CPT Code Resequencing

I don't believe CPT's resequencing initative altered any codes that are used for EDX studies. Here is a short summary in case members encounter it in other aspects of their practice.

Instead of deleting and renumbering codes in order to display related codes together, resequencing allows adjacent placement of related concepts in the codebook regardless of the availability of code numbers for numerical placement. This change allows for greater code continuity over time and creates more options for future growth and flexibility of content.

Resequenced codes are noted with a # symbol in their new, out-of-sequence location. References have been placed numerically throughout the codebook at codes' previous locations that direct users to the out-of-sequence code. Appendix N also contains a list of resequenced codes.

CMS to Hold April Claims for 10 Business Days

CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of services and payment of claims paid under the Medicare Physician Fee Schedule (MPFS). The Temporary Extension Act of 2010, enacted on March 2, 2010, extended the 0% update to the 2010 MPFS through March 31, 2010.

CMS believes Congress will take measures to avert the negative update slated to take effect April 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of April. This hold will only affect claims with dates of service starting on April 1, 2010, and forward. In addition, The hold should have minimal impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.

AANEM will continue to update its members on new information related to the 2010 MPFS extension.

News Coverage of Healthcare Bill Signing

AMA Morning Rounds compiled this summary of news coverage.

Obama signs healthcare bill into law.

The signing of the healthcare reform legislation received very extensive, and overwhelmingly positive, media coverage, much of it casting the event as a historic occasion and as a major triumph for the President and his party. While Republicans continued to appear confident that the new law will be an electoral boon for them this fall, some analysts are now predicting that the win on healthcare gives Democrats new momentum and could change the political dynamic of recent months.

The bill itself is being described in generally positive terms. ABC World News (3/23, lead story, 2:45, Sawyer) said in its lead story last night, devoted to the bill signing at the White House, "As of today, it is the law of the land that every man, woman and child in America will have healthcare coverage." ABC (Tapper) added that Obama "was as happy as we've seen him, perhaps since the inauguration." The CBS Evening News (3/23, lead story, 3:00, Smith) led its broadcast announcing that this is "the closest the nation has ever come to universal coverage," and added that "ecstatic Congressional Democrats treated the President and Vice President like conquering heroes."

NBC Nightly News (3/23, lead story, 3:05, Williams) reported, "It was the end of the fight" Obama "staked his presidency on, and for him a crowning achievement." In his remarks, "the President took pains to highlight reforms that will happen immediately, and nightmare scenarios that won't." USA Today (3/23, Hall), the Washington Post (3/24, A1, Wilson), the New York Times (3/24, A19, Stolberg, Pear), the AP (3/24, Loven), and the Los Angeles Times (3/24, Nicholas, Parsons) also cover the story.

Electrodiagnostic Laboratory Accreditation Program Launches Today!

The much anticipated Electrodiagnostic (EDX) Laboratory Accreditation Program is ready for its first applications. Be among the first EDX laboratories to become accredited. The program recognizes laboratories that demonstrate clinical excellence and commitment to providing the highest quality patient care. The AANEM EDX Laboratory Accreditation designation provides patients, referral sources, and payers with a credible measure of excellence. recognition will be given to the first accredited laboratory in each state. Learn more about the accreditation program, then request an application today!

Healthcare reform passes House 219-212

Last night the House passed the Senate-approved healthcare reform bill 219-212. After passing the bill, the House proceeded to approve "key changes" to it, "part of a prearranged agreement to guarantee passage of the historic legislation. The changes passed by a 220-211 vote. That bill now goes to the Senate for final approval, where it only requires a simple majority to pass. Passage in the Senate and signing by President Obama is expected to occur quickly in the next few days.

Further CMS Guidance on Consultation Services

MLN Matters® SE1010 provides further clarity from CMS for those who who perform initial E/M services previously reported by CPT consultation codes for Medicare beneficiaries and submit claims to Medicare MACs for those services. The document follows a Q&A format. It includes the first information I have seen from CMS regarding low-level inpatient consultation codes 99251 and 99252. A question on page 3 asks how services previously reported with these codes should be billed since they do not meet key requirements for 99221-99223.

AMA Morning Rounds: FDA grants orphan drug status to potential ALS treatment.

The AP (3/10) reported, "Cytokinetics Inc. said Wednesday regulators have granted 'orphan drug' status to its potential" amyotrophic lateral sclerosis, or "Lou Gehrig's disease treatment." The company also "said it plans to start a mid-stage clinical trial in the first half of this year to test the drug's effectiveness." Reuters (3/10, Sengupta) noted that the drug is called CK-2017357.

Senate votes to again delay Medicare cut

The U.S. Senate voted yesterday to delay this year's 21 percent cut in Medicare physician payments until Oct. 1. The AMA continues to call for permanent reform of Medicare's sustainable growth rate formula. "If the House adopts this Senate bill, America's seniors and their physicians will be left in limbo, and access to health care for Medicare patients will continue to be in grave danger," AMA President J. James Rohack, MD, said in a statement.

AMA Morning Rounds: FDA approves Botox to treat elbow, wrist, and finger spasms.

The AP (3/10, Perrone) reports that "the Food and Drug Administration said Tuesday it approved Allergan's...Botox [Botulinum toxin Type A] to treat spasms of the elbow, wrist and fingers." The agency "stressed in a statement that Botox is not approved to treat spasms in larger muscles of the arms or legs." In 2009, "the agency added warnings to Botox about its potential to migrate from limbs to other parts of the body, causing breathing problems."

Bloomberg News (3/10, Peterson) reports that "clinical trials showed the drug helped patients with muscle spasms in the upper limbs, Russell Katz, director of the Food and Drug Administration's Division of Neurology Products, said...in an e-mailed statement." Dow Jones Newswire (3/10, Dooren), Reuters (3/10), and HealthDay (3/9, Roberts) also covered the story.

AMA Morning Rounds: Bristol-Myers Squibb, Allergan to jointly develop drug to treat neuropathic pain

The AP (3/3) reported that "Bristol-Myers Squibb and Allergan will jointly attempt to develop a drug to treat chronic pain from tissue damage, the drugmakers said." According to the AP, "the drug is said to be ready for mid-stage human trials as a treatment for neuropathic pain, or chronic pain usually accompanied by tissue injury. It is common in people with arthritis, cancer, and nerve damage."

The Orange County Business Journal (3/3) reported that "Bristol-Myers gains the rights to develop, make and market the compound," currently known as AGN-209323, "for just about all uses except for those related to the eye, which Allergan retains." Allergan will receive "an initial payment of $40 million and potential payments of up to $373 million if the compound is successful." Reuters (3/3) and the Wall Street Journal (3/3, Becker) also covered the story.

SGR Cut Averted for 1 Month

Last night the Senate voted 78-19 to pass H.R. 4691, the "Temporary Extension Act of 2010," which included provisions to extend 2009 Medicare physician payment rates through the end of the month. As a result, the 21% payment cut that took effect on March 1 has been postponed until April 1.

The bill passed the House on February 25, only to encounter opposition on the Senate floor by Senator Jim Bunning (R-KY), who objected to the legislation being considered as an emergency measure that would not require budgetary offsets. In addition to postponing Medicare physician payment cuts, the bill extended a variety of other expiring programs including unemployment insurance and premium subsidies for COBRA continuation coverage for those whose employment was involuntarily terminated.

Discussions are still underway in the House and Senate on the next steps that will be taken to address the Medicare payment crisis. Proposals are being circulated that would implement still another short-term patch to the sustainable growth rate (SGR) formula, including proposals that would postpone cuts for 90 days, 7 months, or through the end of 2010. The AMA and those currently attending its 2010 National Advocacy Conference in Washington, DC, continue to press for permanent repeal of the SGR, rather than repeating the pattern of short-term remedies that serve to make future payment cuts more severe and increase the cost of permanent Medicare payment reform.

Members are urged to keep up the pressure, especially in the Senate, for enacting legislation to permanently resolve the Medicare physician payment crisis. Use the AMA’s Grassroots Hotline at 800-833-6354 or write an email.