The Affordable Care Act

By Steve Adams, MCS, CPC, CPC-H, CPC-I, PCS, FCS, COA

The Affordable Care Act (ACA) added a section to the Social Security Act which specifies that the Secretary shall identify potentially “misvalued codes” by examining multiple codes that are frequently billed in conjunction with furnishing a single service.

To correct what Medicare deems “misvalued codes,” they are expanding the Multiple Procedure Payment Regulation (MPPR) policy by applying MPPRs to the Technical Component (TC) of diagnostic cardiovascular procedures effective for dates of service January 1, 2013.  This change will have an impact on the way you are reimbursed for common cardiovascular procedures that are billed with multiple CPT codes.

The MPPRs on diagnostic cardiovascular procedures will apply when multiple services are furnished to the same patient on the same day. The MPPRs apply to TC-only services, and to the TC of global services.

 

Here’s how the calculation will work:

 

  • For cardiovascular services, full payment is made for the TC service with the highest payment under the Medicare Physician Fee Schedule (MPFS).
  • Payment will then be calculated at 75 percent for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice, i.e., same Group National Provider Identifier (NPI)) to the same patient on the same day.

 

Here’s how it would look:

 

Remember, the reduction does not apply to professional component (PC) of a service, only the TC portion. The current and proposed payments are summarized below in the following example:

 

 

Code

Code

Total Current Payment

Total 2013 Payment

The MPPR Calculation for the TC portion

 

78452

93306

     
PC

 $ 77

 $  65

 $  142

 $  142

No reduction

TC

           $  427

 $  148

 $  575

 $  538

427 + (.75 x 148)

Global

 $  504

 $  213

 $  717

 $  680

142 + 427 + (.75 x 148)

 

So, whether you are doing a service in the hospital or office, it’s possible that some portion of your service could be reduced.

 

For a complete list of the more than 120 codes this MPPR policy reduction will impact, go to:

 

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1149OTN.pdf

 

Steve Adams is a Senior Consultant for InGauge Healthcare Solutions, Inc., an InHealth company.   Contact him for consulting and educational services at steve.adams@ingaugehsi.com.  Efficiency in Practice is the free eNewsletter for medical practice managers who want to save time, money and reduce risk.  For more information and to access your FREE report, Patient Collections: It’s Make or Break for Many Practices, visit www.efficiencyinpractice.com 

 

This article can be reprinted freely online, as long as the entire article and this resource box are included.

 



Comments are closed.