[Coding] ACOG Coding and Practice Management Update

Anne Diamond ADiamond at acog.org
Wed Mar 2 16:46:43 EST 2011


              Practice Management and Coding Update 
American Congress of Obstetricians and Gynecologists (ACOG)
              March 2011/Vol. 11, Issue 3
 
Welcome to ACOG's Practice Management and Coding Update.  The Update
provides timely information on coding, reimbursement and practice
management issues. Information on a variety of coding and practice
management issues is available on ACOG's web site under the Practice
Management heading at http://www.acog.org/.
 
In this issue of the Update:
1) NEW PREVENTIVE SERVICES MODIFIER; MODIFIER 33
2) CODING RESOURCES 
3) WOMEN AND THE AFFORDABLE CARE ACT
4) CMS EHR INCENTIVE PROGRAM LISTSERVE
5) EDUCATIONAL MATERIAL FROM HHS-OIG
6) MEDICARE 2010 CLAIMS REPROCESSING
7) MEDICAID RAC NEWS
8) HIPAA VIOLATION FINE $4.3 MILLION
9) GENDER PAY GAP FOR NEWLY TRAINED PHYSICIANS
10) ACOG WEBCASTS:
March 8, 2011: Vaginal Birth After Cesarean Section: What's New and
What's Not
April 12, 2010: Coding for Consultation Services
 
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1) NEW PREVENTIVE SERVICES MODIFIER; MODIFIER 33
Description:
Modifier 33 (When the primary purpose of the service is the delivery of
an evidence based service in accordance with a US Preventive Services
Task Force A or B rating in effect and other preventive services
identified in preventive services mandates (legislative or regulatory),
the service may be identified by adding 33 to the procedure. For
separately reported services specifically identified as preventive, the
modifier should not be used.)
 
The Affordable Care Act (ACA) requires health insurance plans to begin
covering preventive services and immunizations without any cost-sharing
such as co-pays, co-insurance, or deductibles when these services are
provided as part of a preventive service office visit. However,
cost-sharing is permitted when the primary reason for the visit is not
preventative, and preventive services are provided in addition to the
“problem or office” visit and both the visit and preventive services
are billed separately.
  
Modifier 33 has been created to allow providers to identify preventive
services that are not subject to cost-sharing.  When multiple preventive
services are provided during a visit and the preventive services are not
subject to cost-sharing, modifier 33 is appended to each preventive
service code.
 
Modifier 33 is applicable for the following services:
1.     Services rated A or B by the US Preventive Services Task Force. 
These are posted annually on the Agency for Healthcare Research and
Quality website at URL:
www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm
2.     Routine immunizations as recommended by the Advisory Committee
on Immunization Practices of the Centers for Disease Control and
Prevention
3.     Preventive care and screenings for children and newborn testing
as supported by the Health Resources and Services Administration
4.     Preventive care and screenings for women as supported by the
Health Resources and Services Administration
Additional information on this modifier may be found in CPT Assistant,
December 2010, New CPT Modifier for Preventive Services 
 
2) CODING RESOURCES: 
TIRED OF WINTER? ATTEND THE CODING WORKSHOP IN PHOENIX- MAR 11-13
There are still some spots available in sunny Phoenix for the Coding
Workshop. Get rid of the winter blah's and learn appropriate coding to
ensure you are not leaving money on the table for services you perform.
For more information (i.e., CME credits, registration, dates, locations,
etc.), visit ACOG's Postgraduate Courses at
http://www.acog.org/postgrad/index.cfm?cpt 
 
ACOG 2011 OB/GYN CODING MANUAL 
Updated annually by ACOG, the ACOG 2011 OB/GYN Coding Manual:
Components of Correct Procedural Coding with CD-ROM contains 2011 CPT
codes and descriptions for procedures performed most often by ob-gyns. 
http://www.acog.org/bookstore/Ob_Gyn_Coding_Manual_Componen_P317C56.cfm
 
3) WOMEN AND THE AFFORDABLE CARE ACT
The Department of Health and Human Services has a new web page (
http://www.healthcare.gov/foryou/women/index.html ) dedicated to the new
rights and benefits available to women under the Affordable Care Act.
 
4) CMS EHR INCENTIVE PROGRAM LISTSERVE
The Centers for Medicare and Medicaid Services (CMS) has a new
listserve about the Medicare and Medicaid Electronic Health Record (EHR)
Incentive Programs. Stay up to date with authoritative information about
the Medicaid and Medicare EHR incentive programs, including registration
and attestation updates, FAQs and details about the payment process. 
Click here (
http://www.cms.gov/EHRIncentivePrograms/65_CMS_EHR_Listserv.asp#TopOfPage
) to sign up for the CMS EHR listserve.
 
5) EDUCATIONAL MATERIAL FROM HHS-OIG
A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and
Abuse is a new publication by the HHS Office of the Inspector General
(OIG) that summarizes the five main Federal fraud and abuse laws: the
False Claims Act, the Anti-Kickback Statute, the Stark Law, the
Exclusion Statute, and the Civil Monetary Penalties Law. The Roadmap
provides tips on how physicians should comply with these laws in their
relationships with payers, vendors, and fellow providers. Also
available: a PowerPoint slide deck and speaker's notes to download and
share. http://oig.hhs.gov/fraud/PhysicianEducation/
 
6) MEDICARE 2010 CLAIMS REPROCESSING
CMS has announced that over the next several weeks, many 2010 Medicare
claims paid under the 2010 Medicare Physician Fee Schedule will be
reprocessed due to the retroactive dates of some provisions under the
Affordable Care Act. The Act was signed by President Obama in March
2010, but some changes were retroactive to January 2010. 
 
Physicians should NOT resubmit claims since they will be denied as
duplicates and slow down the reprocessing. Claims will automatically be
reprocessed and adjusted. Retroactive amounts due will be included in
the physician's next regularly scheduled remittance after the adjustment
is made.
Physicians are also reminded of the OIG policy that says providers will
not be subject to administrative sanctions if they waive beneficiary
cost-sharing amounts attributable to retroactive increases in payment
rates that are a result of new federal statutes or regulations. OIG
Policy (
http://oig.hhs.gov/fraud/docs/alertsandbulletins/Retroactive_Beneficiary_Cost-Sharing_Liability.pdf
)
 
Read the full notification from CMS at:
http://www.acog.org/departments/dept_notice.cfm?recno=19&bulletin=5546
 
7) MEDICAID RAC NEWS
CMS has delayed the deadline for states to implement their Recovery
Audit Contractor program as required under the Affordable Care Act.
States will not have to implement their RAC program by April 1, 2011.
The Final Rule is expected to be published later this year and will
specify the new implementation deadline.
http://www.cms.gov/MedicaidIntegrityProgram/Downloads/6411racdelay.pdf
 
CMS has launched a new Medicaid Recovery Audit Contractor website.
http://www.cms.gov/medicaidracs/home.aspx
 
8) HIPAA VIOLATION FINE $4.3 MILLION
The Department of Health and Human Services Office for Civil Rights
(OCR) has imposed a civil money penalty (CMP) for $4.3 million against
Cignet Health of Prince George's County, MD for violation of the HIPAA
Privacy Rule. This is the first CMP imposed for violation of the HIPAA
Privacy Rule. 
http://www.hhs.gov/ocr/privacy/hipaa/news/cignetnews.html
 
9) GENDER PAY GAP FOR NEWLY TRAINED PHYSICIANS
An article in the February 2011 edition of Health Affairs examines
starting salaries for newly trained physicians leaving residency
programs in New York State from 1999 - 2008. The authors have identified
a gender gap unexplained "by specialty, practice setting, work hours or
other characteristics." In 2008, the mean starting salary for newly
trained male ob-gyns was $203,789 and for newly trained female ob-gyns
was $182,047. Read more at:
http://content.healthaffairs.org/content/30/2/193.abstract
 
10) ACOG WEBCASTS:
 
March 8, 2011: Vaginal Birth After Cesarean Section: What's New and
What's Not
Time: 1:00 – 2:30 PM ET
Presenter: Jeffrey Ecker, MD, FACOG
Cost: $99 ACOG Members; $115 Non-members
Registration: http://www.acog.org/postgrad/pgpage.cfm?recno=563
 
Over the last decade, cesarean rates have risen in the United States.
This is due partly to a decrease in the rate of women choosing a trial
of labor after a past cesarean (TOLAC), as well as a decrease in the
rate of women undergoing vaginal birth after cesarean (VBAC). These
patterns have been observed despite much recent data which suggests that
TOLAC is a safe and appropriate choice for many women who have had a
past cesarean delivery. In recognition of these trends and information,
a panel of the NIH issued a VBAC consensus statement in March 2010.
Additionally, ACOG updated its Practice Bulletin on VBAC in August 2010.
These new data and documents will be reviewed and their conclusions
considered as a part of this presentation. 
 
At the conclusion of this program participants will be able to: 
•Identify appropriate candidates for TOLAC
•Discuss factors associated with both successful VBAC and complications
of TOLAC
•Describe staffing and other resources that have been recommended for
TOLAC, as well an approach to decision making regarding TOLAC when these
resources are not available
•Counsel women who have had past cesarean delivery about options for
subsequent delivery in the context of their complete reproductive plans
 
April 12, 2011: Coding for Consultation Services
Time: 1:00 – 2:30 PM ET
Presenter: Emily Hill, PA
Cost: $99 ACOG Members and AAPC members; $115 Non-members
Registration: http://www.acog.org/postgrad/pgpage.cfm?recno=559
 
This webcast will address the CPT guidelines for reporting and
documenting consultation codes. The distinction between a transfer of
care and a consultation will be explored and clinical examples will be
provided. It will also review the changes in Medicare reimbursement for
consultation codes and offer guidance on reporting consultation services
provided to Medicare patients. The primary distinctions between levels
of service for consultation codes will also be reviewed. 
 
Upon completion of the presentation, the participants will:
• Understand the CPT guidelines for reporting consultation codes 
• Know how to report consultation services to Medicare
• Recognize the difference between a transfer of care and a
consultation service
• Be familiar with the documentation requirements for consultations and
the primary distinctions in levels of care 
 
ACCME Accreditation
The American College of Obstetricians and Gynecologists (ACOG) is
accredited by the Accreditation Council for Continuing Medical Education
(ACCME) to provide continuing medical education for physicians. 
 
AMA CME Category I Credit and ACOG Cognate Credit
The American College of Obstetricians and Gynecologists (ACOG)
designates this educational activity for a maximum of 2 category 1
credits toward the AMA Physician's Recognition Award or up to a maximum
of 2 category 1 ACOG cognate credits. Each physician should claim only
those credits that he/she actually spent in the activity.
 
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