Medicare Compliance & Reimbursement

Don't get too excited about some of the new evaluation and management codes in CPT 2008, because the Centers for Medicare & Medicaid Services (CMS) doesn't share your enthusiasm.

Medicare won't cover new telephone and online E/M codes 98966-98969 and 99441-99444 at all. The services aren't face-to-face, and the codes include services to people other than the patient, such as the patient's guardian, CMS says in the 2008 physician fee schedule final rule.

This is yet another example of the old adage: "Just because there is a code, does not mean you will be paid," says Barbara Cobuzzi, director of outreach for the American Academy of Professional Coders in Salt Lake City.

Medicare constantly pushes physicians to "embrace technology" -- then refuses to pay for phone and online E/M visits, Cobuzzi laments. "It costs money to offer e-services to make sure they are HIPAA secure," she notes, and physicians are unlikely to spend that money if Medicare won't cover them.

"Dealing with patients via electronic means gives the physicians the much needed time they need to see other patients and do paperwork," notes Suzan Hvizdash, physician educator for the University of Pittsburgh Physicians Dept. of Surgery.

New medical team conference codes 99366-99368 will have a "bundled" status because CMS believes they're included in existing E/M codes.

With patients living longer and having more complex problems, Medicare paying for these codes would make more sense, says Hvizdash. "Being able to meet with colleagues to discuss a patient's care is of major benefit to the patient and the insurance companies," she insists.

Marcella Bucknam, manager of compliance education with the University of Washington Physicians, is seeing more and more multi-disciplinary conferences. The conferences help make sure everybody understands the patient's care plan. But it's "almost impossible" to code for these conferences using standard E/M codes, she says.

CMS also stuck to its guns in bundling anticoagulation management codes 99363-99364 with all other services. The same applies for genetic counseling code 96040 and home ventilator management code 94005.

Anticoagulation management helps to guarantee quality care, so it's a shame that Medicare won't pay for it, says Cobuzzi.

But you may still be able to bill for these services if they're all your practice provides during that month, notes Bucknam.