Is it proper to bill 46930 (destroy internal hemorrhoids, $189.71) and 46500 (injection into hemorrhoid(s) $180.69) together? In addition, should we submit additional documentation or a modifier to support both services?

Your carriers report that initial and subsequent hospital services billed as split/shared visits are on the rise. An NPP Report analysis of CMS billing data shows the number of initial hospital care (99221-99223) and subsequent hospital care (99231-99233) services is on a downswing (collectively down to 16.4 million times billed in 2008 from 26.5 million in 2000), but carriers say the services being billed as split/shared is increasing.

Starting Jan. 1, your teaching anesthesiologists will get 100% of the Medicare fee schedule payment instead of 50% when working with two residents on overlapping anesthesia cases. The change, long-sought by anesthesiologists, also helps out certified registered nurse anesthetists (CRNAs) by upping their payments in teaching scenarios as well, according to the final 2010 Physician Fee Schedule (PFS).

Most non-physician practitioners (NPPs) will see modest payment increases across the board in 2010, according to an NPP Report analysis of payment projections from the final 2010 Medicare Physician Fee Schedule. NOTE: It's assumed in this chart that Congress stops the 21.4% Medicare physician cut and that the conversion factor remains steady at $36.0666, which seems likely at least in the short term (see PBN story).

Your non-physician practitioners (NPPs) will be affected in the same way as physicians by a tough new CMS rule on provider enrollment, NPP Report has learned. The new rule requires providers who order services and/or supplies, including NPPs, to have all their enrollment information up-to-date in CMS's online Provider Enrollment Chain Ownership System (PECOS) by April 5, 2010.

We're going to offer the Welcome to Medicare visit next year and we planned to have our two NPs perform the services. However, the doctor says we should bill the NPs' work incident-to. Is it possible to bill this service that way?

You and your peers will receive more money - nearly the equivalent of your payment for new patient visit 99204 (outpatient/office, new, $141.74) - when your physicians furnish the "Welcome to Medicare" exam to your patients (PBN 11/9/09). The 2010 Medicare Physician Fee Schedule raises payment for the preventive service exam G0402 (Initial Preventive Physical Exam during first 12 months of Medicare enrollment) to $104.76 from $92.69 in 2009. You would receive more than $130 if Congress eliminates a 21.29% cut to Medicare reimbursements set for Jan. 1.

This week's question is answered by Margie Scalley Vaught, CPC, coding content specialists for DecisionHealth.

Q. What sort of documentation do we need to support vitamin B12 injections?

Summary: Unspecified drug injections are one of the fastest-growing high-denial drugs commonly billed to Medicare, according to a Part B News analysis of the latest CMS claims data. J3490 (drugs unclassified injection) joins J1562 (Vivaglobin), used for patients with primary immunodeficiency and J0878 (Daptomycin injection), used to fight drug-resistant bacterial infections, in our list of 10 high-growth, high-utilization, high-denial drug codes.

You must use a new G-code to report you've electronically prescribed drugs for a Medicare patient in 2010. You'll forfeit incentive bonuses - amounting to roughly $1,500 per provider - if you continue to report old codes for e-prescribing.