New Vaccine Admin codes

Last week I had a family practice office ask about the new vaccine admin codes that went into effect on Jan 1, 2011. They were confused on when and how you would use them.

The new codes: 90460 and 90461 have replaced the code range 90465-90468 for use when the physician provides counseling to the patients along with the vaccination. You would still use the new codes along with the code identfying the medication administered such as the code 90633 - 90634 for Heb, and 90645 for Hib, and 90680 for rotovirus.

The first new code, 90460 is used to identify the first vaccine component and 90461 is used for each for all additional components in which the physician provided administration AND counseling. 90461 is also noted as an add on code and can not be billed without 90460. Also important to note in the description is that both of the new codes are for administration and counseling in children 18 or younger as opposed to the codes they replaced that had an age limit of 8 years of age.

So what this means is if a nine year old child came in for MMR shot, and the physician provided counseling they would bill out administration for three components: measles, mumps, and rubella, which would be 90460, 90461 x 2

The American Acadmey of Pediatrics has recommended that the code 90461 is billed on one line item with the number of units rather than two sepearte line items of 90461. For more information and some FAQ's, please see their website at:

http://practice.aap.org/content.aspx?aid=2980

You would use still use 90471 and 90472 if there is NO counseling such as flu clinics where patients just walk in, get a shot, and walk out or for patients over the age of 18.

AMA clarifies modifier -25 usage for wellness visits

During their symposium in Chicago in Nov the AMA clarified that in 2011 you will no longer need to append a modifier-25 to wellness visits billed with covered screening tests, however you will still need to use the modifier if you are billing the wellness exam with a separately identifiable E/M service.

They also clarified that the new subsequent observation codes (99224-99226) are designed to be reported by both the physician who initiates observation care and any other doctor who evaluates the patient. For the non-initiating doctors, the AMA states you should report consult codes for non-Medicare payers and the subsequent observation codes for Medicare

Medicare Physician Fee Schedule changes for 2011

The Centers for Medicare & Medicaid Services (CMS) issued a 2011 Medicare Physician Fee Schedule (MPFS) Final Rule Correction Notice to revise some physician work, practice expense (PE) and malpractice (MP) relative value units (RVUs) set forth in the 2011 MPFS Final Rule, published in the Nov. 29, 2010 Federal Register.

Subsequent legislative changes occurring after the publishing of the correction notice have made additional revisions affecting Medicare payments to physicians necessary. Of particular importance is the Medicare and Medicaid Extenders Act of 2011, which President Obama signed into law Dec. 15, 2010. This Act averts the negative update to the fee schedule that would have otherwise taken effect Jan. 1 and provides a zero percent update to the MPFS for claims with dates of service Jan. 1, 2011 through Dec. 31, 2011.

While the PFS update is zero percent, there was an adjustment to the conversion factor (CF) to make the changes budget neutral. The revised CF that will go into effect on Jan. 1, 2011 is $33.9764.

For more information you can view the transmittal here:

http://www.cms.gov/transmittals/downloads/R828OTN.pdf

EHR Incentive Registration

The Medicare and Medicaid EHR Incentive Program Registration and Attestation System portal went live today, although not all states are ready for Medicaid registration.

The portal allows eligible hospitals and professionals to register and participate in meeting Stage 1 meaningful use criteria. Participants are being urged to register even if do not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS). They are also urged to register even if their EHR has not yet been certified. A link to the portal can be found at the bottom of this page.

To use the portal, Eligible Professionals (EPs) participants must have an active National Provider Identifier (NPI) and a National Plan and Provider Enumeration System (NPPES) Web user account. EPs will use their NPPES user ID and password to log into the registration system. Eligible Hospitals registering on the system an active NPI is also required. Users working on behalf of an Eligible Hospital must have an Identity and Access Management system Web user account and be associated to an organization NPI to register.

From the portal there is also a link to the CMS website where provides can access user guides for registration and attestation with information about completing modules, a list of EHR technology that is certified for the program, specification sheets with additional information on each meaningful use objective, and other general resources.

https://ehrincentives.cms.gov/hitech/login.action

New Medicare Coverage for Annual Wellness Visits

Starting January 2011, Medicare will add coverage for annual well visits (AWV), not just the Welcome to Medicare visit.

There are two new HCPCS Level II codes: G0438 and G0439. G0438 is an initial visit for annual wellness. G0439 is a subsequent annual wellness visit. Both include a personalized prevention plan of service.

According to CMS, these codes can be billed as incident-to and will be paid using the same relative value units (RVUs) as 99204 (office/outpatient visit, new, $155.23) for the initial AWV and 99214 (office/outpatient visit, est., $99.93) for subsequent AWVs.

2011 HCPCS Level II Released

The Centers for Medicare & Medicaid Services (CMS) posted the 2011 HCPCS Level II files . There are 147 new codes and modifiers and more than 286 codes have been deleted. A new Table of Drugs and Index has also been released.

A quick overview of changes include a large number of G codes and injectables. Additional changes are in the Q temporary section with new flu tracking codes and the addition of pass-through codes. Most of the deleted codes come from the G section.

New Flu codes

There are five new temporary HCPCS codes that became effective Oct 1, 2010 for flu vaccines in persons over three years of age but they will not be recognized by Medicare processing systems until Jan 1 2011, when the code 90658 will no longer be recognized.

Four of the five new temporary influenza vaccine codes identify a specific name brand of vaccine and should be reported accordingly. They are Q2035 (Afluria), Q2036 (Flulaval), Q2037 (Fluvirin), and Q2038 (Fluzone). The fifth code, Q2039 (NOS), is for all other influenza vaccines that do not fall under one of the name brands listed above.

These should be billed in addition to the administration code for the vaccine.