How Will The New Coding Changes Affect Your Practice?

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Insights On Key Provider And Referral Distinctions

Podiatrists are sometimes unaware that physical and occupational therapists working in doctors’ office settings can obtain and bill under their own provider number.

Since direct physician supervision is required when the service is billed as an “incident-to-service,” some practices are deeming it more practical to bill these services by the therapist. This resolves the requirement that the physician must be physically present during incident-to-service procedures.

Be aware that physical therapy and occupational therapy services will include an annual payment cap of $1,500. This cap becomes effective on July 1. However, these caps do not apply to therapy services provided by a hospital to an outpatient or an inpatient who is not a covered Part A stay. CMS estimates that imposition of these caps will reduce payments for physical and occupational therapy by $240 million during 2003.

On another note, the Physician Self-Referral Law prohibits a doctor from making referrals of Medicare and Medicaid patients for certain health services with which the provider or close family member has a financial relationship, unless an exception applies.

Table 9 of the Federal Register (Vol. 67, No. 251, Tuesday, Dec. 31, 2002, pp.80017-18) contained the 2003 additions and deletions. A complete listing of applicable codes is available online at:

By Billie C. Bradford, MBA

Be Aware Of These Coding Twists
Now there are some answers to the inevitable question: What specific changes are in the wind this year?
CMS finalized the relative value units (RVUs) for Healthcare Common Procedure Coding System (HCPCS) Codes G0245, G0246 and G0247 for the treatment of peripheral neuropathy that became effective on July 1, 2002.
Specifically, CMS stated these services are provided to those diabetic beneficiaries who are “at risk” for foot care problems but do not have an injury or illness of the foot. You should use the appropriate CPT codes (for example, E/M service, debridement service) for any service you provide to a diabetic beneficiary who has an illness or injury to the foot (for example, foot pain, foot ulcer, foot infection).
This year’s CMS changes contain both new codes and revisions to existing codes. CMS has confirmed its determination that CPT Code 97602 for active wound care is already included in the work and practice expenses of CPT Code 97601, and typically the patient has the dressing placed over the wound. It determined the services included in Code 97602 are contained in the work and practice expenses of CPT Code 97022 for whirlpool application. In essence, CMS finalized its decision that Code 97602 is a bundled service and should not be paid separately.
New HCPCS Codes G0281-G0283 have been established to implement the coverage determination for electrical stimulation in wound care. Medicare does not presently cover G0282. Keep in mind that CMS has directed practitioners to avoid using the CPT Code 97032 for any wound care. Medicare also presently identifies electromagnetic stimulation to one or more areas (G0295) as a non-covered service.

An Update On Coding For Shockwave Therapy
In response to multiple requests from CMS contractors to establish a national payment amount, CMS had inaccurately considered CPT Category III Code 0020T for extracorporeal shock wave therapy (ESWT). CMS officials had said that ESWT was “similar to other physical therapy modalities” involving the plantar fascia and had designated it to be paid on the therapy fee schedule.
The American College of Foot and Ankle Surgeons (ACFAS) and the American Podiatric Medical Association (APMA) both worked hard to successfully have that inappropriate determination withdrawn from the 2003 Medicare Fee Schedule and re-evaluated.

CPT Codes: Key Changes You Need To Know
In addition to dealing with the fluctuating dictates from CMS, podiatric practices also are challenged to ensure their adherence to the most current annual changes in CPT codes. Some of the more significant 2003 coding changes that your practice needs to be aware of are presented below.

The American Medical Association CPT benign and malignant lesion excision codes guidelines have been changed significantly for CY 2003. Under the new guidelines, one should determine the code by measuring the greatest clinical diameter of the apparent lesion plus the margin required for complete excision. In other words, the lesion diameter plus the most narrow margins required equal the excised diameter.
The excised diameter is the same whether you have repaired the surgical defect in a linear fashion or reconstructed it (e.g., with a skin graft). You should report each excised lesion separately.
The 2003 malignant lesion guidelines also contain additional coding directives regarding frozen section pathology and any additional excision during the same operative session. Re-excision during the post-op period of the primary excision should include the “-58” modifier.

A Heads-Up On Coding For Injections
The intent behind the 2003 revisions to the descriptors for the CPT Code Series 20550-20553 was to have physicians report codes 20552 and 20553 one time per session, regardless of the number of injections or muscles they injected. You should report codes 20550 and 20551 one time when you have performed multiple or single injections to a single tendon sheath, ligament, tendon origin or tendon insertion. Report injections to multiple tendon sheaths, tendon origins, tendon insertions or ligaments one time for each injection.
The CPT Code 20612 was created this year to separate the aspiration and/or injection of ganglion cyst(s) from Codes 20550, 20600 and 20605.

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