Archive for the ‘Coding Tips’ Category

The Centers for Medicare & Medicaid Services (CMS) has made a few important changes to the National Coverage Determination (NCD) edit software for clinical diagnostic laboratory services worth noting. In particular, a change to the effective date of coverage for three NCD ICD-9-CM diagnosis code lists will allow clinics to recoup any lost payments due to erroneous denials.

The effective date for three NCDs was “inadvertently” changed from Oct. 1, 2007 to July 1, 2009 with the July 1 quarterly release. The January 2010 quarterly release of the edit module for clinical diagnostic laboratory services corrects this mistake.

The affected ICD-9 code lists are those in the following NCDs:

• Prothrombin Time (PT) (190.17)
• Serum Iron Studies (190.18)
• Gamma Glutamyl Transferase (190.32)

The effective date for the ICD-9 codes listed in these NCDs will be revised from July 1, 2009 to Oct. 1, 2007, effective Jan. 1, 2010.

The January 2010 quarterly update also relocates ICD-9 codes 453-50 – 453.52 from the Serum Iron Studies NCD to the Gamma Glutamyl Transferase NCD, effective Jan. 1, 2010.

Medicare instructs contractors in Transmittal 1847, issued Nov. 6, not to search their files to retroactively pay claims but to adjust claims brought to their attention. A provider education article is available on the CMS Web site, and includes a list of affected ICD-9 codes.

National Government Services (NGS) says Error Code (EC) 31 Services incorrectly coded denials have been increasing in relation to CPT® 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count.

“Review of the CERT data shows that the CERT contractor has been re-coding CPT 85025 to show the appropriate service rendered,” NGS writes in its November 2009 Medicare Monthly Review (MMR). So how should billing staff code this service?

NGS says, generally, CPT® 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) is more appropriate.

Correct coding: If the physician has ordered only a CBC (with no mention of a differential), the correct code is 85027.

To prevent EC 31 denials, providers should review the medical records and the physician order/requisition before performing and coding the service to make sure what is being done and billed matches the order.

Confused about the Evaluation and Management Consultation codes in CPT® 2010 (99241-99255)?  Didn’t Medicare just say that, save for HCPCS Level II codes for telehealth consultation, they were out the window? (See “2010 MPFS Final Rule Still Holds Surprises,” EdgeBlast No. 136.) So why are they in the official CPT® code book? Is it a mistake, and if not, does that mean commercial payers are reimbursing for them?

It’s no mistake, says Sheri Bernard, CPC, CPC-H, CPC-P, vice president, clinical coding communications, AAPC. “The codes remain in CPT® 2010 with expanded official guidelines that iden­tify scenarios that in the past would not have been consid­ered consultations,” according to Bernard. 

Check with payers to whom you report these codes to find out if they are reimbursing them and for what services specifically. Unfortunately, at this point no one really knows what all the payers will think of these codes now.

AAPC former NAB member Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, is asking colleagues to contact her with what payers in their states say they will accept come Jan. 1, 2010. She will compile the data into a spreadsheet and make it available via the AAPC Web site.

If you’d like to contribute information to this project, and help Cobuzzi clear the confusion with her grass-roots project, send what you’ve learned about payers in your area to her in an e-mail (b.cobuzzi@att.net).

National Heritage Insurance Company (NHIC) issued a notification update Oct. 14 to clarify its coding and utilization guidelines for certain male external catheters supplied to Medicare beneficiaries.

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Recovery Audit Contractors (RAC) HealthDataInsights (HDI) and CGI Federal have added to their list of new issues eligible for review as per the Centers for Medicare & Medicaid Services (CMS).

The RAC program, mandated by the Tax Relief and Health Care Act of 2006, is being implemented in 2010 to detect and correct past improper Medicare payments.

Tip: Don’t wait until Jan. 1, 2010 to review these new issues and correct any problems your outpatient hospital or physician practice may uncover. Read more »

If you’re confused about carrier rules for coding H1N1 vaccines, you’re not alone. Choosing H1N1 codes  in regard to Medicare and private insurance guidelines, and when to use a modifier can leave you dumbfounded. To answer your H1N1 questions, here’s the low-down on Medicare policies vs. private insurer policies.

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Want to increase the number of claims that successfully complete processing and enhance a positive cash flow? Heed Noridian Administrative Services’ (NAS) advice. The Medicare administrative contractor (B/MAC) has identified its top five denials for the months of July, August, and September and offers solutions and resources. Read more »

The Fistula First Breakthrough Initiative (FFBI) has released a strategic plan for achieving the Center for Medicare & Medicaid Services’ (CMS) goal that two-thirds (66 percent) of prevalent hemodialysis patients will use an arteriovenous (AV) fistula as their primary method of vascular access. Read more »

The American Academy of Dermatology (AAD)  provides advice to avoid filing duplicate claims, which it says occurs in 6 percent of Medicare claim reporting. The common sense document includes the following tips, which help save Medicare and your practice money.

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According to the Centers for Medicare & Medicaid Services (CMS), billing staff often do not know where their physicians performed certain services, such as diagnostic test interpretations. Either that or they simply do not understand place of service (POS) codes enough to make informed decisions.

“The use of office or POS code 11 in certain situations has been problematic,” CMS says in a recent transmittal. Read more »