Appeals: CMS Just Updated Medically Unlikely Edits–Do You Know How to Appeal Them?

Posted on 08. May, 2013 by rpandit.

Many MUEs make sense, but for those that don’t, you can fight back.
By now, most practices are familiar with Medicare’s medically unlikely edits (MUEs), which CMS instituted to prevent overpayments caused by gross billing errors. On April 1, CMS updated the MUE listing, and some of your favorite codes may now be limited by the bundles. When you scour your unpaid claims, make sure you are watching for MUE denials to ensure that you’re getting paid when appropriate but that you fight back when your claims are inappropriately denied.” (more…)

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Practice Management: Time to Re-Enroll Your Gynecologist? You’ll Have an Easier Job, CMS Says

Posted on 24. Apr, 2013 by rpandit.

You can fax or email the revalidation documents this time around.

If your gynecologist sees Medicare patients, re-enrolling your provider every few years is on your to-do list. The good news is that CMS has made improvements to the re-enrollment process, according to an Oct. 10 CMS National Provider Call with the agency’s Provider Enrollment Operations Group.” (more…)

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Medicare: Add to Your Add-On Code Savvy Using 3 CMS Tables

Posted on 08. Apr, 2013 by rpandit.

CCI takes note of these tables. Shouldn’t you?

CPT® doesn’t designate primary codes for every add-on code, but CMS offers a few clues in Transmittal 2636, Change Request 7501, effective April 1, 2013.

Background: An add-on code reports a service that is “always performed in conjunction with another primary service. An add-on code is eligible for payment only if it is reported with an appropriate primary procedure performed by the same practitioner. An add-on code is never eligible for payment if it is the only procedure reported by a practitioner,” states the Transmittal. “Rarely contractors may allow with appropriate submitted documentation, either pre-pay or on appeal, payment for a primary code and add-on code on two consecutive dates of service if the services are appropriately related.” (more…)

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Documentation: New CMS Guidelines To Be Followed To Keep Record Amendments Updated

Posted on 25. Mar, 2013 by rpandit.

Heads up: Single-line corrections are fine.

No practice – or physician – is immune to documentation that needs to be updated. Maybe the physician left out an important piece of information, such as the amount of time spent counseling the patient, or the patient’s diagnosis. When records need to be amended, be sure your practice follows the latest CMS rules, which were revised on Dec. 7, 2012, in Transmittal 442.

In the transmittal, CMS encourages providers to “enter all relevant documents and entries” into the record at the time of service. However, CMS also acknowledges that “occasionally, upon review a provider may discover that certain entries, related to actions that were actually performed at the time of service but not properly documented, need to be amended, corrected, or entered after rendering the service.”

Do this: When adding, correcting, or entering information after the date of service, you should identify it as an amendment, and the physician should sign and date it. Never delete the original entry—instead, ensure that all original content is identifiable. You can do this on a paper record by using a single strike line through the original content. For electronic records, you must “provide a reliable means to clearly identify the original content, the modified content, and the date of authorship of each modification of the record,” CMS says in the transmittal.

If an auditor ever reviews your files, CMS directs them to consider your amended entries—but only if you follow the rules. Auditors “shall not consider undated or unsigned entries handwritten in the margin of the document,” for instance, the Transmittal advises.

CMS advises MACs and auditors that see potential fraud in the documentation to refer those cases to the ZPIC auditors. To read the complete transmittal, visit www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R442PI.pdf.

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Part B Payment: CMS Offers Bilateral Pay Boost for 10 Procedures

Posted on 11. Mar, 2013 by rpandit.

 Plus: G9157 is now payable under the Fee Schedule.

Not all fee schedule changes are bad news.

In the case of the Q2 updates to the Medicare Physician Fee Schedule, CMS offers payment boosts for several procedures, including catheter placement and cardiac Doppler monitoring. Although the Q2 updates have an official implementation date of April 1, many of the changes are effective retroactive to Jan. 1, 2013.

Bilateral Boosts

You’ll now be able to collect more when you perform selective catheter placement (36222-36228) bilaterally. Previously, the bilateral procedure indicator on these codes was “0,” which meant that no additional payment was assigned when surgeons performed the procedure on both sides. However, effective Jan. 1, 2013, the bilateral indicator is “1,” so you can append modifier 50 (Bilateral procedure) and the payment amount will be 150 percent of the fee schedule RVUs.

The same good news awaits for codes 23000 (Removal of subdeltoid calcareous deposits, open), 32997 (Total lung lavage; unilateral), and 32998 (Ablation therapy for reduction or eradication of one or more pulmonary tumor[s] including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral), which will all be billable with modifier 50 going forward. The payment for the bilateral procedures will be 150 percent of the fee schedule amount.

Positive Payment News for This G Code

CMS will now allow payment for G9157 (Transesophageal Doppler use for cardiac monitoring), making its procedural status code now “A” (active) going forward, which means that it will be payable once RVUs are assigned to it. In addition, the procedure has been assigned a PC/TC indicator of “2,” meaning the professional component only will be paid (modifiers 26 and TC are not valid with this code). This is effective Jan. 1, 2013, so your MAC should pay claims retroactively for dates of service on or after Jan. 1.

CMS also revised the descriptors of several CPT® codes as part of the Q2 updates. You can read the document in its entirety at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8169.pdf.

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Annual Wellness Visits: CMS Begins Recouping Overpayments Made for AWVs

Posted on 26. Feb, 2013 by rpandit.

When both the facility and the doctor bill for the same service, Medicare ends up double-paying.

You may have been overpaid for annual wellness visits without even knowing it, but your MAC could come calling for a refund soon, if a recent CMS Transmittal is any indication.

When CMS established the annual wellness visit (AWV) codes G0438 and G0439, the agency noted that it would accept claims from facilities furnishing the service, or from physicians performing it. Unfortunately, however, that information was misinterpreted by some providers, so when AWVs were performed by physicians in the facility setting, both the facility and the doctor submitted Medicare claims for the AWV, and both got paid.

(more…)

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CMS News: Update Your Revalidation Plan With New CMS Instruction

Posted on 13. Feb, 2013 by rpandit.

Kinder, gentler process forestalls ‘revocation.’

Don’t lose your ability to provide Medicare services by missing the boat on re-enrollment. Read on to see what you should do for your general surgery practice when that revalidation notice comes in the mail.

Good news: CMS has made improvements to the re-enrollment process, according to an Oct. 10 CMS National Provider Call with the agency’s Provider Enrollment Operations Group.

(more…)

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Orthopedics In-Depth: Justify Your Choice of Jones Fracture Code in ICD-10

Posted on 23. Jan, 2013 by rpandit.

Confirm side of foot and displacement of fracture.

ICD-9 offers only a single code for closed fracture of metatarsal bone(s) – 825.25 (Fracture of metatarsal bone[s] closed). Note that is the only code for the closed fracture of one or more metatarsal bones and is not specific for a particular metatarsal bone. You can report the same code for fracture in any metatarsal bone, first to fifth.

(more…)

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Obstetrics: Safeguard Your Split Antepartum Care Reimbursement With Expert Tips

Posted on 08. Jan, 2013 by rpandit.

You may have more options than you think.

When dividing ob-gyns’ roles with split antepartum care, the key is counting the visits, coding experts say.

(more…)

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Image Guidance: 64561 Code Definition Catches Up With CCI Edits

Posted on 24. Dec, 2012 by rpandit.

Plus: Radiology guidelines update instructions on reporting S&I separately.

Coding for image guidance with neuroelectrode implant code 64561 will become clearer thanks to a definition change effective Jan. 1, 2013.

Leave 76000, 77002 Off Neurostimulator Claims

CPT® 2013 revises the descriptor of 64561 by adding the underlined text: Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed.

“As with a lot of codes now, imaging is included,” explains Christy Shanley, CPC, department administrator for the University of California, Irvine.

That means you cannot report codes 76000 (2013 definition: Fluoroscopy [separate procedure], up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) with 64561, says Michael A. Ferragamo, MD, FACS, clinical assistant professor, University Hospital, State University of New York, Stony Brook.

CCI: The Correct Coding Initiative (CCI) has bundled 64561 with both 76000 and 77002 since 2001. That means that even before the 2013 code definition change, you weren’t supposed to report the fluoro codes for guidance in connection with 64561 when submitting claims to payers who apply those edits.

(more…)

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