New MLN Matters articles focus in on how you can correct these issues.
No practice enjoys hearing that recovery audit contractors (RACs) will be visiting their office to review files. RACs are well-known to go over claims with a fine-toothed comb to recover overpayments made to your practice. After recovering the cash, the RAC takes a cut of the money—which many practices feel incentivizes them to scrutinize their records even more thoroughly. But if you want to stay out of the RACs’ field of vision, you’ll need to brush up on these five areas that Medicare identified last week as being high-error topics by RACs.
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You have until September to get a handle on the recent changes.
Now that the omnibus rule is finalized, you need to review your all your practice’s business relationship and ensure that all your BA agreements (BAAs) spell out the new breach notification responsibilities, the restrictions on personal health information (PHI) use, and more — all before September rolls around. Here’s what you need to know.
Background: The final rule brought together a slew of outstanding interim and proposed rules relating to HIPAA privacy, security and enforcement, most of which go into effect in September. Although the omnibus rule technically took effect on March 26, you’ll have until Sept. 23 to come into compliance with most of its provisions, according to the law firm Epstein Becker & Green in a white paper.
Get to Know the Recent Changes
Prepare to distinguish between pacemaker battery and other parts.
ICD-10 will require you to be a little more specific about coding pacemaker adjustment encounters, but you should have an easier transition to coding automatic implantable cardiac defibrillator (AICD) encounters.
V53.31, Fitting and adjustment of cardiac pacemaker
V53.32, Fitting and adjustment of automatic implantable cardiac defibrillator
V53.39, Fitting and adjustment of other cardiac device
Expect more detail for wound type, location.
If you thought ICD-9 provided a lot of granularity for reporting open wounds, think again. You won’t believe the detail you’ll need to document when ICD-10 goes into effect on Oct. 1, 2014.
Describe Cut’s Nature
Although the ICD-9 codes primarily use the terms “open wound” or “laceration,” you’ll need to have more information to describe the wound under ICD-10. For instance, the ICD-10 codes often distinguish laceration, puncture wound, and open bite using different codes.
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Question: A patient had a lab outpatient draw in the morning for BMP, and a lab ER draw later in the day for CMP. Can we bill for both of these tests?
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Plus: CMS clarifies rules for opting out of Medicare.
Your physician treated a patient, you submitted a bill to Medicare, collected your payment, and that was that—until CMS sent you a letter demanding a refund since its records indicated you were treating a patient who was incarcerated on the date of service.
Hint: The add-on code for interactive complexity is not a time-based code.
When your clinician experiences specific communication issues that complicate performance of selected psychiatric diagnostic or therapeutic services, you’ll need to factor in an add-on CPT® code, namely +90785, to reimburse for the extra time that your practitioner spent with the patient.
Coding scenario: Your psychiatrist uses play equipment to evaluate a 6-year-old male patient for autism. Since the patient has communication disabilities, you clinician spends a considerable amount of time with him to complete his evaluation.
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Could vertebral fracture assessment get a new code?
The CPT® Editorial Panel has already posted several approved code changes for 2014, but there are more decisions to come. Preview what’s in the works for 2014 with a look at the following three items which were on the May 2013 agenda, with results to be posted this summer.
Term swap: ICD-10 uses ‘depolarization’ instead of ‘beats.’
Many Part B practices see patients with premature heartbeat disorders, so you may have those diagnosis codes at the top of your mind. But in your preparations for ICD-10, pay attention to two key premature beat coding changes to ensure clear sailing for your claims.
- 427.60, Premature beats unspecified
- 427.61, Supraventricular premature beats
- 427.69, Other premature beats
- I49.1, Atrial premature depolarization
- I49.3, Ventricular premature depolarization
- I49.40, Unspecified premature depolarization
- I49.49, Other premature depolarization
Question: Can the special ophthalmological services be provided and reported with the general eye codes? Is modifier 25 required on the eye code if the two are performed together?