October Update To The Medicare Physician Fee Schedule Database

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					October Update To The 2007 Medicare Physician Fee Schedule Database (MPFSDB)


The following are the October updates/additions to the 2007 Medicare Physician Fee Schedule Database
(MPFSDB). These changes are effective for claims processed on or after January 1, 2007 unless otherwise
noted.
Status Code Changes:
• Procedure code 78609-TC/26, the status is changed from C (Carrier price the code) to N (Non-covered
    service). Effective for dates of service on or after January 28, 2005.
Short Descriptor Change:
• Procedure code G8370 Short descriptor: Asthma pt w survey not docum
Bilateral Surgery Indicator Changes:
• Procedure codes 20690, the Bilateral Surgery Indicator is changed from 1 (Bilateral payment adjust does
    apply) to 0 (Bilateral payment adjustment does not apply).
• Procedure codes 38740, 38745, 64412, 64418, and 64613, the Bilateral Surgery Indicator is changed from
    0 (Bilateral payment adjustment does not apply) to 1 (Bilateral payment adjust does apply).
Global Period Changes:
• Procedure code 16035, the global period is changed from 090 (Major surgical procedure) to 000
   (Endoscopic and minor surgeries with related preoperative and postoperative relative values on the day of
   the procedure only included in the fee schedule payment amount, evaluation and management services of
   the day of the procedure generally not payable).
New Codes:
Effective for dates of service on or after October 1, 2007 the following category II codes will be added to the
MPFSDB with a status indicator of ‘M’. The payment indicators are identical for all services. Thus, the
payment indicators will only be listed for the first service (Category II code 1116F).
• Procedure code 1116F Long Descriptor: Auricular or periauricular pain assessed. Short Descriptor:
    Auric/peri pain assessed. Procedure status=M. WRVU=0.00. Non-facility PE RVU=0.00 Facility PE
    RVU=0.00 Malpractice RVU=0.00. PCTC=9. Site of Service=9. Global Surgery=XXX. Multiple
    Procedure=9. Bilateral Surgery=9. Assistant at Surgery=9. Co-Surgery=9. Team Surgery=9. Diagnostic
    Indicator=9. Type of Service=1. Diagnostic Family Imaging Indicator=99
• Procedure code 2035F Long Descriptor: Tympanic membrane mobility assessed with pneumatic
    otoscopy or tympanometry. Short Descriptor: Tymp memb motion exam’d.
• Procedure code 3215F Long Descriptor: Patient has documented immunity to Hepatitis A. Short
    Descriptor: Pt immunity to hep a doc’d.
• Procedure code 3216F Long Descriptor: Patient has documented immunity to Hepatitis B. Short
    Descriptor: Pt immunity to hep b doc’d.
• Procedure code 3219F Long Descriptor: Hepatitis C genotype testing documented as performed prior to
    initiation of antiviral treatment for Hepatitis C. Short Descriptor: Hep c geno tstng doc’d – done.
• Procedure code 3220F Long Descriptor: Hepatitis C quantitative RNA testing documented as performed
    at 12 weeks from initiation of antiviral treatment. Short Descriptor: Hep c quant rna tstng doc’d.
• Procedure code 3230F Long Descriptor: Documentation that hearing test was performed within 6 months
    prior to tympanostomy tube insertion. Short Descriptor: Note hring tst w/in 6 mon.
• Procedure code 3260F Long Descriptor: pT category (primary tumor), pN category (regional lymph
    nodes), and histologic grade documented in pathology report. Short Descriptor: Pt cat/pn cat/hist grd
    doc’d.
•   Procedure code 4130F Long Descriptor: Topical preparations (including OTC) prescribed for acute otitis
    externa. Short Descriptor: Topical prep rx, aoe.
•   Procedure code 4131F Long Descriptor: Systemic antimicrobial therapy prescribed. Short Descriptor:
    Syst antimicrobial thx rx.
•   Procedure code 4132F Long Descriptor: Systemic antimicrobial therapy not prescribed. Short Descriptor:
    No syst antimicrobial thx rx.
•   Procedure code 4133F Long Descriptor: Antihistamines or decongestants prescribed or recommended.
    Short Descriptor: Antihist/decong rx/recom.
•   Procedure code 4134F Long Descriptor: Antihistamines or decongestants neither prescribed nor
    recommended. Short Descriptor: No antihist/decong rx/recom.
•   Procedure code 4135F Long Descriptor: Systemic corticosteroids prescribed. Short Descriptor:
    Systemic corticosteroids rx.
•   Procedure code 4136F Long Descriptor: Systemic corticosteroids not prescribed. Short Descriptor: Syst
    corticosteroids not rx.
•   Procedure code 4150F Long Descriptor: Patient receiving antiviral treatment for Hepatitis C. Short
    Descriptor: Pt not recvng antivir txmnt hepc.
•   Procedure code 4151F Long Descriptor: Patient not receiving antiviral treatment for Hepatitis C. Short
    Descriptor: Pt not recvng antiv hep c.
•   Procedure code 4152F Long Descriptor: Documentation that combination peginterferon and ribavirin
    therapy considered. Short Descriptor: Doc’d peginf/rib thxy consd.
•   Procedure code 4153F Long Descriptor: Combination peginterferon and ribavirin therapy prescribed.
    Short Descriptor: Combo pegintf/rib rx.
•   Procedure code 4154F Long Descriptor: Hepatitis A vaccine series recommended. Short Descriptor:
    Hep a vac series recommended.
•   Procedure code 4155F Long Descriptor: Hepatitis A vaccine series previously received. Short Descriptor:
    Hep a vac series prev recvd.
•   Procedure code 4156F Long Descriptor: Hepatitis B vaccine series recommended. Short Descriptor:
    Hep b vac series recommended.
•   Procedure code 4157F Long Descriptor: Hepatitis B vaccine series previously received. Short Descriptor:
    Hep b vac series prev recvd.
•   Procedure code 4158F Long Descriptor: Patient education regarding risk of alcohol consumption
    performed. Short Descriptor: Pt edu re: alcoh drnkng done.
•   Procedure code 4159F Long Descriptor: Counseling regarding contraception received prior to initiation
    of antiviral treatment. Short Descriptor: Contrcp talk b/4 antiv txmnt.




9/06/2007

				
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