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Here is a list of fees that will be increased on April 1, 2016 and a summary of the fees that were increased last year. Please note some fees were increased twice.
New MSP fees take effect on April 1, 2013. Please download these from teleplan if you haven’t done so already on your EMR. There are several other minor fee increases you may notice.
71630 – use of mesh for hernia repair – extra
This is now $27.22 but can be billed with 71606, 71607 and 71608, effective immediately.
P71630 Use of mesh for hernia repair – extra………………………………………… $27.22
The following fees are effective immediately. They will not appear on the MSP broadcast until April 15 but should download from teleplan onto your EMR.
P71010 – complex consultation for management of malignancy ……………………….. $125.50
P71017 – Special office visit for new diagnosis or recurrent malignancy …………….. $47.64
Please bill only for histologically proven malignancy, not including non-melanoma skin cancer. If this fee is overbilled the fee value will be decreased after the 18 month monitoring period.If you see a patient with “suspected” cancer bill 07010. You can then bill 71017 for the subsequent office visit when cancer is proven. Please see the attached “minute of the commision” for the fee descriptions.
Please use one of the following appropriate diagnostic codes with the new fees:
151 stomach cancer
153 colon cancer
154 rectal cancer
155 liver cancer
156 bile duct cancer
157 pancreas cancer
174 breast cancer
193 thyroid cancer
195 misc cancer
199 misc cancer
You will notice the fee for 07010 has gone back down to $97.77. The reason it was temporarily increased was because 71010 could not be billed retroactively to April 1, 2012. Now that the new fee 71010 is in effect the money has been transferred to the new fee.
Economics, Section of General Surgery
There are some important updates we would like you to know about.
1. New fees for consultation for management of malignancy and special office visit for malignancy
MSP has approved these two new fees for use with new or recurrent cancers (not including non-melanoma skin carcinoma).
These are being funded with our allocation money from the 2012 PMA and will be effective April 1, 2013. WIth these funds we were able to set the special consultation fee at $125.50 and the special office visit fee at $47.64.
2. Because we were not able to implement our new fees retroactive to April of this year the regular consult fee 07010 will be temporarily increased from $97.77 to $99.21 (retroactive to April 1, 2012) for one year then dropped back down to $97.77 on April 1, 2013 so the money can be used to fund our new fees (see #1 above).
3. Thanks to feedback from a member we were successful in amending the description of fee code 71700 to the following:
Closure of congenital “or acquired” anal fistula with rectal advancement flap
4. Finally, we have had a lot of correspondence regarding the new hernia mesh code 71630. The intent of this code was to replace the billing of 07999 with umbilical hernia fees on a revenue neutral basis. Of course since many surgeons were unaware of this agreement it has been unclear exactly what that means. The economics team felt that this fee should be billable with all hernia fees but MSP wanted to exclude multiple fee codes, including 71606, 71607 and 71608.
We have successully argued to have this fee is billable with most hernia fees, including 71606, 71607 and 71608, though this will require a fee reduction from $62.13 to $27.22 to maintain revenue neutrality. This is because of the high volume of 71606 (4650 services per year).
Considering most surgeons were previously not billing this at all and it was essentially restricted to only umbilical hernias, we feel this is an acceptable arrangement. In effect, this is the equivalent to a 10% fee increase for the inguinal hernia fees at no cost to the section.
This still needs to be finalized by the Tariff Committee in November and we will send out another full update later on. For now keep billing the current fee but not with the following fee codes:
71600, 71601, 71602, 71603, 71604, 71605, 71606, 71607, 71608, 71616, 71623, 71624 and 71625
BCMA Section of General Surgery
Click here to view the update.