David J. Freedman, DPM, FASPS, CPC, CPMA, CSFAC • Past Chairperson, 9 th and 10 th Annual National APMA CAC PIAC meeting • Current CAC member Maryland • Certified Professional Coder • Certified Surgical Foot & Ankle Coder • Certified Professional Medical Auditor • Vice President, Foot and Ankle Specialists of the Mid-Atlantic, LLC • APMA Coding Committee, 10 years • ICD 10 Team Leader APMA • 27 years of Coding Experience
2014 BMAD Presentation From 2013 Medicare data
http://www.apma.org/YourPractice/content.cfm?ItemNumber=2426
In 2013, Medicare Part B total allowed charges were $128.0 billion dollars. Of this total, claims submitted by podiatrists represented $2.21 billion or 1.7 percent. Most of the data tables presented in this report include summary data for the top 300 procedures/services for podiatrists, based on 2013 allowed charges ranking. These top 300 procedures/services accounted for 92.8% of podiatric Medicare allowed charges in 2013.
2012 vs 2013 difference: 1) Total Part B had a $0.1 Billion Decrease in allowed charges for all providers. 2) $40 million Increase in podiatric allowed charges 3) Claims submitted by podiatrists represented 1.7% in 2013 same as 2012. 4) top 300 procedures/services accounted for 92.8% of podiatric Medicare allowed charges in 2013 vs 92.3% in 2012
2014 No Changes Consolidation of the J’s 2013 Source: http://www.cms.gov/Medicare/Medicare-Contracting/Medicare- Administrative-Contractors/MACContractStatus.html
A/B MAC AWARDS/CONSOLIDATION Noridian (JE –CA, HI, NV, American Samoa, Guam, Northern Mariana Islands and JF –AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY) = 16 Novitas (JL – DC, DE, MD, NJ, PA, N.VA & JH – AR, CO, LA, MS, NM, OK, TX ) and First Coast (JN – FL, PR, US Virgin Islands) =16 WPS ( J5 (JG) – IA, KS, MO, NE and J8(JI) – IN,MI )=6 NGS (J6 (JG) – IL, MN, WI and JK – CT,NY,MA, ME, NH, RI,VT-NHIC) =11 Palmetto GBA (JM/J11 – NC, SC,VA, WV)=4 CGS (J15 (JI) KY, OH )=2 Cahaba (JJ/J10 – AL, GA, TN )=3 Source: http://www.cms.gov/Medicare/Medicare-Contracting/Medicare- Administrative-Contractors/Downloads/MACs-by-State-Feb-2014.pdf
Total Part B Total Part B EFFECT of (billions) all Allowed DPM % of RUC allowed DPMs Total charges % increase (billions) % increase Allowed 2003 92.7 11 1.43 9 1.5 2004 102.2 10 1.55 8 1.52 2005 106.3 4 1.66 7 1.56 2006 110.4 4 1.71 3 1.60 2007 110.9 0 1.73 1 1.60 2008 114 3 1.81 5 1.60 2009 116.9 3 1.89 4 1.60 2010 122.9 5 2.03 7 1.70 2011 126.7 3 2.13 5 1.70 2012 128.1 1 2.17 2 1.70 2013 128.0 (>-1) 2.21 2 1.70
2014 Bunionectomy
2014 Bunionectomy Podiatry vs Ortho
E&M “NEW” Trends among specialties 2013 Data
2013 Data
Table 5I: 2012 Medicare Part B, Top 300* DPM Services. Allowed Frequency Data by Specialty, Place of Service=OFFICE, All Alwd % of Gen Surg % % of Gen/Fam/Int % Other Physician Podiatry % of Ortho Derm % of of of Phys Chrg s Alwd Alwd Total Alwd Freq Tot Alwd Total Alwd Freq Tota Alwd Rank HCPCS Alwd Freq Total Total Freq Freq al Freq l Freq 33,009 9.9 % 105,007 31.3 22,093 6.6 % 133,526 39.9 127 99201 335,055 23,739 7.1% 17,681 5.3% % % 2,742,567 461,237 16.8 151,798 5.5 % 723,819 26.4 285,699 10.4 917,311 33.4 12 99202 202,703 7.4% % % % % 8,787,444 1,047,172 11.9 416,788 4.7 1,102,200 12.5 % 4,113,332 46.8 3 99203 % 1,383,812 15.7% % 724,140 8.2% % 329,515 4.2 1,151,152 14.8 % 5,691,858 73.3 33 99204 7,767,550 57,128 0.7% 493,443 6.4% 44,454 0.6% % % 95,818 3.8 364,641 14.5 % 1,989,066 79.2 208 99205 2,511,939 1,519 0.1% 58,414 2.3% 2,481 0.1% % % 62,231 1.0 3,182,547 48.6 % 3,116,720 47.6 106 99211 6,544,970 71,707 1.1% 42,122 0.6% 69,643 1.1% % % 5 99212 16,033,231 2,334,399 14.6 569,301 3.6 % 2,372,709 14.8 3,169,996 19.8 % 6,228,957 38.9 % 1,357,870 8.5% % % 4.4% 4,769,105 5.3% 1,137,623 1.3 38,250,063 42.3 37,263,06 41.2 2 99213 90,367,677 3,942,780 % 5,005,042 5.5% % 4 % 555,147 0.7 35,961,285 47.7 36,154,51 48.0 19 99214 75,385,942 198,082 0.3% 1,610,912 2.1% % 906,005 1.2% % 1 % $ Did go up, rank 105,163 1.3 3,316,292 41.1 % 4,495,932 55.8 161 99215 impoved, % is same 8,061,029 4,010 0.0% 123,798 1.5% 15,834 0.2% % %
2013 Podiatric E&M ranking changes compared to 2012: 1) 99212 ranking has remained 5 th 2) 99213 remained same, 2 nd ranked 3) 99214 moved up from 19th to 18 th 4) 99203 remained same, 3 rd ranked 5) 99202 remained same,12 th
2013 Podiatric E&M ranking vs Ortho vs General Sx vs Derm vs compared to 2012: 1) 99203 Is most frequently allowed by Podiatry, Ortho, General Sx and Derm. Derm submitted almost same as 99202 and Gen/Fam/Int & Other Physicians are more commonly submitting 99204 2) 99213 continued as the most frequently allowed in Podiatry, Ortho, Derm, Gen Sx and Gen/Fam/Int
2013 Modifer 25 by Specialty Table 2C-2F: 2013 Medicare Part B, Evaluation & Management Services Utilizing Modifier-25*
Table 9a: 2012 Medicare Part B, Top 50* DPM Services by State TO P 10 STATES *(Top 50 DPM services - ranking based on 2012 allowed charges for podiatry specialty category) % of Tot Allowed Part B Submitted Allowed % Charges Alw Chg Frequency Frequency Paid Total Part B $2,172,230,240 100.0% 44,525,292 37,982,805 85 Top 50 Services $1,754,881,079 80.8% 34,131,234 31,223,043 91 Vermont $2,005,975 40,419 38,726 96 South Dakota $2,647,424 52,214 49,580 95 Wyoming $1,448,048 28,623 26,928 94 California $179,043,051 3,137,651 2,951,411 94 Montana $3,781,478 71,701 67,398 94 South Carolina $19,469,673 393,132 368,138 94 Virginia $26,262,846 494,906 463,297 94 Florida $185,047,515 3,229,477 3,022,910 94 Iowa $18,447,340 408,107 381,960 94 West Virginia $6,646,815 151,171 140,998 93
What Happened to Vermont? 96% in 2012 to 94% in 2013 so only 6% of the claims are being denied! Still a good job. South Dakota best in 2013 with 95.3%, a 0.3% increase. South Dakota, South Carolina, Iowa , Wyoming, Florida, Vermont, California, Montana,, Virginia, Montana Kansas, West Virginia and Virginia GET an “A” your claims were paid 93% or better in 2013
Table 9a: 2012 Medicare Part B, Top 50* DPM Services by State BOTTOM 10 STATES *(Top 50 DPM services - ranking based on 2012 allowed charges for podiatry specialty category Oklahoma $10,587,091 203,821 179,979 88 Minnesota $9,629,158 211,333 186,608 88 Connecticut $26,905,571 601,046 529,013 88 Utah $7,821,104 161,883 142,141 88 Idaho $3,349,558 66,820 58,566 88 Louisiana $13,190,917 269,349 231,091 86 Texas $79,823,063 1,563,785 1,341,398 86 New Mexico $7,535,609 139,636 118,013 85 Mississippi $7,812,115 170,310 142,894 84 Colorado $10,598,930 216,593 169,884 78
What Does It Mean That Minnesota has 86.7% 13.3% of the claims are being denied! Colorado improved from worst in 2012 to 3 rd from worst, Minnesota GETS a “B” because your claims were paid 86.7% in 2013, we have no Grades of “C” in 2013. Is something wrong when 13% of claims are not approved? Total PART B % paid is 84.1% - This is the benchmark and podiatry is all above that mark with Minnesota the lowest at 86.7%.
Podiatry Top 10 for 2012 Chg Allowed Rank HCPCS APMA Short Descriptor Charges Total Top 300 codes $2,006,021,461 1 1 11721 Nail debridement, any method, 6+ $310,469,745 $291,956,732 2 2 99213 Office/outpatient visit, estab, level 3 $113,545,640 3 3 99203 Office/outpatient visit, new, level 3 $104,079,943 4 4 11056 Paring/cutting benign hyperkeratotic les, 2-4 $103,895,296 5 5 99212 Office/outpatient visit, estab, level 2 6 6 11720 Nail debridement, any method, 1-5 $70,303,997 7 9 11042 Debridement, skin & subcut tissue $52,743,991 $50,593,091 8 7 11730 Nail avulsion, partial/total, single $47,352,537 9 8 97597 Remove devit tiss, w/o anes <20 sqcm $42,564,818 10 10 11055 Paring/cutting benign hyperkeratotic les, 1
How does Combo coding help or hurt you financially in 2013? 11721 Vs. 11720+11719 or 11720+G0127? 11721 $44 (National average 2013 up a $1 from 2012) Example #1 11720 $32(Up $1) + 11719 $9(Down $7) = $41 (National average 2013 this went down) Example #2 11720 $32 + G0127 $17 (Up $1) = $49 (National average 2013 this went up) Table 3A: 2013 Medicare Part B, Top 300* DPM Services - Data for Podiatry Listed by Descending HCPCS
Should we be concerned with PQRS reporting 2012 vs 2013? 3017f Colorectal ca screen doc rev 3014f Screen mammo doc rev 2022f Dil retina exam interp rev
Table 11A: 2013 Medicare Part B, CPT Category II Performance Measure Codes- Clearly Podiatry is not doing a good job
Table 11A: 2013 Medicare Part B, CPT Category II Performance Measure Codes- Podiatry is reporting
Table 11: 2012 Medicare Part B, CPT Category III Emerging Technology Codes Extracorporeal shock wave involving 0019T musculoskeletal system, not otherwise specified, low energy Avg % of % of Allowed Total Submitted Allowed Total Alwd SPECIALTY Charges Alw Chg Frequency Frequency Alw Frq Chrg $38,707 100.0% 319 157 100.0% $247 TOTAL $33,867 87.5% 171 133 84.7% $255 Podiatry Family Practice $3,912 10.1% 69 18 11.5% $217 Orthopedic $654 1.7% 22 5 3.2% $131 Surgery General $273 0.7% 1 1 0.6% $273 Surgery
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