ENEWS | NOVEMBER 2010

enews

For information about us and our services contact:

Ginger A Ryder, CMPE, CHBME, CPC 429 SW 41st St, Renton, WA 98057 (425) 656-7377 ginger@e-medex.com www.e-medex.com

enewsNew G Codes Added in 2011 for Smoking Cessation Counseling

Effective August 25, 2010, CMS has changed its policy for the smoking cessation counseling. Tobacco and smoking cessation counseling is now covered not only for those patients who have a condition adversely affected by tobacco use but also for those patients who are asymptomatic.

The new policy reads as follows:

Effective for claims with dates of service on and after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries:

Who use tobacco, regardless 1. of whether they have signs or symptoms of tobacco-related disease;

Who are competent and alert 2. at the time that counseling is provided; and

Whose counseling is 3. furnished by a qualified physician or other Medicare-recognized practitioner.1

CMS has developed two new G-codes which will go into effect January 1, 2011. The codes are:

G0436, smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes and up to 10

minutes; and

G0437, smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes.

The diagnosis codes that should be reported for thes services are ICD-9 codes 305.1 (non-dependent tobacco-use disorder) or V15.82 (history of tobacco use).

As the new G-codes do not go into effect until the new year, CMS has instructed providers to use the unlisted special service code (99199) for smoking cessation counseling for asymptomatic patients between now and December 31, 2010.

CMS will allow two individual tobacco counseling attempts per year. Section 4104 of the Affordable Care Act provided for a waiver of the Medicare coinsurance and Part B deductible requirements for this service effective on or after January 1, 2011. Until that time, this service will be subject to the standard Medicare coinsurance and Part B deductible requirements.

Services provided to patients who are not asymptomatic of a tobacco-related condition will still be reported with CPT codes 99406 and 99407 and will be subject to the Medicare Part B

deductible and co-insurance.

A reminder that these CPT codes are “time-based” codes so your documentation should include the time spent counseling the patient along with the details of the interaction.

The requirements for reporting smoking cessation counseling are as follows:

Face-to-face interaction with •the patient

Assessing readiness for •change

Advising the patient to quit•

Suggesting treatment(s) for •the patient, which can be as simple as supplying them with the phone number to the national smoking ‘quit line’ (800-QUIT NOW), or making other specific referrals.

1 CMS Transmittal 2058

For information about us and our services contact:

Ginger A Ryder, CMPE, CHBME, CPC 429 SW 41st St, Renton, WA 98057 (425) 656-7377 ginger@e-medex.com www.e-medex.com

ENEWS | SEPTEMBER 2010

enewsenews

SGR reduction of 23% will hit December 1

On December 1, 2010 every practice is due for a 23% cut to its Medicare payments (on average). To make matters worse, House and Senate members don’t return until after mid-term elections in early November. How many of those elected members will be “lame ducks” is difficult to predict.

This spells trouble for practices across the county as we wait for yet another fix to the sustainable growth rate (SGR) that was fixed earlier this year and pushed the cut from June 1 to December 1. While a permanent fix to the formula is desirable many associations support a temporary fix this time with the outcome of the elections up in the air.

Stay tuned for developments post election day and plan for payment delays in December. CMS ordered contractors after the last deadline to hold claims processing to avoid erroneous payments after the last SGR fix expired. It is uncertain at this time if they will elect to do the same thing at the expiration of this latest delay.

ICD-9-CM ICD-10-CM

883.0Wound, Open, Finger(s) (Includes fingernail, Thumb(nail) without) mention of complication.

S61.204 Wound, Open, Finger without damage to nail, right ring finger, Unspecified

S61.214 Wound, Open, Finger Laceration without foreign body of Right Ring Finger, without damage to nail

S61.224 Wound, Open, Finger Laceration with foreign body, without damage to nail of right ring finger

S61.234 Wound, Open, Finger puncture wound without foreign body of right ring finger without damage to nail

S61.244 Wound, Open, Finger, puncture wound with foreign body without damage to nail of right ring ringer

S61.254 Wound, Open, Finger, Open bite of finger without damage to nail of right ring finger

S61.304 Wound, Open, Finger, Open Bite of finger with damage to nail of right ring finger

S61.314 Wound, Open, Finger Laceration without foreign body, with damage to nail of right ring finger

S61.324 Wound, Open, Finger Laceration with foreign body with damage to nail of right ring finger

S61.334 Wound, Open, Finger Puncture wound without foreign body, with damage to nail of right ring finger

S61.344 Wound, Open, Finger, puncture wound with foreign body, with damage to nail of right ring finger

S61.354 Wound, Open, Finger, Ope n bite of finger with damage to nail, right ring finger

Continuing with our education of the differences in the new coding system that will be mandated in 2013 we thought we would show you the differences in coding between ICD9 and ICD10 for a very common diagnosis seen in the emergency department: Lacerations (otherwise known in the diagnostic code book as an “Open Wound”).

The example for this edition of our newsletter is a patient who presents to the emergency department with a laceration on the posterior aspect of the 4th digit of the right hand that does not involve any deeper structures.

To the right is a comparison between coding this scenario with ICD-9-CM and ICD-10-CM.

The new system requires that we differentiate in the diagnosis coding right from left, we must specify which finger is lacerated in addition to the manner in which the open wound occurred.

This example shows how much more specific the new coding system will require us to be as coders. This means that the providers will also have to be specific in their documentation or charts will be returned, delayed and slowed for coding issues which will in turn, slowdown billing and reimbursement.

– Ginger A Ryder, CMPE, CHBME, CPC

A “Simple” laceration won’t be simple under I-10