Selective Catheter Placement with Vessel Repair

Plus, don't mix new compression codes with manipulation.

Certain CPT® codes 2012 that sidestepped Correct Coding Initiative (CCI) edit pairs in January are all bundled up as of April 1, 2012. That implies that you'll be required using caution while billing certain vascular injection and blood vessel repair codes together. Read on to learn other changes that general surgery coders need to know.

Avoid 36251 with 35231 and Beyond

CCI 18.1 adds almost 50 edit pairs with the following listed blood vessel repair CPT® codes 2012 in the column 2 position:

    35231 -- (Repair blood vessel with vein graft; neck)

    35236 -- (upper extremity)

    35256 -- (lower extremity)

    35261 -- (Repair blood vessel with graft other than vein; neck)

    35266 -(upper extremity)

    35286 --(lower extremity)

Based on "CPT Manual or CMS manual coding instructions," as per the CCI edit table, you shouldn't report the preceding codes with the following new CPT® codes 2012 for the same vessel:

    36251-36254 - (Selective/superselective catheter placement %u2026)

    37191-37193 - (Insertion/repositioning/retrieval of intravascular vena cava filter %u2026)

Nix Compression With Manipulation

CPT® 2012 added three novel multi-layer compression system ul

li29582 -- (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed)

li29583 -- (Application of multi-layer compression system; upper arm and forearm)

li29584 -- (Application of multi-layer compression system; upper arm, forearm, hand, and fingers)

/ul

bLook for Streamlined Edit Groupings /b br

There's a twist in the way this newest round of edits is organized that could make things stress-free for you. br

bThat was then: /b Since 1996, CMS has allocated procedure-to-procedure CCI Edits either to the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the condition for each edit. The Mutually Exclusive edit file covered edits including two procedures that could not be executed at the same patient encounter as they were mutually exclusive based on anatomic, temporal, or gender considerations. CMS then assigned all other edits to the Column One/Column Two Correct Coding edit file.

This is now: With the April 2012 release, CMS combines the two edit files into the Column One/Column Two Correct Coding edit file. CMS executed the consolidation both for the Physician CCI edit files and the Hospital (also known as theOutpatient Code Editor or OCE) edit files. The change should definitely make it easier for users, as now you'll only have to search the Column One/Column Two edit file for active or formerly deleted edits.

Medicare Physician Fee Schedule: Get Ready For ED E/M Coding Adjustments, Telehealth Coverage

Watch for these RVU changes to determine your 2012 payments

In case you were hoping for a reprieve in 2012 from the recession cost stresses on EDs, the word is that you can anticipate an overall decrease of 1.5 percent in entire 2012 CMS payments. Read this expert medical coding insight and learn how this all breaks down and will influence your ED billing.

2012 Medicare Physician Fee Schedule facts: The Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule Final Rule Nov. 1, 2011, which addresses changes to the physician fee schedule, as well as other significant Medicare Part B payment policies. The rule is effective beginning Jan. 1, 2012 and was published in the Nov. 28, 2011 Federal Register.

Look For Small ED E/M RVUs Decreases

As per the Medicare Physician Fee Schedule 2012 final rule, emergency medicine will involve a -1 percent update to complete RVU values in 2012. This is free of any change to the conversion factor.

The RVUs for ED E/M codes, the governing factor in defining ED reimbursement, have only second decimal point adjustments predominantly due to minor changes in practice expense. Of note, the work RVUs have not changed for 2012 and remain steady at 2011 levels.

See the chart below to compare the precise RVU E/M code breakdown for 2011 and 2012:

Anticipate More Pay for Initial, Subsequent Observation

The good news is that you can look for large RVU gains for initial and subsequent observation care services, whereas the same day observation admit and discharge codes will remain close to the 2011 values.

Prep for Pay Upticks for These ED Procedures

The 2012 RVUs allocated to complex abscess drainage 10061 (Incision and drainage of abscess [e.g. carbuncle, suppurative hidradentits , cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple) will increase by almost 9 percent and the CPR code 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest] will experience a 5 percent increase. The intermediate laceration codes had diverse results. Some of the code work RVUs were reduced marginally and a few of the intermediate code values were augmented.

Medicare Physician Fee Schedule 2102 Update: Telehealth Coverage For ED Services Gets Green Light

And more good news for EDs offering telehealth services: CMS has expanded its telehealth site promotion to cover EDs, which means EDs are now qualified site for telehealth coverage. The ED was not considered a qualified site of services previously, but for 2012, Medicare is creating novel code descriptors for the telehealth codes. The definition is now being expanded beyond inpatients and includes the emergency department.

The 2012 ED telehealth codes, descriptors, and assigned RVUs are listed below. The originating site's reimbursement has been increased as well by 0.6 percent.