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PQRS: Prepare for more requirements, cuts to claims-based measures

September 18, 2014 - By Julia Kyles
The quality reporting changes in the proposed 2015 physician fee schedule are so drastic that medical practices should start working on their quality reporting game plan now, a health care consultant warns. If Medicare implements all of the proposed changes, practices that wait until the end of the... Read More

Don't bet on payment for epithelial ingrowth, a complication of LASIK

September 18, 2014 - By Laura Evans
Question: My ophthalmologist is planning surgery to correct a case of epithelial ingrowth using the following procedure:"The procedures is flap lift, removal of epithelial ingrowth and suturing of flap. Basically, under topical anesthesia (with sedation), I would mark the cornea, then lift the... Read More

Code encounter type, placeholders for ear or nose foreign body

September 18, 2014 - By Laura Evans
When treating a patient with a foreign body in the ear or nose, your clinicians will need to document laterality for ears and whether the visit is an initial, follow-up or late effect for accurate ICD-10 code selection.Foreign bodies are considered injuries, so you'll find the codes in ICD-10 Chapte... Read More

Pay for chronic care management easier in proposed fee schedule, part 2

September 11, 2014 - By Roy Edroso
More good news for practices who offer transitional care management (TCM) services: CMS proposed similarly amending the direct-supervision requirements for those codes (99495-99496). But the E/M service that goes with TCM must be done by the doctor or under his or her direct supervision.The hoops yo... Read More

Read payer policies closely when doing radiofrequency for knee OA

September 11, 2014 - By Laura Evans
Question: One of our doctors is looking into performing minimally invasive genicular nerve ablation procedures and wants me to research the CPT codes and Medicare reimbursement. The procedure uses a cooled radiofrequency procedure to treat osteoarthritis-related knee pain. What CPT code would we use... Read More

CMS sketches out ICD-10 testing schedule, finalizes Oct. 1, 2015 start date, part 2

September 11, 2014 - By Laura Evans
Timely, detailed test results are keyEnd-to-end testing is where providers will find out whether their claims will be paid or denied with ICD-10 codes, says consultant and former CMS official Stanley Nachimson of Nachimson Advisors in Reisterstown, Md.CMS plans to do that for a vastly smaller pool o... Read More

Pay for chronic care management easier in proposed fee schedule

September 03, 2014 - By Roy Edroso
A program to pay for chronic care management (CCM) that CMS proposed last year has undergone changes in the proposed 2015 Medicare physician fee schedule: While the new rules make it easier to fulfill the service with non-physician clinical staff, you'll have to jump through some hoops to earn the $... Read More

Make sure PCI is documented during myocardial infarction to report 92941

September 03, 2014 - By Laura Evans
Question: If a patient is admitted for ST segment elevation myocardial infarction (STEMI), do we report only 92941 for the percutaneous transluminal revascularization if the procedure is done on the date of admission when the STEMI occurred? I have a patient that had a percutaneous coronary int... Read More

CMS sketches out ICD-10 testing schedule, finalizes Oct. 1, 2015 start date

September 03, 2014 - By Laura Evans
Practices will have expanded access to ICD-10 testing next year, including three opportunities each for acknowledgement and end-to-end testing, CMS said.You'll be able to test whether a claim with ICD-10 codes was successfully transmitted and accepted by your Medicare administrative contractor (MAC)... Read More

No new conversion factor and PQRS requirements addressed in proposed fee schedule

August 21, 2014 - By DecisionHealth Staff
Payments set until AprilThe "doc fix" implemented April 1 had a 0% update through March 31, 2015, leaving the conversion factor at $35.8228.CMS didn't include a new conversion factor in the proposed fee schedule, saying that it will submit an estimate of the sustainable growth rate (SGR) and convers... Read More


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