Three separate coding and reimbursement issues are impacting urologists now and will continue to affect practices in 2005. This article will focus on these three issues-ICD-9 changes for 2005, drugs purchased by physicians, and the -59 modifier.
New ICD-9 changes must be implemented now. In the past, we have not implemented ICD-9 codes until the first of the year, and usually we had until April to im-plement new CPT codes. Now, we must start using the new ICD-9 codes when published on Oct. 1 and April 1. This means you should have implemented the new codes into your practice by the time you read this article, and prepare to implement new CPT codes on Jan. 1, 2005. Below are a few of the ICD-9 codes with changed descriptors, deleted codes, and new codes that should have been implemented in your practice as of Oct. 1.
Remember, as discussed in previous articles, always code to the highest level of knowledge at the time you finish a surgery, procedure, or E&M encounter. Do not wait for lab results or change the diagnosis later because of a path report.
Update on LHRH payment The law, rules, and suggestions apply to "all drugs furnished incident to a physician service." By this time you are painfully aware that Medicare rules have changed and in 2005 you will be paid 106% of average sales price (ASP). For a full discussion, refer to Urology Times articles published in September and July .
The final rules on determining ASP were recently published. There are no big surprises, except that the rules on how manu-facturers will report volume discounts, cash discounts, rebates, etc., were changed to allow adjustments to the actual sales price to be reported on a running 12-month average. Therefore, if a manufacturer decides to give a steep discount on a drug in one quarter, the ASP for the next quarter will only be affected by the running 12-month average and not the exact amount discounted the previous quarter. This is not only interesting, but probably smart. The entire process will probably continue to drive down prices on all drugs in which there is competition.
This brings us back to the bottom line. I would encourage you not to sign contracts for next year until:
All contracts should allow for quarterly changes based on changes in payment. Again, let me emphasize that the payments will be based on the national ASP and not what you paid for the drug.
Modifier -59 vs. modifier -51 Bundling and unbundling multiple procedural reductions and the appropriate use of modifiers -51 and -59 continues to mystify a number of urologists and coders. I will attempt to simplify and summarize the rules. For details, refer to earlier articles on bundling, multiple procedures, and modifier -59.