MAJOR BILLING CHANGES IN PHYSICIAN FEE SCHEDULE





The Part B Information Center News Release the following information. “The Centers for Medicare Services (CMS, formerly HCFA) announced significant changes to billing rules, coverage decisions, CPT codes and reimbursement policies in the physician fee schedule. It is necessary to comply with these changes to ensure you collect all the reimbursements you’re entitled to.

Recent policy revisions include:
♦ The 5.38% drop in the RBRVS conversion factor
♦ Higher paying codes for mammograms using digital technologies
♦ Expanded coverage of routine foot exams for diabetics
♦ Special circumstances for billing with new glaucoma-screening codes
CMS also revealed the 2002 RBRVS conversion factor will be set at $36.1992, a 5.38% decrease from 2001.”

20550: NO LONGER UNIVERSAL TRIGGER POINT CODE
This months issue of The Coding Institutes Physical Medicine & Rehab Coding alert Vol. 2, No.12 listed
2002 changes. CPT 2002 includes several important changes for pain management practices, including new
and more accurate codes for billing for trigger point injections and carpal tunnel injections. CPT code 20550 will no longer be accepted for these procedures. In fact, the words “trigger points” have been removed from 20550’s descriptor.

The revision to 20550 and the new codes are as follows:
�� 20526 – injection, therapeutic (e.g., local anesthetic, corticosteroid) carpal tunnel
�� 20550 – injection; tendon sheath, ligament, or ganglion cyst
�� 20551 - injection; tendon origin/ insertion
�� 20552 – injection; single or multiple trigger point(s), one or two muscle group(s)
�� 20553 – injection; single or multiple trigger point(s), three or more muscle groups.

These new trigger point injection codes also eliminate the need for adding modifier –59 (distinct procedural service) to claims for more than one muscle group injected. Insurance’s differed on whether modifier –59 or –51 (multiple procedures) was appropriate.

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