Cardiology / CCI / Hot Coding Topics / Provider News

CCI Edit: 93454-93461 Note These Column Changes For Correct Cardiology Coding

Correct Coding Initiative version 17.1 brings 11,831 new edit pairs, effective April 1 for physicians. That’s the word from a March 17 announcement by Frank Cohen, principal and senior analyst for the Frank Cohen Group. Here’s a look at the major pointers you need to keep in mind to comply with the new cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

1. Prevent Denials by Remembering 93454-93461 Are Diagnostic

New edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

  • 92975 — Thrombolysis coronary; by intracoronary infusion, including selective coronary angiography
  • 92980 — Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
  • 92982 — Percutaneous transluminal coronary balloon angioplasty; single vessel
  • 92995 — Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel.

The 929xx codes in column 1 describe coronary therapies. The 934xx codes in column 2 are diagnostic procedures. You should never use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.

Opportunity: The edits have a modifier indicator of 1, so you may override them with an appropriate modifier when the procedures are distinct. If you report both codes in the edit pair and don’t append a modifier to the column 2 code, Medicare (and payers applying Medicare rules) will reimburse you for only the column 1 code.

The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization in addition to the therapeutic procedures described by 92980 and 92982: “These two distinct procedures (diagnostic catheterization and therapeutic procedures), therefore, should...

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April 18, 2011
Hot Coding Topics / Provider News

Worried about Delayed Pay? Verify Your State’s Prompt Pay Laws

How many times has it happened with you that you submit a clean claim but still don’t get paid even three months later? Do you have any recourse? Yes, thanks to the prompt pay laws that each payer must follow when paying your medical claims.

Verify Which Laws Apply to Your Practice

Each state requires private insurers to pay all clean claims within a certain time frame. If the insurer does not pay the claim in a timely manner, then the payer is subject to paying interest on the charges owed to the practice (or directly to the beneficiary). Most time frames range from 15 to 45 working days, with 30 days about the average.

“If you are a little adventurous, you could search for your state law on the Internet,” says Joseph Lamm, office manager with Stark County Surgeons, Inc. in Massillon, Ohio. Lamm warns, however, that “reading through state laws and their multiple exceptions, references to other sections of state law, and ‘legalese’ can make this a very frustrating exercise.”

“Take advantage of your local or state medical society and the experts they employ to see if your state has a prompt pay law, and to which insurance companies it applies,” Lamm suggests. “The medical societies are on your side and will give you the correct information.”

State prompt pay laws do not apply to federal insurers, because the Federal Government dictates that clean claims must be paid in 30 days for Medicare Part B.

“If a state wants a prompt pay rule that’s longer or shorter, they certainly can do that with reference to other payer services,” says Connie A. Raffa, Esq., partner with Arent Fox, LLP in New York, NY. “But Medicare rules are federal and span across the country.”

If your private payer...

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April 16, 2011
Audit / Provider News

Auditors Review Your Notes Based on the Regs as of the Service Date

auditorIf you performed a consult in 2006, the auditor will use 2006 guidelines — not today’s rules.

Most Part B practices have grown accustomed to tucking consult regulations into the backs of their minds, since Medicare no longer pays for...

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May 12, 2010
Hot Coding Topics

Use Shared Visit to Capitalize on NPP/Physician Teamwork

Forget about incident-to in the facility, but consider this similar billing technique.

ED coders that have never heard of “incident-to” billing have nothing to worry about, as you cannot code for “incident-to” services in the hospital. Coders that don’t understand...

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March 25, 2010
Medicaid / Provider News

Payer Update: UHC Sticks With Consult Codes

Check with Medicaid plans, insurer warns. You can breathe a sigh of relief — one major payer will stick with 99241-99255. UnitedHealthcare (UHC) commercial plans will make no change in payment for consultation codes (99241-99255) at this time, according to a UHC e-mail alert. “Physicians may continue to submit claims for these services, and will be reimbursed according to United-Healthcare payment policies”. Beware: One Medicaid [...] Related articles:

  1. Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report...
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  3. Pssssssst. Payer Report Cards Are OutIf you know your payers’ strengths and weaknesses, you’re better...

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January 12, 2010