How do I know if co surgeon will be paid? What about assistant surgeon?

Transcription

1 How do I know if co surgeon will be paid? What about assistant surgeon? August 24, 2017 How do I find out if an assistant surgeon or co-surgeon is paid on certain procedures that I perform? This information is published by Medicare on the Medicare website. PFSlookup/index.html You can also google Physician Fee Schedule Look up to access the site. Once there, you can enter a single or up to four CPT codes. Follow the prompts and indicate your search is for payment policy indicators (see the search choices below, Table 2). The search will show the codes and several policies, including numbers (see table 3), 0, 1, 2, 9 that indicate the payment status of the code. Table 4, tells you what those codes mean; paid, paid with documentation or not paid. Table 1

2 Table 2

3 Table 3

4 Table 4 Policy indicators Co-Surgeon (62) Assistant Surgeon (80-82) 0 = 1 = 2 = Co-surgeon not permitted Paid with documentation Paid with two specialties 0 = Paid with documentation 1 = Not paid 2 = Paid 9 = Concept does not apply 9 = Concept does not apply of 08/24/17.

5 Moderate sedation Denials. How do we get paid for 99153? August 24, 2017 We are billing the new moderate sedation codes, but are getting denied on the second 15 minutes, Almost all our patients have sedation for more than 15 minutes. What are we doing wrong? You are doing nothing wrong! The codes you are referencing are listed below. Code or are paid without a problem. It s code that is the issue. When Medicare valued these new codes as part of the Medicare Physician Fee Schedule, (or G0500 for GI endoscopy procedures) had an RVU assigned. Code 99153, for the second 15 minutes, (or a minimum of 23 minutes total of sedation) did not have a professional fee value assigned, indicating that Medicare will not pay for these additional minutes. Medicare considers all physician work for moderate sedation to be covered by the single code; (or G0500 for GI endoscopy procedures). Continue to bill per CPT guidelines that allow this second code. Private payors may pay for this code. Write off the Medicare denial. CPT Code Description

6 G0500 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient younger than 5 years of age initial 15 minutes of intra-service time, patient age 5 years or older each additional 15 minutes intra-service time (List separately in addition to code for primary service) Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient age 5 years or older. Report additional time with as appropriate Use only for GI endoscopy procedures for Medicare patients of 08/24/17.

7 Navigation x 2? August 24, 2017 I ve got an upcoming case where I m removing two different brain tumors and I ll be using neuronavigation (+61781). Since I have to make 2 plans, register the coordinates twice, and plan 2 separate trajectories, can I report twice (+61781, or x 2 units)? No. The CPT Assistant, September 2011 indicates that the navigation code is reported once per operative session. of 08/24/17. Global Period for Surgery. Is it billable? August 24, 2017 My patient presented to the ED with an infection at the incision site from a surgery that I did 4 weeks ago. It has a 90 day global. I was on vacation so my general surgeon partner saw the patient and admitted her. What should she bill for

8 this? Since the patient is in a global period for the surgery, this is not billable, by you or any of your partners of the same specialty. From a billing perspective, you and your partners are a single billing entity. Therefore, you all share the global package of the patient s surgery. of 08/24/17. Global Period for Surgery. Is it billable? August 24, 2017 A Medicare patient of mine presented to the Emergency Room with an infection at the surgical incision site from a surgery that I did 4 weeks ago. The surgery has a 90 day global. I was on vacation so my covering physician saw the patient and admitted her. The procedure has a ninety day global period. Is the covering physician able to report an E/M code for this visit? The patient did not have surgery but an I&D at the bedside. This visit is not considered billable by you or the covering physician (same or different group practice) as it is

9 inclusive to the global surgical package. The I&D is also not reportable as the procedure was performed in the ER and not an approved operative suite. of 08/24/17. Moderate sedation Denials. How do we get paid for 99153? August 10, 2017 We are billing the new moderate sedation codes, but are getting denied on the second 15 minutes, Almost all our patients have sedation for more than 15 minutes. What are we doing wrong? You are doing nothing wrong! The codes you are referencing are listed below. Code or are paid without a problem. It s code that is the issue. When Medicare valued these new codes as part of the Medicare Physician Fee Schedule, (or G0500 for GI endoscopy procedures) had an RVU assigned. Code 99153, for the second 15 minutes, (or a minimum of 23 minutes total of sedation) did not have a professional fee value assigned, indicating that Medicare will not pay for these additional minutes. Medicare considers all physician work for moderate sedation to be covered by the

10 single code; (or G0500 for GI endoscopy procedures). Continue to bill per CPT guidelines that allow this second code. Private payors may pay for this code. Write off the Medicare denial. CPT Code G0500 Description Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient younger than 5 years of age initial 15 minutes of intra-service time, patient age 5 years or older each additional 15 minutes intra-service time (List separately in addition to code for primary service) Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient age 5 years or older. Report additional time with as appropriate Use only for GI endoscopy procedures for Medicare patients

11 of 08/10/17. Scribe Question August 10, 2017 In my office, we use a PA as a scribe for new patient office visits for our doctors. We have an electronic medical record and the scribe signs in under her own name when she begins notating for the doctor. What is the correct way to notate in the medical record that the PA is only acting as a scribe and not performing the service personally? Good question. In order to clearly indicate what was performed, the documentation must identify who rendered the service and that the PA was acting solely as a scribe and did not perform any of the services. Remember, a scribe does not ask the patient questions or perform any examination of the patient. Both parties need to sign the medical record (electronically will suffice) and attest to the situation. Noridian, the Jurisdiction E local Medicare contractor, gives the following acceptable attestation example: I,, am scribing for, and in the presence of, Dr.. for the scribe; and I, Dr., personally performed the services described in this documentation, as scribed by in my presence, and it is both accurate and complete. for the physician.

12 Some payors only require the physician to sign the note as an attestation and not make a separate statement (as in the Noridian example above). You may want to check with your payors to see if they have specific verbiage that they look for to support the use of a scribe. of 08/10/17. Global Period for Surgery. Is it billable? August 10, 2017 My patient presented to the ED with an infection at the incision site from a surgery that I did 4 weeks ago. It has a 90 day global. I was on vacation so my general surgeon partner saw the patient and admitted her. What should she bill for this? Since the patient is in a global period for the surgery, this is not billable, by you or any of your partners of the same specialty. From a billing perspective, you and your partners are a single billing entity. Therefore, you all share the global package of the patient s surgery. of 08/10/17.

13 Global Period for Surgery. Is it billable? August 10, 2017 My patient presented to the ED with an infection at the incision site from a surgery that I did 4 weeks ago. It has a 90 day global. I was on vacation so my general surgeon partner saw the patient and admitted her. What should she bill for this? Since the patient is in a global period for the surgery, this is not billable, by you or any of your partners of the same specialty. From a billing perspective, you and your partners are a single billing entity. Therefore, you all share the global package of the patient s surgery. of 08/10/17.

14 Total Thyroidectomy and Reimplantation of Parathyroids August 10, 2017 My doctor did a total thyroidectomy and reimplanted one of the parathyroid glands into the sternocleidomastoid muscle. Can I code in addition to 60240? CPT for the total thyroidectomy is correct. However, if one or more of the parathyroid glands is reimplanted in the same surgical exposure (e.g., SCM muscle) then it is not accurate to separately code The reimplantation should be done through a separate surgical approach/incision for example, the arm of leg, to report of 08/10/17.