AMA Bookstore News, Feb. 14, 2013

February will see the release of the new CPT/RVU 2013 Data File on CD-ROM. This AMA data file allows users to import relative value units (RVUs) and CPT® and HCPCS codes and descriptions into billing and claims reporting software. The data file is in ASCII format and provides complete code descriptions and all Medicare RVUs.

Those users wishing to download the data file instead of purchasing the CD-ROM can do so now.

• The data file includes:
• The five-character CPT and HCPCS codes presented with three code description lengths (short, medium, and full)
• Modifier 26 (professional component-only service), modifier 53 (discontinued procedure), and modifier TC (technical component-only service) information
• RVUs for the three components of each physician’s service covered by the Medicare Program: work RVUs, facility and nonfacility practice expense RVUs, and the professional liability insurance RVUs
• The global period covered by the payment
• The total RVUs for facility and nonfacility settings

For further RVU information, pre-order Medicare RBRVS 2013: The Physicians’ Guide today at a savings of 25%.

AMA also offers an online tool for accurate RVU calculation and claims reporting. Check out RBRVS DataManager Online. To learn more, register for a free CodeManager® Online webinar to learn and ask questions about DataManager as well as the rest of the AMA Coding Online suite.

Medical practices face many challenges in today’s changing health care environment. New rules and regulations make it difficult to keep up with these changes. The Practice Success Series will help keep your practice running smoothly and efficiently, and will help maximize reimbursement and keep you in compliance.

Reimbursement Management: Improving the Success and Profitability of Your Practice will help to understand the entire reimbursement system, and teach you how to obtain the fullest reimbursement of claims possible and avoid allegations of improper claims.

Financial Management of the Medical Practice, third edition, identifies current trends, and examines savvy processes that will enable you to gain greater control of your practice’s financial performance even in the midst of health care reform and economic downturn.

Starting, Buying, and Owning the Medical Practice provides in-depth information on the fundamentals of strategic practice management and future planning for the medical practice. It tackles options, challenges, and trends related to medical practices, and helps to strengthen your position in the marketplace to thrive for many years to come.

Valuing, Selling, and Closing the Medical Practice teaches you how to appraise the value of your practice, while broadening your knowledge base and outlining strategic options and alternatives available to determine the most appropriate models and methods for the dissolution of your practice. 

On January 25, 2013, the Department of Health and Human Services published its long-awaited “Final Rule: Modifications to the HIPAA Privacy, Security, Enforcement Rule under the HITECH Act and Genetic Information Nondiscrimination Act.” The Final Rule is effective Mar. 26, 2013, and requires compliance by all covered entities, business associates, and business associate subcontractors by Sept. 23, 2013.

Beginning Mar. 26, all workforce members must be retrained on Final Rule modifications to policies and procedures. For example, with the change in definition of breach, the Final Rule states, “We emphasize the importance of ensuring that all workforce members are appropriately trained and knowledgeable about what constitutes a breach and on the policies and procedures for reporting, analyzing, and documenting a possible breach of unsecured protected health information…. Covered entities will need to update their policies and procedures and retrain workforce members as necessary to reflect such modifications.”

These modifications will be addressed in the upcoming third edition of HIPAA Plain and Simple: After the Final Rule. AMA will publish that book in September prior to the Sept. 23 compliance date. Pre-order now.

But training of workforce members is required now under existing HIPAA Privacy and Security Rules and the Interim Final Breach Notification Rule. Failure to appropriately train workforce members now may result in substantial fines and penalties if discovered through a compliance audit or complaint or breach investigation. Get the training you need by enrolling today in AMA HIPAA School.

Beginning Mar. 26, AMA HIPAA School courses will include updated Final Rule content. So if you purchase a user account today, you can train to be compliant with current regulations and then retrain after Mar. 26 to be compliant with the Final Rule regulations—at no additional cost. Once a user account is purchased and activated, it remains an activate account that you can return to over and over again without fear of the account expiring.

The American Medical Association (AMA) announced an agreement with the National Library of Medicine that will enhance the National Institute of Health’s Genetic Testing Registry, a centralized public source for information on genetic tests.

Under the agreement, CPT® codes for molecular pathology tests will be integrated into the publicly available Genetic Testing Registry (GTR), which is managed by the National Center for Biotechnology Information, a division of the National Library of Medicine at NIH. The AMA-created CPT codes describe the latest advances in genetic testing and molecular diagnostic services for reporting and tracking purposes.

“Incorporating these CPT codes into GTR will help clinicians pinpoint practical information about genetics in a centralized resource,” said GTR Director Wendy Rubinstein, MD, PhD.

“CPT codes are a critical element to building an infrastructure that supports moving new genetic discoveries to the front lines of clinical care as we move into an era of personalized medicine,” said AMA President Jeremy A. Lazarus, MD. “Adding a CPT coding reference to the Genetic Testing Registry gives physicians an invaluable information source that will enhance the reporting of genetic tests and services.”

The AMA has been involved with coding solutions for molecular pathology services since 1998. New, more detailed CPT codes for molecular pathology became effective in 2012 to capture and describe the latest scientific advances in this rapidly expanding field of medicine. The ongoing process has so far created more than 100 codes for reporting innovative diagnostic services, and advances the AMA’s overarching goal of reducing disease burdens, improving health outcomes and reducing long-term care costs.

In light of the increased development of the molecular pathology section of the CPT codebook, the AMA will begin selling a new CPT 2013 Express Reference Coding Card specific to molecular pathology. The card will be available for download only in late February. A print version of the card will be put into production for the upcoming 2014 CPT code set.

Question: For codes 78813, Positron emission tomography (PET) imaging; whole body, and 78816, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body, what is meant by “whole body”? How far past the mid-thigh (as described in codes 78812 and 78815) do the images need to be, to report the whole body codes? If PET/CT images are obtained from the skull to the groin, may this be reported with code 78815?

Answer: No. PET and PET with CT whole-body imaging codes 78813 and 78816 include imaging of the region from the skull (vertex) to the feet. Because in your scenario images from the skull to the groin were obtained, it is not appropriate to report code 78815, Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh, as the imaging did not include the region from the mid-thigh to the feet. The example described would be reported with code 78814, Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck). Coders should consult with the dictating physician to confirm the anatomic areas included in the study. The procedure report should reflect the study performed and the CPT code reported.

Looking for more coding insight? Check out CPT® Assistant Online.

AMA now offers coding webinars on the topics of CPT Changes 2013 and ICD-10-CM. These pre-recorded webinars feature coding expert and AMA workshop speaker Robin Linker. Each four-hour webinar can be accessed online at any time to fit your busy schedule.

The CPT Changes webinar educates you on the process, rationale, and application for the 568 code changes to the CPT 2013 code set. The speaker provides a hands-on, practical explanation of the changes to the code set along with some deeper insight into the subject and examples for better understanding.

The ICD-10-CM webinar provides the information you need to learn, implement, and code for the new diagnostic code set. The speaker will explain implementation strategies as well as the details and how-to of ICD-10-CM coding.

After you have purchased access to a webinar, you will receive a confirmation email. The email contains a link to and a password for accessing the Webinar. At the end of that email you will also find a sentence that begins “More information and links to presentation materials, if any, can be accessed at….” Click on the Web link that follows to be directed to a PDF of a full attendee guide and CEU certificates.

Have a question for an AMA author? Ask by sending us an email with a subject line of "Question for Insider's View." We’ll select questions to pose to our author and publish the answers here. If we select your question, you'll receive a $25 off coupon for use on the AMA Bookstore.

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AMA will offer the first of our Chicago-based ICD-10-CM Workshops on April 25 and 26. Unlike last year, these interactive workshops in 2013 will expand from one to one-and-a-half days and feature additional exercises and a mock test. Attendees will also receive a free copy of ICD-10-CM: The Complete Official Draft Code Set.

Attendees of these workshops will learn how to code the top national diagnosis codes used within healthcare today as well as begin prepping for upcoming ICD-10-CM credentialing exams.

Additional ICD-10-CM Workshops will be held at AMA’s Chicago headquarters in May, July, and September.

Details are being finalized and more information will be coming to you soon via email. Save the date!

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