H1N1 CPT Code

With both seasonal influenza and H1N1 influenza circulating this flu season, the AMA announced this week it has expedited the publication of a new code specific to vaccine administration and revised existing code 90663 to include the H1N1 vaccine. The new Current Procedural Terminology (CPT®) code issued by the AMA will streamline the reporting and reimbursement procedure for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States. In consultation with the U.S. Department of Health and Human Services, the AMA CPT® Editorial Panel created code 90470 to report H1N1 immunization administration and counseling. Code 90663 was revised by the CPT® Editorial Panel to refer specifically to the H1N1 vaccine product. Both are effective immediately.

HIPAA Breach Notification Rule

New regulations effective September 23, 2009 require all physicians who are covered by HIPAA to notify patients if there are breaches of security involving their medical information. The linked guidance from the AMA summarizes the new requirements. These requirements apply in addition to any notification obligations imposed by state law. These requirements also supplement the obligations imposed by the HIPAA Privacy and Security Rules.

AMA Morning Rounds: Neuromuscular Electrical Stimulation My Help Bed-Ridden Patients

The Los Angeles Times (9/21, Stein) "Booster Shots" blog reported, "The wasting away of muscle tissue can be a serious problem for people who are hospitalized and confined to bed due to a critical illness." But, a team at Johns Hopkins discovered, through meta-analysis, that "by putting patients through neuromuscular electrical stimulation and having them do simple exercises (some with the aid of devices), muscles can be shored up, speeding recuperation and getting people back on their feet." According to the paper published in Critical Care Medicine, the group also "developed a special walker that helps severely ill patients move around more easily, and with fewer helpers."

Reporting H-reflex

The coding manager for a member in Tennessee called me this afternoon with a denial from Cahaba, the new A/B MAC in the state. The two units of 95934 were denied because the number of units exceeded medical necessity. When Dorothy called and spoke to a provider rep. at Cahaba, she was told this was because of a national Correct Coding Initiative (CCI) edit. This isn't entirely correct, as there is no CCI edit for 95934. However, there is a Medically Unlikely Edit (MUE) for 95934. An MUE of one unit has been created for 95934. I recommended that Dorothy try to resubmit one unit with modifier 50. The CPT codebook directs that bilateral H-reflex be reported using modifier 50. Hopefully this will result in reimbursement at 150% of a unilateral study.

I have encountered some variability in the way payors want to see H-reflex studies reported.

• Some consistenly reimburse for two units without a modifer, even though the CPT codebook directs that bilateral studies be reported with modifer 50.
• Some will reimburse for two units when reported with modifier 50.
• Some will reimburse 150% of one unit when reported with modifier 50.
• Some will reimburse for one unit when reported with modifier 50.

The technically correct way to report bilateral H-reflex is to add modifier 50 to a single unit. This SHOULD result in reimbursement that is roughly 150% of a single unit. However, due to variability among payors and their claims editing software, you may have to find which of the above options works through trial and error.