You have two months to prepare for a big change in the way you provide annual wellness visits (AWVs). The health risk assessment (HRA) becomes a required component of the AWV on Jan. 1, 2012, and it will be yet another obstacle to furnishing AWVs for many primary care physicians, experts tell Part B News.

You and your peers will lose millions of dollars on physician interpretations of diagnostic imaging scans once the 25% multiple procedure payment (MPPR) hits the professional component (PC) in less than two months.

Remember: CMS finalized the imaging cut to the PC of CT, MRI and ultrasound tests in its 2012 Physician Fee Schedule final rule on Nov. 1, with virtually no changes from the proposed rule other than reducing the pay cut from a 50% discount to 25%. Starting Jan. 1, you will only get 75% of the fee schedule rate for interpretations of multiple imaging scans done on the same patient, in the same day. NOTE: Provider payments for imaging readings will always be paid in full for the highest-value test interpreted in the same session, while all others read that session will be paid at 75%.

Medicare has expanded its influenza vaccine code offerings this year, so make sure you have the most complete, up-to-date list of codes and fees. There are the Q-codes that CMS wants you to use instead of 90658 for intramuscular vaccines given to Medicare patients age 3 or older, effective Jan. 1, 2011. Here they are, with their ASP drug prices, effective Oct. 1.

• Q2035 (Afluria), $11.543.
• Q2036 (Flulaval), $8.784
• Q2037 (Fluvirin), $13.652.
• Q2038 (Fluzone), $13.306.
• Q2039 (Not otherwise specified flu vaccine). No national payment limit, fee set by your local contractor.

This chart looks at denial rates for E/M services by code level and by primary care versus specialists, based on the latest two years of CMS claims data. NOTE: “Primary care” reflects combined data for family practice, general practice and internal medicine. “Specialists” represent combined data for most other specialties recognized by CMS, excluding those with low annual Medicare utilization, such as plastic surgeons.

How do you code for a patient who comes in for an office visit, is tested for allergies, leaves the office with a vial of medicine for injection for the allergies and is given the first injection in office of multiple antigens?