Pediatricians who were thrilled with CPT 2011’s move to paying vaccines per component got a setback from Medicare’s rejection of the recommended RVUs for new vaccine administration codes 90460 and 90461.

The Relative Update Committe recommended that the 2011 Medicare Physician Fee Schedule and Resource Based Relative Value Scale assign 0.20 practice expense (PE) RVUs to 90460 and 0.16 PE RVUs to 90461. But CMS disagreed with the proposal. “We disagree with the recommendations and will maintain 0.17 RVUs for code 90460 and 0.15 RVUs for code 90461 since these codes would be billed on a per toxoid basis,” said Kenneth Simon, MD, MBA, Senior Medical Officer, Center for Medicare and AMA CPT Editorial Panel Member, in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT® and RBRVS 2011 Annual Symposium on Nov. 10, 2010.

The increased PEs represent an increase in RVUs from the 2010 values for comparable codes 90465/90467 and 90466/90468. The RUC requested the increase in value due to increased time for patient education. Since the new codes are valued per component, CMS felt no increase was warranted.

CMS assigned RVUs to 90460 and 90461 by crosswalking them with the values of the noncounseling vaccine administration codes 90471 and 90472. This means that new code 90460 has the same RVUs as 90471, and each unit of 90461 has the same RVUs as 90472.

The work and total RVUs for the codes include:

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Medicare Physician Fee Schedule rate won’t be cut 23 percent.

Although the government appeared poised to take a big bite out of your next Medicare Part B payments, you now have another month before you need to worry about losing pay. That’s because the 23 percent Medicare Physician Fee Schedule conversion factor cut that practices have feared since January was once again kicked to the curb by Congress.

On Nov. 18, the Senate voted to halt the Medicare physician pay cut for one month, and the House returned from Thanksgiving break on Nov. 29, at which point they also voted to freeze Medicare pay through the end of 2010.  

Medicare pay is set to drop even further effective Jan. 1, 2011, and the current legislation does not change that. The AMA had urged Congress to curb the 2010 cuts and to extend the conversion factor freeze through 2011, but that did not materialize. The AMA continued to hold out hope, however, that Congress would work on a pay fix for 2011 in the interim.

“Today, Congress staved off a Medicare meltdown for seniors, but this short-term reprieve ends when a 25 percent Medicare cut to physicians begins January 1,” AMA President Cecil Wilson, MD said in a Nov. 29 statement. “While this short-term delay helps ensure that physicians can continue to care for seniors for the next month, congressional action early in December to stop the cut for one year will inject stability into the Medicare program and ensure that Medicare delivers on its promise of health coverage for America’s seniors.”

Senate Finance Committee chair Max Baucus (D-Mont.) and ranking member Charles Grassley (R-Iowa) have vowed to pursue a full-year fix to the Medicare payment formula that they could enact before the 25 percent cuts kick in on...

 These terms nail down your diabetic retinopathy imaging code choice.

In CPT® 2011 in the place of your old familiar SCODI code, you’ll find three area specific codes. Check out these tips on finding the correct code for imaging as well as DR services.

Code 92135 is being split into three more specific codes. The scanning computerized ophthalmic diagnostic imaging or SCODI code got used a lot in 2010 and was a high volume code. CPT 2011 deletes the code. Pick the new code based on the particular area the imaging is performed on as follows:

92227 Vs. 92228: Look at DR Status

Diabetic retinopathy is the leading cause of blindness. Yet early detection makes the condition correctable 95 percent of the time. Imaging retina center technicians can easily look at a photo and read it. The ophthalmologist can then determine if the patient has DR, the stage it’s in, and the proper course of treatment.

Equate the term “Detection” that’s in new diabetic retinopathy imaging code 92227 (Remote imaging for detection of retinal diseases [e.g., retinopathy in a patient with diabetes] with analysis and report under physician supervision, unilateral or bilateral]) with “screening” for diabetic retinopathy. “Use this...