Transcript 2009 Medicare Update - Florida Podiatric Medical Association

Stephen Meritt, D.P.M.
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FCSO will be following cases of multiple ulcer
debridements.
More then 2 ulcer debridements per session
may result in requests for documentation of
medical necessity.
All ulcer treatments, whether surgical
debridement or office visits require location,
sizing, and staging of the ulcerations.
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New ICD 9 codes have been added for 2009.
These are additional use codes for staging
that are to be added to the pressure ulcer
location codes when billing for ulcer
debridement.
Documentation in your medical records must
match the billing codes submitted.
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Stage I – Healing pressure ulcer, pre-ulcer
skin changes limited to persistent focal
erythema.
Stage II – Healing pressure ulcer with
abrasion, blister, partial thickness skin loss
involving epidermis and/or dermis.
Stage III – Healing pressure ulcer with full
thickness skin loss involving damage to
necrosis of subcutaneous tissue.
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Stage IV – Healing pressure ulcer with
necrosis of soft tissue through to underlying
muscle, tendon, or bone.
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707.20 – 707.25 Pressure ulcer stages
Code first site of pressure ulcer then add
staging code.
707.07 Heel ulcer and 707.09 Other site.
Decubitus ulcer of heel stage II would be
coded for billing as, - 707.07 (707.22).
Decubitus ulcer of the 5th metatarsal head
stage IV would be coded as, - 707.09(707.24)
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20696 Application of multiplane (pins or
wires in more than one plane), unilateral,
external fixation with stereotactic computerassisted adjustment.
20697 – exchange (i.e., removal and
replacement) of strut, each.
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64455 Injection(s), anesthetic agent and/or
steroid, plantar common digital nerve(s) –
(e.g., Morton’s neuroma).
64632 Destruction by neurolytic agent,
plantar common digital nerve, (Morton’s
neuroma).
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Starting in 2009 if you E-prescribe and
submit the coding G8443 on your Medicare
billing and this makes up at least 10% of
your Medicare charges, then you could
receive a 2% bonus in 2010. That is 2% of all
your 2009 Medicare charges.
You must have a qualified electronic
prescribing system.
G8445 for visits with no prescriptions written.
G8446 for pharmacy limitations or Pt. refusal.
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Must be able to generate a complete
medication list with available data from
pharmacies and benefit managers.
Be able to select medications and transmit
prescriptions electronically (not via fax)
following applicable federal standards, after
warning the prescriber of any possible safety
issues associated with the drug orders.
Provide information on lower-cost,
therapeutically appropriate alternatives.
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Provide drug plan information, such as
formularies, patient eligibility and
authorization requirements.
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CMS has completely banned the use of
signature stamps on billing, progress notes,
orders, and treatment plans. Only written or
electronic signatures will be allowed as well
as fax copies of an original written signature.
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CMS had expanded PECOS (Provider
Enrollment, Chain and Ownership System) to
Florida.
Allows physicians to enroll, make a change in
their Medicare enrollment, view their
Medicare enrollment information on file with
Medicare, and check on the status of a
Medicare enrollment application on line.
https://pecos.cms.hhs.gov
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Accreditation is NOT required for podiatrists.
If you have been denied – reapply.
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The FTC recently came out with “red flag
rules” which will apply to us.
Federal legislation passed that requires any
creditor that maintains a covered account to
have very specific identity theft prevention
mechanisms and policies in place.
Creditor: anyone who defers payment for
services or provides a service and
subsequently follows up with a bill for
services already provided. Starts March 1???
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If you have a resident in surgery with you,
then you must use a –GC modifier on your
billing form. (28298 –GC)
You must indicate in your operative note that
you were present for the entire case or the
key portions of the case. (Failure to note this
could result in non-payment or a refund
request)
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Progress note/H & P documentation examples
Complete Assessment: “ I was present with
the resident during the history and exam. I
discussed the case with the resident and
agree with the findings and plan as
documented in the resident’s note.” OR
“I saw and evaluated the patient. Discussed
with resident and agree with resident’s
findings and plan as documented in the
resident’s note.”
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Subsequent visit : “I saw and evaluated the
patient. Discussed with resident and agree
with resident’s findings and plan as
documented in the resident’s note.” OR
“I saw the patient with the resident and agree
with the resident’s findings and plan”
Unacceptable Documentation:
“Agree with above.” or “Rounded, Reviewed
and agree.” or “Discussed with resident.
Agree.” or “Seen and agree.” or signature.