Will You Benefit From These MPFS Quarterly Update Changes?

Keeping up with quarterly Medicare Physician Fee Schedule updates can be tough. One reason is that sometimes the changes are implemented on one date and effective in the past. Confused? Examples can help with that. The changes below have an implementation date of Monday, Oct. 2, 2017, as part of the October quarterly MPFS update. But the effective date is Jan. 1, 2017.

Keep in mind: When the effective date is in the past, you can bring changes that benefit you to your payer’s attention to get payment adjustments on claims already submitted. Just be sure to wait until after the implementation date.

20245 Global Split Gets New Look

Code 20245 (Biopsy, bone, open; deep (e.g., humeral shaft, ischium, femoral shaft)) will see changes to its pre-op, intra-op, and post-op global split.

Before Oct. 1, these are the percentages posted in the MPFS:

  • Pre-op: 10
  • Intra-op: 80
  • Post-op: 10.

But with the quarterly update (and retroactive back to Jan. 1), the split will be as shown below for this code, which has a 000 global period:

  • Pre-op: 0
  • Intra-op: 0
  • Post-op: 0.

36473 Gets Bilateral Boost

Bilateral indicator changes are always important to watch, so don’t miss this one for 36473 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated).

Until the update occurs, the bilateral indicator is set at 0, which essentially means you get paid the same whether you report a unilateral or bilateral service.

After the update, and retroactive back to Jan. 1, the bilateral indicator will be set at 1, which means the 150 percent payment adjustment for bilateral procedures will apply.

This change makes sense considering the code is about treatment of the first vein in a single extremity.

64897 Post-Op Goes to Lucky 13

Like 20245, 64897 (Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to 4 cm length) will see a change to its global split.

Pre-update, the percentage split adds up to 97:

  • Pre-op: 11
  • Intra-op: 76
  • Post-op: 10.

The update changes the post-op to 13, bringing the total to 100. Again, the effective date is Jan. 1, 2017.

93668 Moves From N to C

The pre-update coverage status for 93668 (Peripheral arterial disease (PAD) rehabilitation, per session) is N, meaning the service is noncovered for Medicare.

After the update, and retroactive to Jan. 1, the coverage status indicator will be C. That means the coverage and fees are up to contractor discretion.

What About You?

Do you revisit old claims when retroactive changes benefit you?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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