Part B Insider (Multispecialty) Coding Alert

Plus: CMS adds RVUs to immunization administration codes that reflect work preparing the vaccine.

As of Jan. 1, the Medicare deductible does not apply to the Welcome to Medicare exam, announced Amy Bassano, MA, with CMS in the presentation "Medicare Physician Payment Schedule 2009 Changes and Beyond" at the CPT and RBRVS

2009 Annual Symposium in Chicago. "This program aspect caused a lot of criticism," she said.

Now patients who come in for the required enrollment exam will not have the exam applied to meeting their deductible. Since this is the beneficiary's first charge, the exam became the patient's responsibility.

You can also forget struggling with reporting the Welcome to Medicare exam when your physician does not order an ECG. "We removed the EKG requirement," Bassano explains. This will be an educational service in which the physician may

refer the patient for the diagnostic service if necessary.

In other news ...

• You no longer have to think of clinical staff work preparing vaccines as a freebie service.

CMS had originally said that it would not pay for clinical staff time spent for vaccine administration quality assurance, noted Amy Bassano, MA, director of CMS hospital and ambulatory policy group in the presentation, "Medicare Physician

Payment Schedule 2009 Changes and Beyond" at the CPT and RBRVS 2009 Annual Symposium in Chicago.

"But when we looked at other similar services, we realized the relative value units included that time," she said. So CMS added that into immunization administration codes 90465, 90467, 90471, and 90473.

Before you say "So what? I don't charge Medicare for vaccine administration," rest assured the increase will benefit you. Medicaid and others set their payment rates based on the Medicare physician fee schedule values, explains Bassano.

For instance, code 90465 gets a 0.02 added practice expense boost to bring its total RVUs in 2009 to 0.58 effective Jan. 1.