Otolaryngology Coding Alert

CMS offers several bits of good news in its newly-finalized 2013 Medicare Physician Fee Schedule, including new transitional care management codes and associated payment for primary care doctors -- but the agency also included a 26.5 percent conversion factor cut that could impact practices across-the-board if Congress doesn't act to reverse it before Jan. 1.

On Nov. 1, CMS released its Final Medicare Physician Fee Schedule for 2013. The 1,362-page document, which will be published in the Nov. 16 Federal Register, offers a look into how the agency configures its RVU assignments, and shows just which specialties will escape drastic cuts to their reimbursement.

• 99495: Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge, medical decision-making of at least moderate complexity during the service period, and face-to-face visit within 14 calendar days of discharge
• 99496: Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge, medical decision-making of high complexity during the service period, and face-to-face visit within 7 calendar days of discharge

What's not included: CMS is quick to note that these new codes are only for face-to-face services, and all payments for non-face-to-face care management should be bundled into payments for your face-to-face E/M services. In addition, Medicare won't pay for services furnished to people other than the beneficiary, and will not separately pay for phone calls, medical team conferences, or prolonged services without patient contact.

Discharge management: Your Medicare contractor will pay for both a hospital discharge code and the appropriate TCM code, but you won't collect for TCM services that you perform within the global period of a surgery with 10 or 90 global days, the Final Rule says.

Payment: CMS assigns a work RVU of 2.11 to 99495 with a typical time of 40 minutes, and a work RVU of 3.05 to 99496, with an intra-service time of 50 minutes.

Many physician groups were pleased with the introduction of these important new codes. "The AMA appreciates that CMS recognizes the value of these services for improving the overall quality of health, as this rule supports physicians working in emerging models of care and the work involved in transitioning patients from one care setting to the next," AMA President Ardis D. Hoven, MD, said in a Nov. 1 statement.