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 »

On Jan. 3, 2011, the Centers for Medicare & Medicaid Services (CMS) intends to implement changes to the Medicare claims-processing system that would end a temporary provision that allows suppliers to use their own national provider identifiers (NPI) in the referring provider field. The Office of Inspector General (OIG) says in an April report the implementation date of these edits has been delayed twice already permitting a claims-processing vulnerability for nearly two years now.  Read more »

When your physician documents a service involving placement of interstitial devices for radiation therapy guidance, remember to look in the medical chart for any supplies that may have been used. In addition to the procedure code for implanting the device, your physician can also separately report the implantable tissue markers used to perform the service, according to the Centers for Medicare & Medicaid Services (CMS).

Implantable tissue markers are separately billable and payable when used in conjunction with CPT® 55876 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple.

An implantable tissue marker incorporates a contrast agent sealed within a chamber in a container formed from a solid material. The contrast agent is selected to produce a change, such as an increase, in signal intensity under magnetic resonance imaging (MRI). An additional contrast agent may also be sealed within the chamber to provide visibility under another imaging modality, such as computed tomographic (CT) imaging or ultrasound imaging.

Effective Feb. 26, 2010, Medicare will separately reimburse HCPCS Level II code A4648 Tissue marker, implantable, any type, when supplied on the same date as the procedure and reported on the same claim.

This policy, specified in Pub. 100-20 of the Medicare Claims Processing Manual, applies only to physicians paid under the Medicare Physician Fee Schedule (MPFS) payment system. No separate payment for HCPCS Level II A4648 will be made to hospitals, ambulatory surgical centers (ASCs) or other facilities paid under the Inpatient Prospective Payment System (IPPS) or Outpatient Prospective Payment System (OPPS)/ASC payment system.

CMS communicated this one-time notification in Transmittal 604, Change Request (CR) 6579 on Nov. 27.

TrailBlazer Health Enterprises issued a notice Nov. 20 reminding physicians that HCPCS Level II code J3420 Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg is non-covered as a self-administered drug effective for dates of service on or after Oct. 12, as indicated on the Self-Administered Drug Exclusions list.

When billing vitamin B-12 administered on dates of service prior to Oct. 12, Medicare is establishing dual-diagnosis limited coverage for J3420.

When administered for anemia in the treatment of cancer, J3420 requires the most recent hematocrit (HCT) and/or Hemoglobin (Hgb) reading on the claim. This applies to claims received on or after April 7, 2008, with dates of service on or after Jan. 1, 2008.

Primary ICD-9-CM codes covered for J3420 include 266.2, 281.0-281.1, 281.3, and V58.11. Codes 266.2 and 281.1 require a secondary diagnoses code, such as 123.4, 336.2, or 357.4. See the TrailBlazer notice for a complete list of secondary diagnoses codes.

Read the TrailBlazer notice for a list of covered ICD-9-CM codes.

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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If your practice can’t seem to successfully bill for the professional component lately, there could be a logical explanation. It could be something as simple as an incorrect modifier.

According to First Coast Service Options Inc. (FCSO), an excessive number of claims from providers are being denied because they request payment for the professional component using the wrong modifier with the CPT^® or HCPCS Level II code.

Prevent Delays and/or Denial

When billing for the professional component of a procedure, hospital outpatient departments, ambulatory surgical centers (ASCs), and other practitioners should properly identify the service by adding modifier 26 Professional component to the appropriate CPT^® or HCPCS Level II code — not the new modifier effective July 1,  PC Wrong surgery on patient.

Medicare automatically denies all lines related to an erroneous surgery with dates of service on or after Jan. 15, including claims for related hospitalizations.

Claims Appeal

FCSO advises providers appeal claims billed in error with modifier PC and subsequently denied for wrong surgery. Correcting and resubmitting these claims won’t work. Only an appeal will remove the edit logic that was installed for the beneficiary and date of service of the wrong surgery based on the initial claim.

The U.S. Food and Drug Administration (FDA) has approved Vasovist® (gadofosveset trisodium), a new injectable contrast imaging agent for use in patients undergoing magnetic resonance angiography (MRA).

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The 2009 Medicare Physician Fee Schedule (MPFS) final rule, published Nov. 19, 2008, produced a number of policy changes for health care professionals. Included in these changes is the payment amount for HCPCS Level II code Q3014 Telehealth originating site facility fee.

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A federal district court last month found Medicare and some of its contractors had unlawfully limited payments for DuoNeb, an inhalation drug used to treat chronic obstructive pulmonary disease, according to The New York Times. Read more »

Hospitals can add to their list of covered services new HCPCS Level II code C9899, Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage, that will be effective for services furnished on or after Jan. 1, 2009. Use form TOB-12X for claims of this nature.

This code was missing from an earlier Centers for Medicare & Medicaid Services (CMS) transmittal. Transmittal 1628, issued Nov. 3, rescinds transmittal 1597, issued Sept. 12. Read more »