You know from experience that the biggest E/M code of all is 99213 (office/outpatient visit, est., $66.74) - but that's only in terms of utilization, a Part B News analysis shows.

You and your peers bill mid-level E/M code 99213 (office/outpatient visit, est., $66.74) more than any other E/M service, a trend visible in every year of CMS claims data dating back to 2000. But even while higher-level codes 99214 and 99215 have slowly grown over the last four years, the tendency to undercode 99213 remains strong - and financially costly.

Republicans made big gains in Congress on Election Day Nov. 2, but passing a multi-billion dollar Medicare payment fix bill will still be the responsibility of Democrats in power. You're just over two weeks away from a 23% cut to your Medicare reimbursements on Dec. 1 (PBN 10/11/10). After that, payment rates are scheduled to drop another 7% on Jan. 1.

Your practice can still tap into a major source of new revenue in 2011 via Medicare's new annual wellness visits, but your physicians must now offer to provide end-of-life planning as part of the service, according to the 2011 Physician Fee Schedule (PFS) final rule. To be clear: This new component, dubbed "voluntary advance care planning" in the final rule, is voluntary in that patients may refuse to have it included in their annual wellness visit (AWV).

You're counting on a Democratic Congress, dozens of members of which were just swept out of office over public anxiety about health care reform, to step in and save the day after CMS's 2011 Final Physician Fee Schedule produced an expected 30% cut to your payments set to take effect Jan. 1.

CMS released the finalized 2011 Medicare Physician Fee Schedule on Nov. 2, leaving you with little time to read and analyze all the contents of the 2,023-page rule. Here is Part B News' in-depth analysis of what changes CMS decided to go forward with in 2011. Part B News will have more coverage of the final rule in future issues of the newsletter and at www.partbnews.com.

This week's question is answered by Regan Bode, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.

Q. If a radiologist reads a patient's mammogram and then sits down with the patient for five to 10 minutes to discuss the results, can the radiologist bill an E/M code in addition to the mammogram?

You'll now have a two-year window to train and prepare your physicians and staff for the ICD-10 transition. Start to plan today how you'll use this time to educate employees to be prepared when the transition hits. The two-year window comes as a result of CMS's ICD-9-CM Coordination and Maintenance Committee decision that it will partially freeze the ICD-9-CM and ICD-10-CM and ICD-10-PCS code sets.

The start date for external testing of version 5010 for external testing between payers and providers is quickly approaching. A few insurers, such as BlueCross/BlueShield of North Carolina, are currently ready for 5010 external testing on Jan. 1, but most payers are not, experts say.

Summary: These charts compare a specialty's average payment per service to its total annual Medicare payment for 2008 and 2009. NOTE: Average payments per service were calculated by dividing total Medicare revenue by the number of successfully paid services. These 10 specialties were chosen because they had very high annual Medicare utilization in 2009, ranging from nearly 44 million claims billed annually (infectious disease) to nearly 328 million claims (hematology/oncology).