General Surgery Coding Alert

You win some and lose some with updates.

Don't get too comfortable with the nearly brand-new 2011 Medicare Physician Fee Schedule. On Feb. 4, CMS announced several changes to payment indicators that will impact the amounts that you collect from your Medicare Administrative Contractor (MAC).

The agency had some good news -- and some bad news -- in MLN Matters article MM7319, which had an effective date of Jan. 1 and an implementation date of April 4.

Look for Bilateral Surgery Revisions

Your bilateral surgery pay will drop when you perform chemodenervation, thanks to one of the new changes. The bilateral surgery indicator for 64613-64614 (Chemodenervation of muscle[s]...) will go from 1 (150 percent payment adjustment for bilateral procedures applies) to 2 (150 percent payment adjustment for bilateral procedure does not apply.) CMS rules now indicate that the RVUs for this code series are already based on the procedure being performed bilaterally.

Likewise, the bilateral surgery indicator for 77071 (Manual application of stress performed by physician 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," says Randall Karpf, a coding and billing consultant in East Hartford, Conn. "However, since the descriptor refers to inclusion of the contralateral joint, it would be hard to argue the fact that the code is inherently bilateral."

Check Out These Global Days Changes

CMS 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 included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable).

To read the MLN Matters article profiling the Fee Schedulechanges, visit www.cms.gov/MLNMattersArticles/Downloads/MM7319.pdf.