If you’ve ever wondered whether Medicare actually pays attention to CPT’s Category III codes, the AMA offers an answer with the release of the new codes included in CPT 2010.
First and foremost, CPT will delete the Category III cardiac computed tomography (CT) imaging codes 0144T-0151T and replace them with new, permanent Category I codes, as follows:
• 75571 — CT, heart, without contrast material, with quantitative evaluation of coronary calcium
• 75572 — CT, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)
We’re starting to learn what new CPT codes we’ll be using come January 1, 2010. Coding News will keep you posted over the coming weeks, along with analysis from coding experts around the country so that you know what to expect for your practice’s bottom line.
CPT 2010 has created over a dozen tumor excision codes that require you to designate the tumor size. For instance, code 21930 represents a tumor excision of the soft tissue of the back or flank measuring less than 3 cm, while 21931 describes the same tumor but 3 cm or greater.
“Until these codes, there has never been a way to express the depth of removing a tumor or tumorous mass except with modifier 22 (Unusual procedural services),” says Leslie Johnson, CPC, quality control auditor for Duke University Health System and owner of the billing and…
Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting 99213 based on time?
Answer: Yes, for CPT purposes, a certified nurse specialist billing under his own provider number counts the same as a nurse practitioner or physician assistant. So if the office visit meets the requirements for time-based billing — counseling and/or coordination of care comprises more than 50 percent of the face-to-face CNS-patient encounter and documentation indicates the encounter’s total face-to-face time, the counseling minutes, and a discussion summary — the CNS can choose the office level using time, such as 15 face-to-face minutes for 99213 (Office or other outpatient visit for the evaluation and management of an established patient …) as the sole criteria.
Be careful: Check your state law. State scope of practice laws may restrict services and procedures that nonphysician practitioners may…
Correctly billing your nonphysician practitioners (NPPs) incident-to services means the difference between 85 and 100 percent reimbursement. But if you bill incident-to haphazardly, you’re just waving a red flag at auditors.
And those auditors are jonesin’ to find incident to billing problems. Just check out this recent report from the HHS Office of Inspector General to learn the kinds of mistakes they’re looking for.
But have no fear. If you use the following list of questions to evaluate your incident-to claims for all the must-have components, and be sure the documentation includes the same, you’ll have nothing to worry about if auditors come knocking.
1. Do the Services Involve Direct Supervision?
Direct means that the supervising physician must be in the immediate office suite while incident-to services are being provided. But if…
Question: During a practice meeting last week, the subject of Clinical Laboratory Improvement Amendments (CLIA) waivers came up. We are currently not CLIA-waived, and we will discuss it again at next month’s meeting. I was wondering if you could offer any input? Should we apply for a CLIA waiver?
Answer: Whether or not the waiver is worth it is up to your individual practice. However, a practice is not allowed to perform many basic laboratory services without CLIA-waived status. So if your practice does not get the waiver, you could be missing out on possible pay for some simple screens.
Example: Here are a few of the tests that have CLIA-waived status to help you decide:
• 81002 — Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy
The OIG is watching your ultrasound orders and code combinations — and it doesn’t like what it sees. Take note of these problem spots to keep your claims in the clear.
An OIG audit of ultrasound services billed in 2007 found that nearly one in five ultrasound claims “had characteristics that raise concerns about whether the claims are appropriate,” according to a July 2009 audit report titled “Medicare Part B Billing for Ultrasound.”
The most common error: Roughly 17 percent of 2007 Part B ultrasound claims lacked prior service claims by the ordering physician, the OIG indicated.
What this means: Several physicians ordered ultrasounds for patients that they hadn’t treated within the last year. “The OIG would wonder why the doctor would order an ultrasound for a patient who [the ordering physician] hasn’t examined,” notes Allison Larro, Esq., an Atlanta-based attorney.
Question: My anesthesiologist performed a sciatic nerve block for a patient with postoperative pain on the same day he provided general anesthesia for that patient’s knee surgery. How should I code this?
Answer: Use modifier 59 (Distinct procedural service) when you need to show that your physician performed two distinct services on the same day. When your physician places a sciatic nerve block for postoperative pain management (for example, 64445, Injection, anesthetic agent; sciatic nerve, single), and on the same day provided general anesthesia for knee surgery (01400, Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified), your final codes are 64445-59 for the block, along with 01400 for the anesthesia.
AUDIO: Take the billing ache out of postoperative pain. With Joanne Mehmert, CPC, CCS-P.
The Office of Inspector General and Recovery Audit Contractors are out to audit non-compliant ultrasound claims, so knowing the rules is more important than ever. And we’ve got a link and a handy checklist to keep you out of trouble.
If you’re wondering when a radiologist can bill for a test without the treating physician’s order, we’ve got the link where CMS answers your question, plus a handy checklist.
Posted on 22. Oct, 2009 by in Hot Coding Topics.
You could be losing money to a computer glitch and not know it, experts say.
If you don’t nip a computer glitch in the bud, you may be plagued with improper denials and other claim holdups. Here are seven things you can do to seek out and solve glitch-related problems:
1. Eyeball Your EOBs
Watch your explanation of benefits (EOB) forms, and keep your eyes open for denials and downcodes that don’t look correct.
2. Check Your A/R
Always review your accounts receivable (A/R) to ensure that you’ve received the payments you’re due. If a computer glitch kept your MAC from paying you, don’t hesitate to point it out to the payer.
Turns out the old saying is true:If you haven’t done anything wrong, an OIGaudit is nothing to worry about.
A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG’s eye due to a “high volume of Medicare claims in comparison to other cardiologists throughout New York state,”according to the OIG’s report on the topic, which was released on Oct. 14.
The OIGreviewed the cardiologist’s records for the three-year period, but found that the physician, who specialized in non-invasive procedures, complied with Medicare reimbursement requirements. Therefore, the OIG made no recommendations and did not request any fund recovery from the physician.
What your practice can learn: If you have a physician who specializes in a particular condition or…