First Coast Service Options (physician involvement)

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Anonymous

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Dear FUS Members,

We are writing to inform you that Dr. Terry Regan has had a number of discussions with Dr. James Corcoran from First Coast Service Options (FCSO) over the last few weeks in regards to Posterior Tibial Nerve Stimulation (PTNS) CPT 64566.

The discussions have primarily revolved around how much involvement is required of the physician in performing these procedures and how much latitude can be given to ancillary staff.

The feeling from First Coast Service Options (FCSO) is that the Local Coverage Determination (LCD) is written in such a way that it requires the physician to be involved in the needle placement and electrode settings and it is not sufficient for the physician to delegate the entire procedure to ancillary staff and just be present in the facility. Dr. Regan has reviewed the LCD with Dr. Corcoran for this code and FCSO is adamant about the physician involvement. We continue to work with FCSO to see if this can be modified in some way, however, in the meantime the physician should document his involvement in each of these procedures.

We felt that it was important to share this information with all of the members of the FUS.

We look forward to seeing all of you at the 2013 Annual Meeting being held this year in Tampa August 29 through September 1st.

Sincerely,

Michael Binder, MD
FUS President
 












First of all, MANY states follow FCSO's lead on coverage (remember when the unlisted code was pushed out - FCSO was in the lead of the charge). FCSO's followed the AUA's strong stance on PTNS having it's "own" code not a bogus code that CMS gave them.

Secondly, it takes more than 3 minutes because the patient is AWAKE and actually will have a conversation with the physician. All for a payment of $100.00 if the co-pay is collected and all the while the room is blocked for 45 minutes for a 30 minute treatment. He makes more money doing a Cystro.

Thirdly, the FCSO CAC member (urologist) is also on the AUA board. Hum, what are the chances that the AUA is going follow FCSO's recommendation? Pretty strong. Do you NOT know that the other Medicare districts talk to each other? Why did FCSO take over a year to approve PTNS after the code was published - because UPI screwed the Urologist in the past and did NOT help them when the unlisted code wasn't paid.

Finally, do not think the GYNs are going to be your saving grace. They perform co-surgeries with urologist and will hear about what is going on with UPI.

Karma baby Karma.
 












Anonymous said:
Dear FUS Members,

We are writing to inform you that Dr. Terry Regan has had a number of discussions with Dr. James Corcoran from First Coast Service Options (FCSO) over the last few weeks in regards to Posterior Tibial Nerve Stimulation (PTNS) CPT 64566.

The discussions have primarily revolved around how much involvement is required of the physician in performing these procedures and how much latitude can be given to ancillary staff.

The feeling from First Coast Service Options (FCSO) is that the Local Coverage Determination (LCD) is written in such a way that it requires the physician to be involved in the needle placement and electrode settings and it is not sufficient for the physician to delegate the entire procedure to ancillary staff and just be present in the facility. Dr. Regan has reviewed the LCD with Dr. Corcoran for this code and FCSO is adamant about the physician involvement. We continue to work with FCSO to see if this can be modified in some way, however, in the meantime the physician should document his involvement in each of these procedures.

We felt that it was important to share this information with all of the members of the FUS.

We look forward to seeing all of you at the 2013 Annual Meeting being held this year in Tampa August 29 through September 1st.

Sincerely,

Michael Binder, MD
FUS President
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LOVE IT!!!!
 






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