CMS eliminates consultation codes – FAQs, and guidance available

In the final 2010 physician fee schedule, the Centers for Medicare & Medicaid Services (CMS) eliminated the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G-codes) on a budget-neutral basis. Instead, CMS increased the work relative value units (RVUs) for new and established office visits, as well as initial hospital and initial nursing facility visits.

Recently, CMS released Transmittal 1875 and MLN Matters 6740 which provides guidance to practices on how to bill for services for Medicare Part B patients now that consultation codes have been eliminated. CMS announced that the modifier to distinguish the admitting physician from other physicians who may furnish care is “-AI.” The admitting physician should append the “-AI” modifier along with initial visit codes to their claims while other physicians who perform initial evaluations should only bill the appropriate evaluation and management (E/M) code. CMS instructs providers to select the appropriate E/M codes based on the content of services provided and not the level of documentation.

According to agency, documentation should merely support the level of services provided. CMS advises practices to take time and/or controlling factors into consideration when determining the level of service provided. In this transmittal, CMS also clarifies billing procedures for:

• Observation services;


• Inpatient hospital care;


• Emergency departments; and


• Nursing facility services

(From MGMA Washington Connexion 12/17/09)

24/7 Access to Virginia Prescription Monitoring Program (PMP) Now Available

The Virginia Prescription Monitoring Program (PMP) is pleased to announce that requests for prescription history informa¬tion on drugs in Schedules II, III, or IV for a specific individual may now be made online, 24 hours a day, seven days a week, with an automated response being received within approximately one minute. This newly automated process has significantly increased the number of requests that can be processed daily and allows a prescriber or pharmacist to request information during nights and weekends when the information may be needed the most.

The prescription monitoring program collects prescription data for Schedule II-IV drugs into a central database which can then be used by limited authorized users to assist in deterring the illegitimate use of prescription drugs. The information collected in this program is maintained by the Virginia Department of Health Professions, and strict security and confidentiality measures are enforced. Only those persons authorized by law can be provided information from the database, and the list of authorized persons is very limited. Prescribers and dispensers may query the database to assist in determining treatment history and to rule out the possibility that a patient is "doctor shopping" or "scamming" in order to obtain controlled substances.

As of May 13th, 2009, prescribers are no longer required to obtain individual written consent from their patients to receive a PMP Report. A written notice in a public area of your office staring that your practice may utilize the PMP program to obtain patient histories is sufficient. If you prefer, you may continue to obtain individual written consent for each patient.

If you are a prescriber or pharmacist and have not registered to use the program you will find registration form & instructions at http://www.dhp.virginia.gov/dhp_programs/pmp/default.asp

New USP Standards for Heparin Products Will Result in Decreased Potency

The United States Food and Drug Administration (FDA) recently alerted health care professionals to a change in heparin manufacturing that is expected to decrease the potency of the com¬mon blood-clotting drug. Adjustments may be needed to achieve the desired anticoagulant effect in some patients. While the United States Pharmacopeia (USP) manufacturing controls took effect October 1, 2009, for production, FDA asked manufacturers to not ship the new product to customers until October 8, 2009, or later. For more information from FDA or USP on this subject, visit http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm184502.htm or www.usp.org/hottopics/heparin.html

Quarterly CCI edits posted

The Centers for Medicare & Medicaid Services (CMS) recently posted the Correct Coding Initiative (CCI) edits that take effect Jan. 1. In the agency’s words, the purpose of the CCI is “to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.”
Read a CMS CCI educational article.