MEDICAL BILLING NEWSLETTER (FL.03)              3/27/93
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INITIAL OBSERVATION CODES (99221-99220)
Medicare has advised that the codes may be used (per day) for each day that the
patient is in the "observation" status. Watch for a change from HCFA.
The intent of the AMA in definition was to be similar to that of the Initial
Hospital Care codes, however until notified by Medicare code as per Update
Jan/Feb pg 31 .

MEDICARE NON-COVERED PROCEDURES 
Work hardening/Conditioning 97545 and 97546
Thermography 93760 and 93762 (effect 12/21/92)
PTA 35472 
Developmental testing 95881 
Cognitive function testing 95882 (changed from "bundled" status)


CONSULTATIONS WITHIN A GROUP
Medicare will pay for consultations within a group as long as they meet the
requirements of a consultation i.e.;(1) requested by the attending physician;
(2)obtain history, and examine the patient; and (3)provide attending physician
with written report of findings.


RBRVS is the basis for determining the relative value of a physician service.
Translated to dollars and "SENSE" it is the  value of the physician's practice.
A firm handle on the "values" of each billed procedure as it relates to
practice expenses will be a critical factor for the future.   
An analysis of a transition code is very good example:

                CPT code 10040  RBRV data for FL locality 2
                Par allow = $35.73
                Non par allow = $33.94
                Charge limit = $39.03
                Work RVU = 1.37
                Pract. RVU = .32
                Malprac RVU =.83
                Total RVU= 2.52
                RVU amount =  81.62  (RVUs x GPCIloc 2 x CF)

The Medicare historical fee for this service is $21.00. Although the Medicare
charge Limit cannot exceed $39.03, the recommended fee for non Medicare is
(not less than) $106.11.  The transition fee regulations apply only to
Medicare services to be phased in throughout 1995.

Use the RBRV data in determining the percentage of expenses of each procedure.
The percentage of the fee dollar for 10040 is  54.37% for physician work,
12.70% for practice expense, and 32.94% for malpractice expense.

For a complete Evaluation analyses of you practice fee's contact PC
Management. We can provide RBRVS data for physican services through out the
United States. [pec/PCM]