TMA Young Physicians Memo

Summer 2014

Apply for the TMA Leadership College by July 2

TMA is now accepting applications for the TMA Leadership College Class of 2015. The deadline to apply is July 2.

The TMA Leadership College, established in 2010 as part of TMA's effort to ensure strong and sustainable physician leadership within organized medicine, is geared toward active TMA members younger than 40 or who are in the first eight years of practice.

Leadership College graduates serve as thought leaders who can close the divide among clinicians and health care policymakers, and as trusted leaders within their local communities. Many also receive priority consideration for appointment to TMA councils and committees.

Visit the TMA Leadership College webpage for full program details, a class schedule, and application. 

For more information, contact Christina Shepherd in TMA Membership Development by calling (512) 370-1443 or by emailing

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Free TMA Publication: Business Basics

Thanks to a generous grant from The Physicians Foundation, you can download Business Basics for Physicians, TMA's newest publication, free.

Business Basics for Physicians guides you through essential business skills like hiring and managing staff, developing a budget, crafting administrative policies and procedures, and promoting the practice. Learn more on the TMA website, or download now.

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Congratulations to Newly Elected TMA Officers

The TMA Young Physician Section elected new YPS Executive Council members and TMA delegates and alternates at TexMed 2014 in Fort Worth on May 2. Congratulations to the following newly elected officers:

Young Physician Section Executive Council
Chair Walter Root, MD
San Antonio 

Chair-Elect Gerad Troutman, MD
Immediate Past Chair Carrie DeMoor, MD

AMA Delegates
Thiendella Diagne, MD

Eddie Patton Jr., MD
Sugar Land 

Jennifer Rushton, MD

Michelle Rodriguez, MD
San Marcos 

TMA Delegates
Alisa Berger, MD

Lake Jackson 
George Osuchukwu, MD

Harbir Singh, MD

Nicholas Steinour, MD

Julie Sullivan, MD

Sandra Williams, DO

TMA Alternate Delegates
Jennifer Johnson, MD

Stacy Norrell, MD

Tina Philip, DO

Jennifer Rushton, MD

Parin Shah, MD
Sugar Land 

Brad White, MD

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AMA Annual Meeting Wrap-Up

Delegates aggressively called for rapid intervention into the scandal-plagued Veterans Administration health care system, set new telemedicine policy, and adopted guidelines for physician-led health care teams at the 2014 Annual Meeting of the American Medical Association House of Delegates.

More than 100 Texas physicians, residents, medical students, and alliance members representing TMA, various sections, and national specialty societies participated in the June 7-11 meeting in Chicago. TMA's Young Physician Section sent four physician delegates to the AMA Young Physician Section. Additionally, eight young Texas physicians represented their specialty societies or served in national leadership positions. The Texas delegation left the meeting having elected all three candidates it ran for AMA office and winning adoption of numerous Texas policy statements.

Be sure to save the date for the AMA Interim Meeting in Dallas Nov. 8-11. 

Outside help for the VA
Led by the delegations from Texas and Florida, the AMA house called on President Barack Obama to "take immediate action to provide timely access to health care for veterans utilizing the health care sector outside the Veterans Administration (VA) until the VA can provide health care in a timely manner."

Delegates also asked Congress to "act rapidly to enact a bipartisan, long-term solution" to the excessive delays in care that have been documented within the VA system.

"The problems are complex, they are longstanding, and they're not amenable to a quick fix," said Asa Lockhart, MD, the Tyler anesthesiologist who took the lead on the issue for the Texas physicians. "The only answer is to ask the president to take some sort of immediate action in order for veterans to seek health care outside of the VA system."

David McKalip, MD, a neurosurgeon from St. Petersburg, Fla., exhorted his colleagues in the House of Delegates to step up to the challenge. "American veterans are dying and suffering due to delays in care," he said. "Our AMA should ask for the only action that can fix this now."

TMA President Austin King, MD, who traveled to Chicago for the AMA meeting, added his voice to the chorus calling for immediate action. "Our veterans have stepped up and served our country, so physicians want to be able to step in and serve them," Dr. King said. "It is tragic that our veterans have been forced to wait for the health care they need and deserve, so Texas physicians and our colleagues across the nation want to help care for them until the VA can right the ship."

The AMA house also encouraged all physicians to participate, when needed, in the care of veterans, and recommended that state and local medical societies across the country create registries of physicians offering to see veterans and to share that registry with community organizations and local VA officials. TMA immediately set up a form on the TMA website for Texas physicians to enlist in that registry. Visit to sign up.

Texans in the spotlight
Delegates enthusiastically elected former TMA President Sue Rudd Bailey, MD, of Fort Worth to a fourth term as vice speaker of the AMA house. At the conclusion of the meeting, Texas delegates announced Dr. Bailey will run for speaker in June 2015. The current speaker — Andrew Gurman, MD, of Pennsylvania — will vie to become president-elect.

In a close race with eight candidates seeking one of five positions, Houston's Russell Kridel, MD, won a seat on the AMA Board of Trustees. "I hope to further the AMA's goals of preserving the patient-physician relationship and improving the health of the nation," said the facial plastic surgeon, who is a former president of the TMA Foundation.

As one of four candidates running for four available seats on the AMA Council on Medical Service, Dr. Lockhart won his post by acclamation.

Some younger Texans also won elections at the AMA meeting:    

  • Nnenna Ejesieme, MD, of The University of Texas (UT) Southwestern Medical Center, is the newly elected chair of Region 3 of the AMA Resident and Fellow Section.
  • Elected to the Medical Student Section Region 3 Executive Council were: Angie Hamouie, UT Medical Branch at Galveston, secretary; and Tennessee Bailey, UT Health Science Center at San Antonio, membership chair.    

In addition to adopting the Texas resolution on care for veterans, the delegates voted to support all or most of three other resolutions the Texans brought from the TMA House of Delegates. They direct AMA to:    

  • Take strong action — including protection of state prompt pay laws and the development of alternative financing solutions — to help practices deal with the stress and uncertainty of providing care to patients who are in the 90-day grace period for not paying their Affordable Care Act (ACA) marketplace insurance premiums.
  • Compare government estimates to actual time and costs incurred by physicians to comply with such government mandates as the Physician Quality Reporting System and the meaningful use electronic health record incentive program.
  • Convene delegates to the U.S. Pharmacopeial (USP) Convention to protest and seek changes to the "immediate-use" exception to USP Chapter 797 guidelines, including the "one-hour rule."    

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How to Use Modifier 59 in Medicare Claims

Modifier 59, the distinct procedural service modifier associated with Medicare National Correct Coding Initiative (NCCI) edits, is one you might find confusing (many practices do). Follow these guidelines when using the modifier to bypass an NCCI edit.  

  • A common correct use of modifier 59 is for surgical procedures, nonsurgical therapeutic procedures, or diagnostic procedures that you performed at different anatomic sites and ordinarily would not perform on the same day, and that you cannot describe by one of the more specific anatomic NCCI-associated modifiers — i.e., RT, LT, E1-E4, FA, F1-F9, TA, T1-T9, LC, LD, RC, LM, or RI. 

Under NCCI, "different anatomic sites" means different organs or, in certain instances, different lesions in the same organ. Typically NCCI edits prevent the billing of lesions and sites not considered separate and distinct. Thus you would use modifier 59 to identify clearly independent services that represent significant departures from the usual situations described by the NCCI edit. Note that the treatment of contiguous structures in the same organ or anatomic region does not constitute treatment of different anatomic sites. 

  • A common incorrect use of modifier 59 is applying it on the basis of the narrative description of the two codes of the code pair being different. The descriptors of the two codes of an NCCI code pair edit usually represent different, although possibly overlapping, procedures. The edit indicates that when you perform them at the same time on the same anatomic site, those procedures are not considered "separate and distinct," and you should not bill them together. Therefore, don't use modifier 59 simply based on the two codes being "different procedures." However, if you perform the two procedures at separate anatomic sites or at different times on the same date of service, you may append modifier 59 to indicate that they are different procedures on that date of service.  

Other correct uses of modifier 59 are for:  

  • Surgical procedures, nonsurgical therapeutic procedures, or diagnostic procedures you perform during different patient encounters on the same day that you cannot describe with one of the more specific NCCI-associated modifiers 24, 25, 27, 57, 58, 78, 79, or 91. 
  • Two services described by timed codes you provide during the same encounter only when you perform them sequentially (i.e., one service is completed before the subsequent service begins). 
  • A diagnostic procedure you complete before you begin a therapeutic procedure only when the diagnostic procedure is the basis for performing the therapeutic procedure. If the diagnostic procedure is an inherent component of the surgical procedure, do not bill it separately. 
  • A diagnostic procedure you perform subsequent to a completed therapeutic procedure only when the diagnostic procedure is not a common, expected, or necessary follow-up to the therapeutic procedure. If the post-procedure diagnostic procedure is an inherent component of or otherwise included in the therapeutic procedure, do not bill it separately.   

Remember: Any time you use modifier 59, your documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries). Don't use the modifier to bypass an edit unless you've met the criteria for its use.

The Centers for Medicare & Medicaid Services provides a series of examples of how to use modifier 59 (PDF) in various circumstances, and the full CPT definition, in MLN Matters No. SE1418 Revised.

Have coding or billing questions? Contact TMA's certified coders at (800) 880-1300, ext. 1414 or at for help.

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Save the Date

Mark your calendar for the TMA Fall Conference, which will take place Sept. 12-13 at Hyatt Regency Lost Pines Resort & Spa in Bastrop. The conference provides an opportunity for physicians to conduct TMA business, obtain continuing medical education, and network with peers.

This year, the conference visits a new venue just 30 minutes from downtown Austin. Situated on the banks of the Lower Colorado River, the Hyatt Regency Lost Pines combines the natural beauty revered by early Native Americans with the colorful, regional history and culture of the Lost Pines Region for a true Texas wilderness escape. In addition to conference events, attendees can enjoy a variety of amenities including golf, spa time, horseback riding, hiking, archery, tennis, and the water park.

TMA’s special room rate is $199 for single or double occupancy. Reserve a room by calling (888) 421-1442 and asking for the TMA Fall Conference discount, or reserve your room online. The deadline to receive this special rate is Thursday, Aug. 21. Sleeping rooms are subject to a 7-percent occupancy tax rate. Local sales tax is 6.75 percent.

Online registration opened June 23 at The conference is a free benefit to TMA members; the fee for nonmember physicians is $125. Contact the TMA Knowledge Center at (800) 880-7955 or with questions. 

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New-to-Texas Physicians Can Start Here

Are you a new Texas physician? Have you recruited a physician for your practice from out of state?

TMA’s Welcome to Texas webpage can help new or returning Texans get their practices up and running. The page provides links doctors need to obtain a Texas license, plus contact information for relevant state and federal agencies and links to resources such as practice consulting for setups, health insurance plan contacts, and employee salary data.

TMA members can email the TMA Knowledge Center or call (800) 880-7955 for fast answers to questions about membership, TMA member benefits and services, practice management or legal information, and more. 

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Good Health Grants Available from TMAF

TMA Foundation is accepting applications for its 2014-15 Medical Community Grants and Medical Student Leadership Grants programs. Eligible applicants include TMA county medical societies, and alliance and medical student chapters. 
TMAF is seeking programs that feature collaborations among medicine, business, and community and that address TMA priorities such as obesity, tobacco, immunizations, health disparities, unplanned pregnancy, mental health, environmental health, violence, and disaster preparedness and response. Society and alliance chapters may apply for up to $7,500; medical student chapters may apply for up to $3,000. 
Find out more, including summer deadlines, on the TMAF website

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 Stay Connected

Keep up with important news and connect with colleagues across the state through the YPS Facebook page.

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