AMA Morning Rounds: H1N1 Hits Children with Neuromuscular Disorders

USA Today (2/18, Sternberg) reports that "thousands of children and adolescents with neuromuscular disorders, asthma and other conditions...are suffering consequences of H1N1 that will linger long after the 2009/2010 swine flu pandemic ends." Although "no one knows exactly why flu has such a devastating effect on" these children, "the evidence has been mounting since late 2005. Researchers at Children's Hospital of Philadelphia "reported that, even in typical flu years, children with these ailments were six times more likely than other children to develop severe complications from flu."

Access 2007 Re-Run and 2008 PQRI Feedback Reports

Physicians may now access their 2007 re-run and 2008 Physician Quality Reporting Initiative (PQRI) data through a new tool. CMS has created the “Verify Report Portal” which is available on the PQRI Qualitynet Portal. In addition to PQRI information, these reports will provide individual physicians with information on their Medicare Part B Physician Fee Schedule allowed charges for the 2007 or 2008 PQRI reporting period, upon which an incentive payment is based.

The tool is available at https://www.qualitynet.org/portal/server.pt.

Paraspinal Mapping Superior to Imaging for Diagnosing Stenosis

A recent JAMA commentary by AANEM member Dr. Andy Haig, notes that while most surgeons use imaging to diagnose stenosis and make surgical recommendations, recent studies have shed doubt on the ability of imaging to confirm a diagnosis of stenosis. In contrast, new data has shown that paraspinal mapping can reliably identify patients with clinical stenosis. Haig says there are three key steps that need to be taken:“Find and treat what is not stenosis, define and treat the effects of stenosis, and treat presumed stenosis without a definitive diagnosis. Failing all of these steps, a positive diagnosis is an important consideration before surgery,” said Haig.

“I hope this commentary can begin a shift in the way some of these topics are considered and researched. Patients don’t present with stenosis; they present with back pain. As physicians, our guidelines should reflect that we diagnose and treat patients who have symptoms that help us make a diagnosis and treatment plan,” Haig concluded.

The commentary written was published in the January 6, 2010, issue of JAMA. The article was co-author by Christy Tomkins, PhD.

SGR Delay Expires March 1

The clock is ticking—tell your senators to repeal the SGR. With a 21 percent cut in Medicare physician payments scheduled to take effect in just 20 days, the time to persuade lawmakers to pass a permanent repeal of Medicare's sustainable growth rate (SGR) formula is ticking away. Contact your U.S. senators and insist that they pass legislation to repeal the SGR formula to avert the cuts, which are slated to take effect March 1. Use the AMA's toll-free grassroots hotline at (800) 833-6354 or write them an e-mail.

New Jersey Legislature Fixes Nerve Conduction Statute

On January 16, one of his last days in office, Governor Jon Corzine signed into law a bill correcting an error that restricted both performance and interpretation of NCSs to physicians and certain other health care professionals. The law took effect immediately. It is now again be statutorily legal for physicians to supervise the performance of NCSs by technologists.

It was never the legislature's intent to prohibit this practice. The inadvertent addition of a single word to a 2005 law during committee revision changed the meaning to require both interpretation and performance of NCSs by physicians and certain other health care professionals. That problem is now fixed.

CPT Publishes Guidance for Consultation Coding

CPT just released an informational memo addressing consultation services and transfer of care. Much of the memo will not apply for Medicare patients since CMS is no longer accepting consultation codes. The memo suggests that Medicare contractor websites are the best place to locate further coding inforamtion for Medicare patients.

Unfortunately, a lack of direction from CMS to contractors has resulted different solutions for reporting low-level inpatient consultations. Until more specific guidance from CMS is given, adhere to the key elements of the service provided when selecting the appropriate code. For example, level 3 inpatient consultation (99253) requires detailed history, detailed exam, and low complexity decision making. This matches exactly with level 1 inpatient hospital care (99221), which requires detailed history, detailed exam, and low complexity decision making.

AMA Morning Rounds: Genzyme expects Pompe drug determination

The AP (1/21) reported, "Genzyme Corp. said Thursday the Food and Drug Administration is scheduled to make a decision on its Pompe disease drug Lumizyme [alglucosidase alfa] by June 17." The agency "had refused to approve Lumizyme until Genzyme fixed manufacturing problems at a facility in Allston Landing, MA," where "some of the bioreactors...contained a virus that slowed down the production of the company's drugs." The drugmaker "is seeking FDA clearance to market the Lumizyme it produces in 4,000-liter bioreactor tanks at its facility in Belgium."

The Boston Business Journal (1/22, Donnelly) reports, "The company said in November it would address the FDA's concerns about the manufacturing processes at the Allston plant by adding internal controls, updating the filling and finishing capabilities and using contract manufacturers and Genzyme's own Ireland manufacturing plant." Since then, "Genzyme has...hired a new senior vice president of global product quality and entered into an agreement with" Hospira Worldwide Inc. "to provide fill and finish manufacturing services." Dow Jones Newswire (1/22, Gryta) also covers the story.

CMS expands Medicare Advantage payment dispute resolution process

Last year, CMS established a payment dispute resolution process for physicians who encountered problems in getting accurate compensation from Medicare Advantage (MA) private fee-for-service (PFFS) plans. Now, CMS has expanded the process to include non-contracted physicians and to include all MA organizations, including HMOs and PPOs, not just PFFS plans. The dispute resolution process can be used by non-contracted physicians to address problems of MA organizations paying less than regular Medicare rates as well as downcoding of claims, but not for denied claims. The contractor handling the disputed payments is First Coast Service Options, Inc. Information on how to initiate the dispute resolution process is available on the FSCO website.