Afew CPT changes have taken effect for 2010 that affect dermatology, and practices should assure that they have modified their coding accordingly. A key change is deletion of code 14300 (Adjacent tissue transfer or rearrangement, more than 30 sq cm, unusual or complicated, any area). However, the following codes have been added to replace it:

  • 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm)
  • 14302 (each additional 30.0 sq cm, or part thereof, list separately in addition to code for primary procedure).

Some other codes sometimes used in dermatology are listed as having grammatical changes. The definitions have not changed; written numbers have been replaced with numerals. They are 15787 (abrasion), 56605, biopsy of vulva, and 96913, PUVA.

Medicare Changes for 2010
Consultation Codes.
A great deal of attention has been paid to the elimination of the consultation codes. Only the G codes used for telehealth consultations remain in use. Savings realized through the elimination of consult codes will be used to increase payments for the existing E/M services. There will also be an adjustment for the surgical global period to reflect the higher value of the E/M services rendered during the postoperative period.

CMS has cited numerous unsuccessful attempts to educate the medical community regarding rules of consultations as the reason for eliminating the codes, stating that in 2001 (apparently the most recent year for which statistics are available) Medicare allowed $1.1 billion more for consultations than it should have.

RVU Increases. Among other Medicare changes, there are very slight increases in the work RVUs for 13120 and 13121 (complex repair codes).

Patient Deductible. The Medicare patient deductible has increased by $20 to $155.00. Coinsurance remains at 20 percent of the allowed amount.

Incentives and Quality Reporting. Revisions to the ePrescribing program and PQRI will change some of the reporting requirements. Providers will be eligible for a two percent incentive bonus for each of the two programs. The bonuses are calculated on all Medicare allowed charges, not just the charges related to the measures reported.

The PQRI change with the largest impact on dermatology involves the melanoma measures: 136, 137, and 138 will be reportable through an electronic registry only.

To find registries go to Select “Alternative reporting mechanisms.” Scroll down to “downloads” section, select “Qualified registries for 2010 PQRI reporting,” There will be only one reporting period: January 1, 2010 through December 31, 2010. All measures must be reported by February 28, 2011 to qualify for the bonus payment.

It is not too late to participate in PQRI for 2009. The entire year may be reported through a registry; the deadline is February 28, 2010. Use the instructions above to locate registries participating in the 2009 PQRI.

E-Prescribing providers will be allowed to report e-prescribing through registries or by claims. Some group practices may qualify for incentive payment based on a determination at the group practice level rather than at the individual provider level.

For more information on the group practice reporting, go to, select “Medicare incentives” then E-Prescribing Initiative Program.”

Physician Fee Schedule. As of this writing, there has been a temporary congressional action on the physician fee schedule. The conversion factor has been increased from 36.0666 to 36.0856, which will provide a very slight increase in reimbursements until March 1. (The conversion factor is the number by which the Relative Value Units for each code are multiplied to produce the physician fee schedule.) With no further Congressional intervention, there will be a reduction in the conversion factor resulting in a Medicare physician fee schedule reduction of 21.2 percent. The true remedy to this annual problem is a change to the current law that requires the application of the Sustainable Growth Rate (SGR) to Medicare physician payment. Physicians should contact senators and representatives to encourage action.