Medicare Compliance & Reimbursement

CMS continues push for disposal of non-physician workpool. 

Physicians could soon have codes for wound care, stereotactic radiotherapy and rapid lung screens--if some proposed codes become reality.

The American Medical Association provided more clues to the codes physicians might see in 2006 or 2007. The AMA posted the agendas for the June meeting of the CPT Editorial Panel and the upcoming October meeting of the RVU Update Committee and Health Care Professionals Advisory Committee.

In June, the CPT panel discussed a number of proposed new codes, including sustained graduated high-moderate venous ulcer compression therapy, proposed by the Society for Vascular Surgery and the Association for the Advancement of Wound Care. Other “old business” included islet cell transplantation, laser vaporization of the prostate, stereotactic radiation therapy, limited cytopathology re-screening and antibody screening by the indirect antiglobulin test tube method.

“New business” at the June CPT panel meeting included endovenous ablation therapy of incompetent vein via microwave, genetic counseling, collection of blood specimens via arterial access devices, revision of prosthetic vaginal graft via abdominal approach, coronary artery CT, rapid lung screen, Doppler ultrasound of transplanted kidney, and abdominal/pelvic computed tomography.

Listen up: Proposals also included music therapy, which is less likely to obtain Medicare coverage even if it receives a code.

The agenda for the October meeting of the CPT panel includes several other items, including subcortical brain mapping, endotoxin activity assay, alpha-fetoprotin-L3, cytocentrifugation, whole body integumentary photography, transcranial magnetic stimulation to treat clinical depression, health and behavior assessment/intervention, laparscopic supracervical hysterectomy, West Nile virus antibody assay and revision for intracoronary ultrasound.
 
The AMA has posted the agenda for October’s annual meeting of the HCPAC and the RUC. The committees will consider optometrists’ proposal for a new code for corneal topography. They’ll also discuss issues involved in the five-year review of the Resource-Based Relative Value System, which may increase RVUs for some evaluation and management codes.

The meeting promises to tackle CMS’ proposal to eliminate the non-physician workpool. CMS uses this workpool to allocate costs to office-based procedures, which involve little or no physician work and derive most of the payment from the technical component.

According to the American College of Cardiology Web site, CMS decided not to replace the non-physician workpool with cost data collected from specialty societies in 2005 because there were questions about the new method of calculating the costs of these procedures.