Endocrine Insider
August 27, 2010
(See Full Issue)
To ensure adequate reimbursement for endocrinologists, The Endocrine Society responded to two seperate opportunities to have input into payment policies.
CMS Proposed Rule
The Endocrine Society submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the 2011 Medicare Physician Fee Schedule Proposed Rule. The proposed rule makes recommendations on payment rates and policies for the upcoming year that impact Medicare payments.
The Society’s comments (2011 Physician Fee Schedule Comments) addressed five issues of concern to endocrinologists and their patients, including:
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Issues (Diabetic Testing Supplies)
- Diabetes Self-Management Training (DSMT) Services
- Identifying, Reviewing and Validating the RVU’s of Potentially Misvalued Codes
- Incentive Payments for Primary Care Services
- Consultation Code Billing Policy
CMS will review and consider the comments that are received from the public and release a Final Rule at the end of the year in which it will finalize policies and payment rates for 2011.
DXA and VFA
In separate comments to the National Correct Coding Initiative, The Society joined with the American Association of Clinical Endocrinologists, American College of Rheumatology, and International Society for Clinical Densitometry to oppose a proposed change that will impact CPT code 77080 [dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)] and CPT code 77082 [(dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment]. Because the procedure described by CPT code 77080 includes DXA studies of the spine, CMS believes that vertebral fracture assessment (VFA) is integral to the films and evaluation of the DXA studies of the spine and requires minimal effort on behalf of the physician or technician. As a result, CMS proposes that the two codes could not be billed by the same physician on the same patient on the same day. The Society opposes this change because the two procedures are distinctly different and performing VFA in conjunction with a DXA scan is not a simple add-on procedure. The Society contends that the additional work required to reposition and review the scans justifies separate payment codes. The comments can be viewed here: DXA and VFA Letter.
