Effective Nov. 6, physicians separately can report implantable tissue markers (HCPCS Level II A4648 Tissue marker, implantable, any type, each) and implantable radiation dosimeters (A4650 Implantable radiation dosimeter, each) in Medicare Part B claims.

To receive payment for these miscellaneous supplies, codes A4648 and A4650 must be billed in conjunction with one of the following CPT^® codes:

19499 Unlisted procedure, breast

32553 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous intra-thoracic, single or multiple

49411 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple

55876 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

If one of the above CPT® codes is not paid on the same claim (or in history) with the same date of service, payment will be denied.

No policy change has been made for hospitals paid under the Outpatient Prospective Payment System (OPPS), Inpatient Prospective Payment System (IPPS), or ambulatory surgical centers (ASCs) paid under the ASC Payment System. Current Medicare policy continues to instruct Medicare contractors not to separately reimburse claims for HCPCS Level II codes A4648 or A4650 to hospitals and ASCs paid under these payment systems.

Refer to the Centers for Medicare & Medicaid Services (CMS) Transmittal 745, Change Request (CR) 6968, issued Aug. 6, for further clarification of this physician payment policy in Pub. 100-20 of the Medicare Claims Processing Manual.

Effective Jan. 1, 2011, the Centers for Medicare & Medicaid Services (CMS) will establish durable medical equipment prosthesis, orthotics and supplies (DMEPOS) specialty code B5 for ocularists.

The American Society of Ocularists defines an ocularist as a “carefully trained technician skilled in the arts of fitting, shaping, and painting ocular prostheses.” In addition to creating ocular prostheses, the ocularist shows the patient how to handle and care for them, and provides long-term care through periodic examinations.

Patients who need to be referred to an ocularist usually fall into the following categories:

• Recent enucleation/evisceration
• Problems with an existing prosthesis
• Blind eyes requiring a scleral shell
• Congenital anophthalmia/microphthalmia

Patients with existing ocular prostheses often need to be referred to the ocularist for problems with either the surface condition of the prosthesis or problems with the fit of the prosthetic eye or scleral shell.

Services provided by the ocularist include:

• Cleaning
• Polishing
• Enlargement
• Reduction
• Replacement

Due to the requirements of most insurance policies, a written prescription from the referring physician or other appropriate eye care specialist often is required.

TrailBlazer Health has launched a new online tool designed to help providers determine how multiple services of the same code should be submitted to Medicare Part B.

The Multiple Services of the Same Code Interactive Decision Tree tool gives providers the billing instructions and information they need to make the appropriate decision for when modifier 76 Repeat procedure or service by same physician may be used and how to bill bilateral procedures.

The provider simply selects the answer that applies to the claim in question. Either a new question or instructions automatically displays based on the answer to the question. Also based on the answers to questions, the provider may be led to the Modifier Code Search tool, which provides descriptions and guidelines for commonly used modifiers used in Medicare claims filing.

By G. John Verhovshek, MA, CPC

Certain circumstances call for practices to discard unused portions of drugs. For instance, Botox® (onabotulinumtoxin A) currently has a shelf life of only four hours when reconstituted. If the entire vial isn’t used within that time, the only option is to discard the remaining supply.

This waste is not necessarily money down the (proverbial) drain, however. You may report drug waste for those drugs the billing entity paid for and provides. For example, you wouldn’t bill waste for provider-administered drugs the patient purchased from a pharmacy. Nor would you report waste for drugs supplied by a facility. Read more »

From 2006 to 2008, Medicare erroneously allowed millions of dollars for routine maintenance and servicing and repairs of capped rental durable medical equipment (DME), and supplier practices adversely affected some beneficiaries with high-cost repairs, according to an Office of Inspector General (OIG) report released this month.

Read more »

Beginning with the April 2010 update, the Centers for Medicare & Medicaid Services (CMS) now posts the National Correct Coding Initiative (NCCI) Edit files in Microsoft Excel 2007 and in text formats. Because Excel 2007 can support a larger number of rows, each code range is contained in one file as opposed to multiple files.

This should correct the incompatibility issues that some users experienced last quarter with the Excel 2003 files. Please be aware that Excel 2003 and earlier versions of the software have a maximum row count of 65,536. Some of the NCCI Edit files exceed the maximum row count. If you do not have Excel 2007, you should use the text format to import the data into an application that can support larger files.

More information on NCCI edits and download files are on the CMS website.

Source: NHIC, Corp. July 2010 J14 A/B MAC Resource

The Centers for Medicare & Medicaid Services released July 23 the October quarterly update for the 2010 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule.

As part of this update, the Alaska and Hawaii fee schedule amounts for HCPCS Level II code E0973 Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each are being revised to correct errors made in the calculation of the fee schedule amounts. Contractors are instructed to adjust previously processed claims for code E0973 with service dates on or after Jan. 1, if they are resubmitted as adjustments.

Also included in the October quarterly update, per Transmittal 686 (Change Request (CR) 6743), the claims filing jurisdiction for HCPCS Level II code L8509 Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type is changing from DME Medicare administrative contractors (MACs) to Parts A/B MACs/Part B carriers, effective Oct. 1.

Source: CMS Transmittal 2006, CR 7070, issued July 23

Practitioners, medical groups and clinics, and independent diagnostic testing facilities (IDTFs)—or any eligible professional who has billed for the technical component (TC) of a CPT® advanced diagnostic code in the past six months, for that matter—can expect to receive the first of five letters from a Medicare contractor by Aug. 13. The letter is a reminder that they must be accredited by Jan. 1, 2012 to continue furnishing advanced diagnostic imaging services to Medicare beneficiaries.

Advanced diagnostic imaging includes magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET).

The Centers for Medicare & Medicaid Services (CMS) states in the letter: “Since we expect it can take up to nine months from the time you initiate the accreditation process to completion, we urge you to begin the accreditation process for advanced diagnostic imaging services as soon as possible.”

CMS approved three national accreditation organizations—the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission—to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation requirement applies only to the suppliers of the images themselves, and not to the physicians interpreting the images.

CMS July 9 Transmittal 727 replaces July 2 Transmittal 726 to change the implementation date and July 2010 reporting requirements so contractors have sufficient time to mail this first round of the notification letter to affected providers. Standard X-ray code 72200 Radiologic examination, sacroiliac joints; less than three views has been removed from the list of CPT® codes because it isn’t considered an advanced diagnostic imaging service.

Other diagnostic imaging types excluded from this accreditation requirement include ultrasound, fluoroscopy, and mammography.

A notice with comment period the Centers for Medicare & Medicaid Services (CMS) published July 22 in the Federal Register updates the 2011 Skilled Nursing Facility Prospective Payment System (SNF PPS) and delays implementation of a Patient Protection and Affordable Care Act provision.

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An Office of Inspector General (OIG) review of jurisdiction C Medicare payments for selected Durable Medical Equipment, Prosthetics and Supply (DMEPOS) claims submitted in 2007 found that modifier KX Specific required documentation on file was not effective in ensuring required supporting documentation was on file. Based on the June 2010 review, the OIG estimates that Palmetto Government Benefits Administrators (Palmetto GBA) and CIGNA Government Services (CGS) inappropriately paid approximately $137 million to suppliers.

For certain DMEPOS, suppliers must use modifier KX on filed Medicare claims to indicate the claims meet Medicare coverage criteria and that the suppliers have the required documentation on file.

The types of missing documentation included:

• proof of delivery,
• physician’s order,
• use or compliant use follow-up documentation, and
• physician’s statement.

The errors, according to the OIG report, occurred because Palmetto GBA’s and CGS’ electronic edits were ineffective. What’s more, CGS added modifier KX to claims at the request of suppliers who said they had erroneously failed to add it to their claims.