David J. Freedman, DPM, FASPS, CPC, CPMA, CSFAC Past Chairperson, 9 - PowerPoint PPT Presentation

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