Part B Insider (Multispecialty) Coding Alert
Family Practitioners, Oncologists Hit by Drug Cuts
The Centers for Medicare & Medicaid Services unveiled a "dirty baker's dozen" of cuts to prescription drugs that the carriers reimburse, which took effect April 1. The cuts hit family practitioners, oncologists and anyone who deals with infectious diseases, says consultant Crystal Reeves with the Coker Group in Roswell, Ga. Family practitioners will find their payments reduced for J1030 and J1040, injected methylprednisolone in 40-mg and 80-mg doses. As of January, the two codes reimbursed $5.09 and $10.17 respectively, but now they're down to $4.30 and $5.18. The change may make billing for the larger dose economically impossible. A couple of chemotherapy drugs were also targeted for significant reductions, Reeves says. J9000, doxorubicin HCl (10 mg), came down from $50.96 to $42.82, and J9093, cyclophosphamide, lyophilized (100 mg), was reduced from $5.98 to $5.82. And J0360, hydralazine injection up to 20 mg, was cut from $17.81 to $16.04, while lidocaine injection, J2000, was cut from $4.12 for 50 cc to $3.99. The steepest cut of all hit J2690, procainamide HCl injections, up to 1 gram, which dropped from $11.03 to $1.52.
Meanwhile, vaccinations, pain medications and stroke medications also took a hit from the latest round of cuts. Rho(d)Ig (RhIg), in minidose form (90385), was cut from $51.21 to $35.91, and the percutaneous Bacillus Calmette-Guerin vaccine (90585) went down from $174.63 to $160.13.
Finally, somatropin injections (J2941), which most carriers won't cover, dropped from $45.56 to $43.74, and injected streptokinase, per 250,000 IU (J2995), dropped from $126.67 to $89.06. Injected tobramycin sulfate, up to 80 mg (J3260), dropped from $6.38 to $5.84.
Part B Insider (Multispecialty) Coding Alert
- CODING:
Don't Let Defunct Edits Bite Into Your Reimbursement
If you're relying on your software to digest the Correct Coding Initiative edits [...] - PARTICIPATION:
July 'Double Whammy' Could Hit Nonparticipating Hardest
It just keeps getting more and more confusing. Now, not only will your payments from [...] - CCI:
April Brings Dozens of New CCI Edits
Attention, coders! Forget last month's coding rulebook, because it's a whole new ball game now. [...] - CCI:
Where Modifiers Won't Help, You Must Modify Your Behavior
Bad news for coders: Your ingenuity in using modifiers as a way of getting around [...] - MEDICARE:
OIG Gives Coding Company a Seminar in Pain
Have you been duped by coding and billing education companies that tout nonexistent formal affiliations [...] - STUDIES & SURVEYS:
Physicians Tightening Access for Medicare Patients
More and more physicians are hesitating to take on new Medicare patients - but they [...] - TEAR-OUT GUIDE:
Take Note of Added, Deleted ASC Codes
If you don't have hours to spend culling the Federal Register for the correct codes [...] - COVERAGE:
New Radiation Reimbursement Restrictions Could Burn You
Cahaba GBA announced a policy on coverage of intensely moderated radiation therapy (IMRT), a new [...] - COVERAGE:
Dx Should Be Reason for Extra Nursing Home Visits
If a physician visits a nursing home patient more frequently than Medicare will usually cover, [...] - APPEALS:
Carrier Reps Catch Customer-Service Spirit
The next time you call your carrier, you may be on hold for a little [...] - MODIFIERS:
Know Global Period Rules to Avoid a World of Trouble
If you're trying to bill for new services during the global period after a major [...] - ASSOCIATIONS:
Coders Should Have Access to Member Areas
Want to make sure you're billing in the most up-to-date code combinations and keeping up [...] - CODING:
Suppliers Divide and Conquer Disputed Code
Want to write your own codes? Build a big tent and invite everyone in. That's [...] - INDUSTRY NOTES:
Earn CMEs for Quality Improvement
Physicians have one more incentive to get involved with the Centers for Medicare & Medicaid [...] - PRESCRIPTION DRUGS:
Family Practitioners, Oncologists Hit by Drug Cuts
The Centers for Medicare & Medicaid Services unveiled a "dirty baker's dozen" of cuts to [...] - FRAUD & ABUSE:
Your Patients Are Watching You
If your explanation-of-benefits forms look suspicious to some of your patients, don't be surprised if [...] - TO PARTICIPATE OR NOT?
It makes sense for the Centers for Medicare & Medicaid Services to do things to [...]
