimbursement rate, experts say. 

How have inpatient E/M utilization by nurse practitioners (NPs) and physician assistants (PAs) changed from 2009 to 2010 – the first year in which CMS stopped accepting consultation codes (99241-99255)? In 2010, inpatient consults were required to be billed as initial or subsequent hospital care codes (99221-99233) by CMS. All figures are based on the latest Medicare claims data from 2010. NOTE: All billing data for NPs and PAs are based only on services billed under their own individual national provider identifiers (NPIs). CMS does not distinguish between physician-billed services and those billed incident-to by NPPs.

Can a nurse practitioner (NP) perform a joint injection? If so, whose name goes on the documentation if the NP performs the injection while the doctor is performing an E/M visit on the same patient? Also, is this encounter billed under the physician’s or the NP’s national provider identifier (NPI)?

Don’t expect the industry-wide transition to version 5010 format on Jan. 1, 2012 to go over smoothly, meaning your practice will be financially vulnerable. But whether it’s your payers, your practice management system (PMS) vendor, or even you who isn’t ready for the switch, you need a contingency plan in place to prevent cash flow disruption, experts say.

You have two months to prepare for a big change in the way you provide annual wellness visits (AWVs). The health risk assessment (HRA) becomes a required component of the AWV on Jan. 1, 2012, and it will be yet another obstacle to furnishing AWVs for many primary care physicians, experts tell Part B News.

You and your peers will lose millions of dollars on physician interpretations of diagnostic imaging scans once the 25% multiple procedure payment (MPPR) hits the professional component (PC) in less than two months.

Remember: CMS finalized the imaging cut to the PC of CT, MRI and ultrasound tests in its 2012 Physician Fee Schedule final rule on Nov. 1, with virtually no changes from the proposed rule other than reducing the pay cut from a 50% discount to 25%. Starting Jan. 1, you will only get 75% of the fee schedule rate for interpretations of multiple imaging scans done on the same patient, in the same day. NOTE: Provider payments for imaging readings will always be paid in full for the highest-value test interpreted in the same session, while all others read that session will be paid at 75%.

Medicare has expanded its influenza vaccine code offerings this year, so make sure you have the most complete, up-to-date list of codes and fees. There are the Q-codes that CMS wants you to use instead of 90658 for intramuscular vaccines given to Medicare patients age 3 or older, effective Jan. 1, 2011. Here they are, with their ASP drug prices, effective Oct. 1.

• Q2035 (Afluria), $11.543.
• Q2036 (Flulaval), $8.784
• Q2037 (Fluvirin), $13.652.
• Q2038 (Fluzone), $13.306.
• Q2039 (Not otherwise specified flu vaccine). No national payment limit, fee set by your local contractor.