This update is a contribution from our “Coding Guru Gail” Thanks so much for allowing me to send out… Also, be sure to check out the Cigna website at the end of this post for webinars and free education regarding medicare services.... HAPPY CODING!
Starting Jan 1, 2011 you may now bill your patients for one annual wellness exam each year. The annual wellness exam is a service separate from other preventative services such as smoking cessation and breast and pelvic exams. You are free to bill all covered preventative services along with the annual wellness exam. You are also free to bill an additional E&M on the same day, however it must be separately identifiable and must be due to the need of an acute problem. It needs to fall outside the scope of long term issues that need addressed.
G0438- Billed for the patients first ever annual wellness visit (AWV) RVU's = 99204
G0439- Billed for every subsequent annual wellness visit (AWV) RVU's = 99214
There are nine required criteria that need to be performed and documented
- Establish/update individual medical and family history
- Create/update a list of current providers and suppliers, and medications including supplements such as vitamins
- Measure height, weight, body mass index or weight circumference, blood pressure and heart rate
- Check for signs of any cognitive impairment ( CMS has declined to provide any standardized tool and suggests providers rely on there "best clinical judgement")
- Screen for depression and functional status ( only required to be done on the first ever exam G0438)
- Establish/update schedule of screening services for the next 5-10 years
- Establish/update a list of risk factors
- Furnish personalized health advice and referral where needed to health education or prevention counseling services or programs
CPT changes 2011
Evaluation and Management
New CPT codes for Observation Subsequent Care codes. These codes are used for all subsequent days following an admission to Observation status prior to discharge
99224- Subsequent observation care- per day- requires 2 out of 3 components
-problem focused history
-problem focused exam
-Medical decision making straightforward or low complexity
99225- Subsequent observation care- per day- requires 2 out of 3 components
- expanded problem focused history
- expanded problem focused exam
- Medical decision making moderate complexity
99226- Subsequent observation care- per day- requires 2 out of 3 components
- detailed history
- detailed exam
- Medical decision making high complexity
New Medicare specific wellness codes
G0438- Annual wellness visit (AWV) First AWF (billable 1 year after Welcome to Medicare exam if performed on first year of Medicare)
G0439- Annual wellness visit (AWV) Subsequent years AWF
See above for the required documentation components.
G0436- Smoking and tobacco cessation counseling visit for asymptomatic patient 3-10 minutes
G0437- Smoking and tobacco cessation counseling visit for asymptomatic patient greater than 10 minutes
99406 and 99407 will still be used for symptomatic patients
Two skin debridement codes have been deleted. 11040 and 11041. Providers are instructed to use
97597 sharp selective skin debridement for ongoing care- 1st 20 sq cm
Other debridement codes 11010-11044 have new language to clarify how many square centimeters of subcutaneous, muscle, fascia or bone were debrided. Codes 11045, 11046, 11047 and 97598 have been added to capture each additional 20 sq cm of debridement.
Providers should now document how many square centimeters of debridement was performed in their procedure note
Two new spinal arthrodesis codes
20551- Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C-2
20552- - Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; each additional interspace
Lower leg Vascular intervention codes 37720-37235 have been deleted. New CPT codes 37720-37235 have been added to encompass catherizing the vessel, interventions and radiologic supervision and interpretation related to the intervention performed.
Heart Catherization codes 93501-93556 have been deleted and replaced with new Heart Catherization codes 93451-93533. The new cath codes encompass right, coronary artery or right and left into one code that includes the injection and the imaging supervision.
Cardiac testing changes includes deletion of Holter codes 93230-93237. New codes 93224-93227 have been added with new language that states up to 48 hours instead of for 24 hours.
New codes 43327-43338 for laparotomy paraesophageal hiatal hernia repairs
New codes 43753-43757 for gastric intubation procedures
Nervous System Surgery
There are some code description revisions for transforminal epidural injections to include imaging guidance
New code 64611 Chemodenervation of parotid and submandibular salivary glands
Immunization administration with counseling codes 90465-90468 have been deleted.
New codes added
90460-Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; 1st vaccine or toxoid
+ 90461- add on code- each additional vaccine or toxoid
New Vaccine codes (all pending FDA approval)
90644 Meningococcal conjugate vaccine,seroproups C&Y and Hemophilus influenza B, tetnus toxoid conjugate (Hib-MenCY-TT) 4 dose schedule children 2-15 mos of age
90644- Influenza virus vaccine, pandemic formula, live, for intranasal
90666- Influenza virus vaccine, pandemic formula, split virus, preservative free for intramuscular use
90667- Influenza virus vaccine, pandemic formula, split virus, adjuvanted for intramuscular use
90668- Influenza virus vaccine, pandemic formula, split virus for intramuscular use
New Medicare code
Q2037- for influenza vaccine-90658 no longer payable
Deleted codes J0170-adrenaline epinephrine- Use code J0171
J0559-Penicillin G benzathine and Penicillin G Procaine 2500 units
- use code J0558
J0560- Penicillin G benzathine, up to 600, 000 units – Use code J0561
J0570- Penicillin G benzathine, up to 1,200, 000 units- Use code J0561
J0580- Penicillin G benzathine, up to 2,400, 000 units- Use code J0561
New code J0561- Penicillin G benzathine, 100,000 units
J0558- Penicillin G benzathine and Pencillin G procaine 100, 000 units
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