Part B Insider (Multispecialty) Coding Alert
ICD COVERAGE EXPANDS - BUT ONLY SLIGHTLY
Healthcare providers will soon be able to bill Medicare for implantable cardioverter defibrillators in more circumstances. But the extent of the ICD coverage expansion is not as broad as many had hoped.
patients with coronary artery disease with prior myocardial infarction, left ventricular ejection fraction of less than or equal to 0.35, and inducible, sustained ventricular tachycardia or ventricular fibrillation at electrophysiological study; and
patients with a prior heart attack and left ventricular ejection fraction of less than or equal to 0.30, and an electrical conduction abnormality in the heart, duration of greater than 120 milliseconds.
The Centers for Medicare & Medicaid Services announced June 6 that it will be adding the following two indications to Medicare coverage:
Those types of cases represent only a portion of patients studied in the Multicenter Automatic Defibrillator Implantation Trial II. Device manufacturers Guidant Corp. and Medtronic Inc. had hoped CMS would agree to cover a much larger population.
Broader coverage of ICDs may be in the offing, as CMS has promised to revisit the issue early next year.
Part B Insider (Multispecialty) Coding Alert
- Physician Payments:
Congressmen Call For Drug-Free Physician Growth Rate
Physicians are getting shafted because drug expenses make their payments look as if they're growing [...] - MEDICARE OVERHAUL:
Physicians, Brace Yourselves for Medicare Reform
A Medicare reform plan could pass as soon as this summer, but you're not likely [...] - Medicare Prescription Drugs:
SENATE FINANCE PRODUCES BIPARTISAN Rx PLAN
Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and ranking Democrat Max Baucus (D-Mont.) unveiled a [...] - Medicare Private Plans:
Nudging Patients Into Private Health Plans
Physicians may still have to deal with preferred provider organizations, but it won't be in [...] - Payment Revisions:
Eye Surgeons Win Boost as CMS Reviews RVUs
Good news for physicians billing for voice prosthetics and eye surgery codes.
The quarterly housekeeping [...] - Drugs:
Jan. 1 Could Be D-Day for Drug Payments
Oncologists and others who dispense medications under Medicare could be under the gun in a [...] - OIG Excludes 200 per Month
Heads up, physicians. The HHS Office of Inspector General is out for blood.
In its [...] - Studies & Surveys:
Emergency Care Costs Doctors $4.2 Billion a Year
Think it's just emergency department physicians who suffer from unreimbursed emergency care? You're off your [...] - Coverage:
ICD COVERAGE EXPANDS - BUT ONLY SLIGHTLY
Healthcare providers will soon be able to bill Medicare for implantable cardioverter defibrillators in more [...] - REIMBURSEMENT:
New Guidelines Mean Broader Application of Deep Brain Stimulation Codes
New guidelines from the Centers for Medicare & Medicaid Services have allowed for broader use [...] - Don't Forget to Charge for Programming
Following implantation of a DBS unit, the surgeon (or a neurologist) must test the device [...] - Coding:
Add Prolonged Services to Applicable E/M Only
If you're billing for prolonged service codes 99354-99357, you should be careful to avoid adding [...] - Legislation:
SENATORS AGREE ON GENERIC DRUG BILL
A bipartisan compromise announced June 5 means the Senate is again likely to pass legislation [...] - Coverage:
Beneficiary Rage Leads to Likely Coverage
Taking the Centers for Medicare & Medicaid Services to court proved a worthwhile strategy for [...] - Reimbursement:
An ED Visit and a Hospital Admission on the Same Day? Earn Proper Payment
How can you code for optimal reimbursement if the surgeon sees a patient in the [...] - Coding:
Can't Decide Between -51 and -59? Here's How to Choose
Physicians, coders and payers alike often have trouble distinguishing between modifiers -59 (Distinct procedural service) [...] - Physician Notes:
Radiologist-Hospital JV Clears Anti-Kickback Hurdles
The fact that radiologists don't typically order the tests they perform allowed an otherwise potentially [...]
