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: http://cms.hhs.gov/medlearn/refphys.asp#dhsupdate

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Author(s): 
By Billie C. Bradford, MBA

Other Coding Essentials
The CPT Code 27870 previously was used to report an ankle arthrodesis performed by any method. However, a code descriptor change in 2003 removed “any method” from the nomenclature to clarify that the code intent involves only an “open” surgical approach. CPT Code 29899 has been added in 2003 CPT to identify the arthroscopic ankle fusion procedure.
The CPT Code 29540 for applying strapping has been clarified by a descriptor change that now says you can report the code for “strapping, ankle and/or foot.”
The 2003 CPT has also deleted all language within the modifier descriptors referencing the use of five-digit modifier codes (e.g., 09959 can no longer be used as an alternative to modifier “-59”).

Ms. Bradford is the Director of the Department of Socioeconomics and Practice Management for the American College of Foot and Ankle Surgeons. She is the author of two textbooks on ICD-9-CM coding for physician offices. For additional information, please contact Ms. Bradford at ACFAS headquarters, 847-292-2237, ext. 322, or via e-mail at wbradfordb@aol.com or bcb@acfas.org.

Editor’s Note: For a related article, see “Maximize Your Reimbursement: A Guide To Billing In Diabetic Care,” in the March issue of Podiatry Today or visit the archives at www.podiatrytoday.com.

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