Coding Category
Fecal occult blood testing (FOBT) detects the presence of trace amounts of blood in stool. Most payers will cover this service, but keep in mind there is a distinction between screening and diagnostic FOBT.
Only two tests qualify as screenings: The first of these is the guaiac test (82270 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening [ie, patient was provided 3 cards or single triple card for consecutive collection]). For this test, the patient is given cards and collects the specimen. You will report 82270 when the patient returns the cards.
The second type of screening FOBT is the immunoassay test. This test is reported differently for private and Medicare payers. For payers who follow CPT® guidelines, report 82274 Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations.
Per Medicare National Coverage Determination (NCD) rules for Medicare beneficiaries, “When testing is done for the purpose of screening for colorectal cancer in the absence of signs, symptoms, conditions, or complaints associated with gastrointestinal blood loss,” you should report G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous determinations (immunoassay-based, fecal-occult blood tests).
Medicare will allow either one covered guaiac-based or one covered immunoassay-based screening FOBT (but not both) during a 12-month period for beneficiaries age 50 or older.
Screening FOBTs are also covered for Medicare beneficiaries residing at skilled nursing facilities. The FOBT is reported once for the testing of up to three separate specimens (comprising either one or two tests, per specimen). Medicare requires that the patient—not the physician—must collect the sample.
The immunoassay is a Clinical Laboratory Improvement Amendments (CLIA) waved test, and should be reported with modifier QW CLIA waived test appended. For payers who follow CPT® rules, report 82274-QW; for Medicare payers, report G0328-QW.
If a patient presents to the office with symptoms, report a diagnostic (rather than a screening) FOBT with 82272 Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening.
May 22nd, 2013
Medicare rules for coding colonoscopy differ from American Medical Association (AMA) rules, particularly with regard to “incomplete” colonoscopies. For a better explanation of the differences, AAPC’s Managing Editor G. John Verhovshek, MA, CPC, recently published an article through the California Medical Association.
“Some non-Medicare payers may follow CMS guidelines for an incomplete colonoscopy (modifier 53), while others may adhere to CPT® instructions (modifier 52),” he says. “Check with your third-party payers for their recommendations.”
Read the full article.
May 10th, 2013
Thoracentesis is a puncture made between the ribs into the pleural cavity to aspirate or remove accumulated fluid (pleural effusion) from the chest cavity. A needle attached to a syringe is introduced through the skin and chest wall until it penetrates the pleura.
For 2013, CPT® deleted 32421 and 32422, previously used to describe thoracentesis, and replaced them with two new codes:
● 32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance
● 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance
The deleted codes previously allowed for separate reporting of image guidance (e.g., 76942, 77002, 77012), when performed. The new codes require that you report the procedure based on whether it is performed with imaging guidance.
Report 32554 when imaging guidance is not used; and report 32555 when the thoracentesis is performed with imaging guidance. CPT® includes a parenthetical note instructing you not to report imaging guidance separately with either 32554 or 32555. Imaging guidance includes any combination of fluoroscopy ultrasound, computed tomography, or magnetic resonance imaging.
Codes 32554 and 32555 describe chest drainage by a needle or catheter that is removed at the end of the procedure. New codes 32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance and 32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance were created to report the percutaneous drainage of pleural fluid. Unlike thoracentesis, a tube or catheter is left in place to allow for continuous drainage. Once again, proper code assignment is determined based on whether the provider uses imaging guidance. Do not report imaging guidance separately when assigning 32556 or 32557.
Code 32551 Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure) represents open placement of a chest tube (e.g., for empyema, traumatic hemothorax, or pneumothorax), which always is done without imaging guidance.
The exception: Code 32550 Insertion of indwelling tunneled pleural catheter with cuff describes tunneled chest tube placement. Imaging guidance can be reported separately when this is performed. When imaging guidance has been provided, report 75989 Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation.
May 7th, 2013
Documentation is more important than ever. Barbara Aubry, RN, CPC, CHCQM, FAIHCQ, recently authored an article for Advance for Health Information Professionals, in which she tracks healthcare industry movements from a regulatory perspective. In the article Ms. Aubry specifically analyzes actions recently taken by the Office of Inspector General (OIG) and the OIG’s studies of evaluation and management (E/M) code use.
“[The OIG has] identified 1,700 individual physicians who consistently bill higher-level E/M codes,” she notes. “If you have any concern about your practice’s E/M coding or your hospital’s E/M coding, it’s time to take action.”
Read the full article.
May 2nd, 2013
By Delly Parham, CPC
Using locum tenens physicians to fill in for regular physicians may cost your practice instead of helping it if you don’t understand how to bill for their services. To ensure you get paid and stay in compliance, you must adhere to Medicare and commercial payer guidelines.
Practices usually use locum tenens (Latin for “lieutenant”) physicians when the regular physician is absent because of vacation, illness, childbirth, business, education, active duty, or having left the practice. The advantages of hiring a locum tenens physician versus using a physician in the same practice or in the same area are that it:
- Retains the regular physician’s existing patients
- Introduces new patients to the practice
- Maintains the patient level
- Keeps revenue with the regular physician
Most practices using the services of a locum tenens go through a recruiting agency, such as Comp Health. These companies handle the licensing requirements, professional liability insurance, and screening of the locum tenens, taking the liability and burden off practices. The practice or group pays the recruiting agency, and the agency pays the locum tenens physician. If your practice chooses to hire the locum tenens directly, you must:
- Check your state licensing laws for licensing requirements. Most – if not all – states require physicians to be licensed in that state.
- Check with your professional liability insurance carrier.
- Make sure the locum tenens is in good standing and get his or her professional liability insurance certificate, verifying it covers the services the locum tenens will be performing for the regular physician.
Whether you use a recruiting agency or hire the locum tenens physician directly, the practice must:
- Train staff with information about locum tenens physician to retain patients with the regular physician and give them incentive to see locum tenens without fear, for example:
- The locum tenens is temporary and will only see them once or for a short period of time.
- The locum tenens’ experience and expertise as a physician.
The period for which a single locum tenens physician may substitute cannot be more than 60 continuous days. The 60-day period begins the first day the locum tenens physician provides services for Medicare patients of the regular physician. An exception to this 60-day rule is for regular physicians who are called to active duty in the armed forces. The time is unlimited. See Social Security Act at section 1842(b)(6)(D.)
The regular physician:
- Must schedule appointments under his or her schedule.
- Is the only physician who can break the locum tenens’ 60-day period.
- May re-set the 60-day period by returning to practice and see patients only one day after the initial 60-days and use the same locum tenens.
- Must bill for the services of the locum tenens.
- Must put his or her National Provider Identification (NPI) number on all filed claims.
- May use more than one locum tenens to substitute for absences during the 60-day period.
- May reimburse the locum tenens a fixed amount per diem or similar fee for time.
- Must keep a record of each service furnished by the locum tenens physician and the NPI.
A locum tenens physician:
- Fills in for the regular physician for 60 continuous calendar days.
- Can substitute only if the regular physician is absent for any of the reasons above.
- Cannot substitute more than 60 continuous calendar days, unless there is a break in the 60-day by the regular physician.
- Cannot re-set the 60-day clock by taking a day off.
- Generally does not have a practice of his or her own and moves from area to area as needed.
- Is usually an independent contractor of the regular physician or group rather than an employee.
- Does not have to be enrolled in the Medicare program to see Medicare patients
- Cannot be a non-physician practitioner (e.g., NPs, CRNAs, PAs).
- Cannot bill Medicare for services within the 60-day continuous period in his or her name or NPI.
The regular physician bills and receives payment from Medicare and other payers who follow Medicare’s guidelines for the locum tenens physician’s services as though the regular physician performs the services. The regular physician must put the regular physician NPI in box 24J and his or her name in box 31 of CMS 1500 and the regular physician or group name and NPI in box 33 of the CMS 1500. Other Medicare rules include:
- Use the name and NPI of the regular physician or group.
- Use modifier Q6 after the procedure code (Q6 identifies services by locum tenens physician).
- If the only service a locum tenens physician performs is post-operative for an operation within a global period, it cannot be billed with Q6 modifier because the regular physician is paid a global fee, and it’s not necessary to include the service on the claim.
- If a regular physician requires the locum tenens physician to provide services for longer than 60 continuous days without a break, the locum tenens physician must enroll with the practice.
Other payers have different rules. TRICARE requires that non-contracted locum tenens physicians complete a certificate or other document to be linked to the regular physician or group tax identification number. Some Medicaid programs (e.g., Florida Medicaid) require the locum tenens physician bill under his or her own name and NPI. Blue Cross Blue Shield adheres to the guidelines of Section 125b of the Social Security Act. (BCBS Manual for Physicians and Providers, May 2010).
Source:
Medicare Claims Processing Manual, chapter 1, section 30:2.11
April 19th, 2013
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