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RAC Fact: Watch Out For Medicare’s Once-in-a-Lifetime Services

Posted on 20. Sep, 2009 by in Hot Coding Topics



G0389 & the IPPE codes may be potential RAC targets

If you’ve been sweating it out, waiting for the recovery audit contractors (RACs) to announce where they’ll be focusing their audit efforts, you may or may not be relieved to know two RAC contractors have posted the areas they’ll have their eye on. More on that below …

Both lists include once-in-a-lifetime procedures, so named because you should report them just once in a beneficiary’s lifetime. Examples of once-in-a-lifetimes codes include G0402, G0403, G0404 and G0405 — HCPCS codes associated with the ‘Welcome to Medicare Visit,’ CMS explains on this info sheet.

Radiology Coders Beware: This ‘once-in-a-lifetime’ RAC focus could bring G0389 (Ultrasound B-scan and/or real time with image documentation; for abdominal aortic aneurysm [AAA] screening) claims under scrutiny because the code represents a onetime AAA screening for Medicare patients referred following an initial preventive physical examination.

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