New knee pain injection code

On Nov. 12, the Health Care Financing Administration announced assignment of a new unique code to facilitate Medicare billing for Hyalgan (sodium hyaluronate) for intra-articular injection for the relief of pain in osteoarthritis of the knee.

The new code for Hyalgan, J7315, went into effect Jan. 1, and should be used for all Hyalgan injections on or after that date. In the United States, Hyalgan is marketed to non-orthopedic physicians by Sanofi, and to orthopedic surgeons by Sanofi’s marketing partner, OrthoLogic.

Hyalgan is used to relieve the pain of osteo arthritis of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and to simple analgesics such as acetaminophen.

Physician pay raises remain flat

Compensation for both primary care and specialty physicians has remained flat for two years in a row, says a recent survey by the Medical Group Management Association in Englewood, CO.

The MGMA’s Physician Compensation and Production Survey says 1997 pay for primary care physicians rose just 0.86% to $135,791, while specialist pay fell 0.48% to $220,476. The year before, primary care compensation rose only 1.42%, while specialists’ income increased 2.58%.

Susan A. Cejka, president of consultants Cejka & Company in St. Louis, attributes much of this stagnation to cross-currents in today’s health care economy. "We’re seeing overhead take a larger share of practice income as it becomes more expensive to administer practices," she says. "Costs are going up, fees are coming down, and physicians are getting squeezed in the middle."

Midlevel providers, however, came out winners. Their compensation jumped 4.41% to $57,907, reflecting an increased demand for their services. "In many managed care markets, you are seeing one midlevel provider being recruited for every two physicians," says Cejka.

Among selected specialities, income for noninvasive cardiology rose by 5.19%, much more than the average, to $259,961. Meanwhile, income for invasive cardiologists dropped the most, by 7.7 % to $326,537.

AMA wants dietary rules

The American Medical Association’s House of Delegates voted at its December meeting in Honolulu to develop ethical guidelines covering the sale of dietary supplements sold in physician offices.

According to the resolution, the AMA will "develop ethical guidelines that will discriminate between the legitimate provision of medically necessary goods and services in physicians’ offices and physicians’ marketing activities that exploit the patient-physician trust." The new guidelines are to be ready by the association’s June annual meeting.

The resolution further states that "physicians are being heavily marketed by health and fitness companies to recommend, sell and distribute nutritional fitness and weight management products, such as vitamins and dietary supplements, to their patients. . . . Some companies encourage physicians to recruit other members of the profession, offering financial rewards such as a percentage of the sales made by the recruited physician."

Whether physicians should even be allowed to sell nonmedical items in their office has been an ongoing issue for the AMA. In 1997, the AMA Council on Ethical and Judicial Affairs recommended against the sale of nonmedical items because some doctors might take advantage of the physician-patient relationship, pressuring patients to buy products that are not medically necessary.

Oral cancer drug coverage OK’d

Authorized Medicare intermediaries can now pay for Food and Drug Administration-approved oral anti-cancer pro-drugs on claims dated on or after Jan. 1, 1999. The Health Care Financing Administration approved the change based on recent advances in the drug’s metabolic make-up. Payment is under Part B on a reasonable cost basis with deductibles and coinsurance.

Providers must report the pro-drugs under revenue code 636 using existing HCPCS code 18999, prescription drug, oral, chemotherapeutic, not otherwise specified.The name of the drug, number of units, and a diagnosis of cancer also must be reported.

According to Medicare, no payment will be paid unless a cancer diagnosis appears on record type 70 when either the UB-92 flat file or FLs 67-75 for the hard copy UB-92 is used.

Digital cardiac device covered

The Health Care Financing Administration has approved the noninvasive BioZ digital cardiac output monitoring device for full Medicare coverage. The BioZ, manufactured by CardioDynamics International in San Diego, will provide continuous data on a wide range of measurements of the heart’s ability to deliver oxygen-rich blood throughout the body.

Patients suffering from hypertension and congestive heart failure, as well as those wearing pacemakers and requiring fluid management, are expected to benefit from the technology.