Medicare Compliance & Reimbursement

The American Medical Association (AMA) has made no secret of the fact that it is less than enthralled with the proposition of adopting ICD-10 as the new diagnosis coding system. Not only did the AMA's House of Delegates vote last year to repeal ICD-10 (which CMS did not adopt), but the group also applauded the news earlier this year that ICD-10 would be delayed from its original implementation date of 2013.

Now the AMA has taken additional steps to express its disillusionment with ICD-10, announcing on June 19 that its House of Delegates adopted a policy to evaluate ICD-11 as a potential "alternative" to replace ICD-9, an AMA news release noted.

"ICD-10 coding will create unnecessary and significant financial and administrative burdens for physicians," said AMA President-elect Ardis Dee Hoven, MD in a June 19 statement. "It is critical to evaluate alternatives to ICD-9 that will make for a less cumbersome transition for physicians and allow physicians to focus on their primary priority -- patient care. AMA voted today to consider ICD-11 as a possible alternative. The policy also asks the AMA and other stakeholders, such as the Centers for Medicare and Medicaid Services, to examine other options."

CMS has not yet responded to the AMA's news. Keep an eye on these pages for more on this story.

92980 May Be Out the Door in 2013 as Part of a Major PCI Overhaul

If you like to be the first to know about potential new codes, we've got a site you need to know.

To find summaries of CPT® Editorial Panel meeting actions -- such as accepting code proposals -- check out the documents at www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-summary-panel-actions.page.

What's in store for cardiology? "Once again, it looks as though the cardiology specialty will be heavily impacted with code changes for 2013. Looking at the proposed changes for new codes and revised codes, we are looking to take another hit on reimbursement. The goal over the past few years, it appears, is to completely streamline component coding for cardiology related procedures," says Terry A. Fletcher, BS, CPC, CCS-P, CCS, CEMC, CCC, CMSCS, CMC, of California-based Terry Fletcher Consulting.

Remember: These changes are tentative. The final CPT® 2013 codes won't be finalized until the fall of 2012.

Percutaneous coronary intervention (PCI) codes are on the list for possible overhaul, notes Fletcher. And that means you could say so long to some of your most commonly used codes.

CPT® may delete:

• 92980-92981, Transcatheter placement of an intracoronary stent(s) ...
• 92982 and 92984, Percutaneous transluminal coronary balloon angioplasty ...
• 92995-92996, Percutaneous transluminal coronary atherectomy ...

To fill the void, you could see 13 new PCI codes. You can get a sense of how big a change this could be from the panel's reference to accepting "revisions of cross references which restructures the entire section."

NJ Doctor Confesses To Accepting Cash For Imaging Referrals

Accepting cash in exchange for referring patients to an imaging facility won't just net you some extra cash -- it can also get you some jail time.

A New Jersey-based doctor admitted last week that she accepted cash kickback payments from an MRI center in exchange for patient referrals. She is the fourth physician charged with participating in the scheme, which netted her payments for every MRI and CAT scan she referred to the facility.

The doctor accepted just over $3,000 from the facility, but could face five years in prison and a $25,000 fine.

To read more about the government's charges against the doctor, visit www.justice.gov/usao/nj/Press/files/Deguzman, Daisy Plea News Release.html.