1. CARRIER ADVISORY COMMITTEE REPORT 2014
Brent M. Harwood, DPM Diplomate of the American Board of Podiatric Surgery Carrier Advisory Committee Chairman

2. Local Coverage Determination (LCD) & Articles
Can be found on Cahaba’s website at:
Under Quick links Part B; Click on LCD’s
You can then view the following:
Active LCDs
Status of Draft LCDs
Articles
Retired LCDs and Articles
This page will also explain how to submit a comment for a Draft LCD
Any doctor can comment during the comment period which is 45 days

3. LCD L34368 & Article A48902 Routine Foot Care
New Documentation Requirements: - Physical findings and services must be precise and specific (e.g. left great toe, or right foot, 4th digit) Documentation of co-existing systemic illness should be maintained - A description of each debrided nail that reflects clinical descriptors consistent with mycotic nails. If appropriate the clinical descriptor may encompass multiple nails with the same findings. (e.g. The nail for toes 1, 3, 5 are yellow, brittle, thickened, etc.)

4. LCD L31428 Surgery: Bioengineered Skin Substitutes (BSS) for the Treatment of Diabetic &Venous Stasis Ulcers of the L.E.
Indications:
1. Failure to respond to standard wound therapy occurs when no
documented measurable signs of healing for at least 30
consecutive days
2. Standard Wound Therapy includes:
- Patient’s vascular status and correction if possible
- Optimization of nutritional status
- Optimization of glucose control (when applicable)
- Debridement by any means to remove devitalized tissue
- Maintenance of a clean, moist bed of granulation tissue
with appropriate moist dressings
- Appropriate off-loading
- Necessary treatment to resolve any infection that might be
present

5. LCD L33072 Surgery: Nerve Blocks & Electrostimulation for Peripheral Neuropathy
Limitations:
The use of nerve blocks with or without the use of electrostimulation and the use of electrostimulation alone for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically reasonable and necessary. Medical management using systemic medications is clinically indicated for the treatment of these conditions.
At present, the literature and scientific evidence supporting the use of peripheral nerve blocks with or without the use of electrostimulation and the use of electrostimulation alone for neuropathies or peripheral neuropathies caused by underlying systemic diseases is insufficient to warrant coverage.
These procedures are considered investigational and are not eligible for coverage for the treatment of neuropathies or peripheral neuropathies caused by underlying systemic diseases.

6. LCD L33072 Surgery: Nerve Blocks & Electrostimulation for Peripheral Neuropathy continued…
CPT Code 64450
ICD-9 Codes that DO NOT support Medical Necessity: – –
*Causalgia of lower limb*
*Other mononeuritis of lower limb*
355.8, 355.9
356.0 – 356.9
357.0 – 357.9
729.2, 729.5

7. PQRI Reporting
For 2014 there are significant changes in requirements to qualify for the incentive payment
Reporting period is for the entire year and payment will be 0.5% of Medicare Part B FFS payments
Report on 9 Measures for at least 50% of eligible Medicare patients
The 9 Measures should represent at least 3 of the 6 National Quality Strategy (NQS) domains
To avoid the 2% penalty in 2016 report on at least 3 Measures

8. Measures we are Reporting
2. Measure 128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up - % of patients aged 18 years and older - Reported once per reporting period - Bill CPT , If BMI is outside of normal parameters; a f/u plan is documented Use the following Quality Data Coding Options to Report: - G8420 (Calculated BMI within normal parameters & documented - G8417 (Calculated above normal parameters & f/u plan documented - G8418 (Calculated below normal parameters & f/u plan documented - G8421 (BMI not calculated)

9. Measures we are Reporting
2. Measure 163 Diabetes Mellitus: Foot Exam - % of patients aged years of age with diabetes who had a foot exam (i.e. visual inspection, sensory exam with monofilament AND pulse exam) during the measurement period - Reported once per reporting period - Diagnosis billed Bill CPT , Use the following Quality Data Coding Options to Report: - G9226 (Foot examination performed) - G9224 (Foot exam not performed for medical reason) - G9225 (Foot exam not performed, reason not given)

10. Measures we are Reporting
3. Measure 226 Preventive Care and Screening: Tobacco Use:
Screening and Cessation Intervention
- % of patients aged 18 years and older who were screened
for tobacco use one or more times within 24 months and
who received cessation counseling intervention if identified
as a tobacco user
- Reported once per reporting period
- Bill CPT ,
Use the following Quality Data Coding Options to Report:
F (Patient screened for tobacco use and received tobacco cessation
intervention)
F (Patient screened for tobacco use and identified as a non-user of
tobacco)
F (8P) Patient screened for tobacco use and identified as a user but
did not receive tobacco cessation counseling

11. Measures we are Reporting
4. Measure 20 Perioperative Care: Timing of Prophylactic Antibiotic - Ordering
Physician
- % of surgical patients aged 18 years and older undergoing
procedures with the indications for prophylactic parenteral
ABx, who have an order to be given within one hour (if
fluoroquinolone or vancomycin, two hours) prior to the
surgical incision
- Reported each time a procedure is performed during the
reporting period
- Bill CPT 28192, 28193, 28293, 28485, 28715
Use the following Quality Data Coding Options to Report:
- G8630 (Documentation of order for prophylactic parenteral antibiotics
were given within 1 hour of prior to start of procedure)

12. Measures we are Reporting
5. Measure 21 Perioperative Care: Selection of Prophylactic Antibiotic – 1st OR 2nd Generation Cephalosporin - % of surgical patients aged 18 years and older - Reported each time a procedure is performed during the reported period - Bill CPT 28192, 28193, 28293, 28485, Use the following Quality Data Coding Options to Report: F (Documentation of order for cefazolin OR cefuroxime for antimicrobial prophylaxis F (1P) (Documentation of medical reasons for not ordering cefazolin OR cefuroxime for antimicrobial prophylaxis)

13. Measures we are Reporting
6. Measure 22 Perioperative Care: Discontinuation of Prophylactic Antibiotic (Non-Cardiac Procedures) - % of non-cardiac surgical patients aged 18 years and older - Reported each time a procedure is performed during the reporting period - Bill CPT 28192, 28193, 28293, 28485, Use the following Quality Data Coding Options to Report: F (Documentation that order was given to discontinue prophylactic antibiotics within 24 hours of surgical end time, non-cardiac procedure)

14. Measures 20, 21, 22 CPT Coding
28193 – Removal of foreign body, foot, subcutaneous complicated
28293 – Correction, hallux valgus (bunion), with or without
sesamoidectomy; resection of joint with implant
28485 – Open treatment of metatarsal fracture, includes internal
fixation, when performed, each
28715 – Arthrodesis; triple

15. Measures we are Reporting
7. Measure 131 Pain Assessment and Follow-Up - % of visits for patients aged 18 years and older with documentation of a pain assessment through discussion with the patient including the use of a standardized tool(s) on each visit AND documentation of a f/u plan when pain is present - Reported each visit during the reporting period - No diagnosis associated with this measure - Bill CPT , Use the following Quality Data Coding Options to Report: - G8730 (Pain assessment documented as positive & f/u plan documented - G8731 (Pain assessment documented as negative, no f/u plan required

16. Measures we are Reporting
8. Measure 245 Chronic Wound Care: Use of Wound Surface
Culture Technique
- % of patient visits for those patients aged 18 years and older
with a diagnosis of chronic skin ulcer without the use of a
wound surface culture technique
- Reported at each visit during the reported period
- Bill diagnosis – , – 707.9
- Bill CPT – 99205, – 99215
Use the following Quality Data Coding Options to Report:
F (Technique other than surface culture of the wound
exudated used OR wound surface culture technique not used)

17. Measures we are Reporting
9. Measure 246 Chronic Wound Care: Use of Wet to Dry Dressings
in Patients
- % of patient visits for those patients aged 18 years and older
with a diagnosis of chronic skin ulcer without a prescription
or recommendation to use wet to dry dressings
- Reported at each visit during the reporting period
- Bill Diagnosis – , – 707.9
- Bill CPT – 99205, – 99215
Use the following Quality Data Coding Options to Report:
F (Use of wet to dry dressings neither prescribed nor
recommended)

18. For More information on 2014 PQRS Measures
Please refer to:
Choose Medicare
Under Quality Initiatives/Patient Assessment Instruments
Choose Physician Quality Reporting System
To the left click on Measure Codes
At bottom of screen, under Related Links; choose 2014 PQRS Individual Claims Registry Measures Specs Supporting Docs

19. Maintenance of Certification (MOC)
Replaces the current ABPS Recertification process in 2016
All Diplomates issued a time-limited certificate will be required to participate in the MOC program to maintain certification
MOC is voluntary for ABPS Recertification in the years 2012 – 2015 but is mandatory in 2016
An additional incentive payment of 0.5%

20. Requirements for Maintenance of Certification (MOC)
Maintain a valid, unrestricted podiatric license in the US or Canada
Maintain active surgical privileges at either an accredited hospital or surgical center
Participate in educational and self assessment programs requiring an evaluation of material learned. ABPS requires 200 continuing education credits per 10 year cycle, including 20 credits with a self assessment component
Complete a formalized, secure examination consisting of the fundamental diagnostic skills, medical knowledge, and clinical judgment to provide quality care every 10 year cycle
Successfully complete a Practice Assessment consisting of patient surveys, chart review for approved quality measures, peer review surveys, and a practice improvement plan every 10 year cycle

21. 2011 Medicare Recoups for Initial Office Visits
How we handled the recoups for initial office visit with
a procedure:
1. We sent the claim to appeals
2. We refiled the claims with a 25 modifier even though it
was not needed
**Claims were paid**
We have sent a letter to Dr. McKinney, Cahaba’s Medical Director, indicating the 25 modifier was not needed but awaiting for reply

22. Do not use bilateral AFO’s for fall prevention

23. Dispensing Diabetic Shoes (What you need if you are audited)
Prescribing physician’s detailed written order
Diabetic Shoe Certification (Signature within 3 months of delivery & must be signed by MD or DO)
Diabetic Screening (Signature within 3 months of delivery & must be signed by MD or DO)
Note from certifying physician stating patient is diabetic and is being treated for diabetes and condition is documented from Shoe Certification

24. Dispensing Diabetic Shoes continued… (What you need if you are audited)
Supplier in-person evaluation (Must be within 6 months of delivery)
Supplier in-person visit at time of delivery
Receipt of DME
ABN
For more information on diabetic shoes and documentation, refer to LCD L11525 and Article A37065

25. Thank You!!