General Surgery Coding: Cms Is Already Changing Part B Payment For This Year

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You should not get too comfortable with the nearly brand-new 2011 Medicare Physician Fee Schedule. On February 4, CMS announced various changes to payment indicators that'll impact the amounts that you gather from your Medicare Administrative Contractor (MAC).


While the agency had some good news, it had some bad news too.


Look for bilateral surgery revisions


Your bilateral surgery pay will go down when you perform chemodenervation, owing to one of the just-in changes. The bilateral surgery indicator for 64613-64614 will go from 1 (150 percent payment adjustment for bilateral procedures applies) to 2 (150 percent payment adjustment for bilateral procedure does not apply.). The agency rules now indicate that the relative value units for this code series are already based on the procedure being carried out bilaterally.


In the same manner, the bilateral surgery indicator for 77071 (manual application of stress carried out by the doctor for joint radiography, including contralateral joint if indicated) will change from 3 (200 ...
... percent payment adjustment for bilateral procedures apply; modifier 50 appropriate if performed bilaterally) to 2.


This could be a big drop for practices that were collecting twice the reimbursement and now will get no payment adjustment. But then, since the descriptor refers to inclusion of the contralateral joint, it would be tough to argue the fact that the code is inherently bilateral.


Take a look at these global days changes


The agency will change the global days for codes 31579 (Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy) and 92511 (Nasopharyngoscopy with endoscope [separate procedure]) from XXX (Global concept does not apply) to 000 (Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only covered in the fee schedule payment amount; E/M services on the day of the procedure usually not payable).


For more on this and for other specialty-specific articles to assist your general surgery coding, sign up for a good medical coding resource like Coding Institute.