Medicare audits have revealed recurring errors in billing with add-on and place-of-service codes. In addition, Medicare continues to receive claims that appear to be duplicate because they lack an appropriate modifier. Here are some guidelines for correct billing.
As patients, we don't have the thousands of dollars it costs to tap into the extensive database information required for the entire body of CPT codes. But the AMA does offer us an easy way to look up one code at a time, for free.
Providers, suppliers, billing companies and clearinghouses can submit ICD-10 acknowledgement test claims anytime up to the new planned October 1, 2015 ICD-10 implementation date. However, the Centers for Medicare and…
Information regarding the ICD-10 delay continues to trickle out of the Centers for Medicare and Medicaid Services. CMS has announced that the partial code freeze for ICD-9-CM and ICD-10 will…
Health Revenue Assurance Holdings Inc. (otcqb:HRAA) ("HRAA") a leading provider of revenue integrity solutions for healthcare provider organizations, announced its response to the one year compliance deadline delay for converting…
The American Physical Therapy Association (APTA) reports that due to the magnitude of proposed changes to an entire family of physical medicine and rehabilitation codes, the editorial panel of the…
The new ICD-10 acupuncture insurance billing diagnosis codes are mandatory beginning October 2014. Here is a list of easy ICD-10 codes for insurance billing and reimbursement. This system is very…
The Center for Medicare and Medicaid Services (CMS) has proposed switching wound care reimbursement from the current pay-for-service model, in which the treating physician bills the government based on the…
The numbers are in! According to the American Medical Association (AMA), there will be 329 total code changes in 2014, to include 175 new codes, 107 revised codes, and 47…
Before 2011, hospitalists had only Centers for Medicare & Medicaid Services’ (CMS) specialty-specific CPT distribution data, and no hospitalist-specific data, available when looking for benchmarks against which to compare their…
Bill all three or get a denial: supply, injection, and illumination. Coding for photodynamic therapy (PDT) involves three key components, which means you should look into multiple CPT® codes to describe your claim appropriately. But this could jeopard...
Reporting modifier 78 for a staged procedure? Expect denials.
When it comes to appending CPT® modifiers to your codes, the rules can be daunting, and Medicare’s regulations only compound the confusion. But if you’re up to speed on these key modifier billing practices, you’ll be raking in deserved pay.
Check out the following five tips to ensure that you aren’t missing any opportunities.
1. Don’t Avoid Modifier 26.
If your physician provides an interpretation and report for an x-ray or other radiological service in the treatment of a patient, that’s not always just part of his E/M—in some cases, you can separately bill for the interpretation and report by appending modifier 26 (Professional component) to the CPT® code.
Typically, the technologist that performed the patient’s x-ray will bill the code — such as 71010 (Radiologic examination, chest; single view, frontal) — with modifier TC (Technical component) to indicate that he is billing for the equipment, room charge, film and radiologic technician, but not for the physician’s interpretation. If the physician who renders the interpretation is with a separate professional group and is not a hospital employee, you should report the service with modifier 26 to obtain his proper share of the reimbursement.
2. Know the Difference Between Modifiers 58 and 78.
Because both modifier 58 and 78 describe procedures performed during another surgery’s global period, it can be easy to confuse them. But differentiating between the two can mean the difference between collecting your due and filing endless appeals.
Key: You’ll report modifier 78 (Unplanned return to the operating room for a related procedure during the postoperative period) when conditions arising from the initial surgery (complications) rather than the patient’s condition...
Get the lowdown on when to code separately for fluoroscopy.
If your physician performs interventional pain management (IPM) services, you’ll need to be up to speed on four top IPM procedures to make sure you’re earning full deserved reimbursement for your claims.
Difference: Pain management specialists are physicians who study pain and perform less invasive injections (soft tissue, peripheral nerve, and joint injections) and medication management to help relieve patients’ pain. One common pain management procedure is trigger point injection (20552, Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) or 20553, single or multiple trigger point[s], 3 or more muscle[s]). An interventional pain management specialist’s scope includes spinal diagnostic and therapeutic procedures and other invasive techniques like nerve stimulator or opioid pump insertion, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. When submitting claims, you’ll use specialty designation 72 for pain management or 09 for interventional pain management.
Learn the Most Common Injections
All injections are not created equal – and they’re not coded the same. Here’s your guide to four types of treatments that commonly fall under the IPM umbrella.
Facet injections: CPT® includes a range of codes describing the various sites and levels associated with paravertebral facet joint and facet joint nerve injections. You’ll find these in code family 64490-64495 (Injection(s), diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT]). If your physician uses ultrasound guidance during the injection procedure, turn to the Category III code section of CPT® instead. There you’ll find codes 0216T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance). You’ll choose the appropriate code based on the anatomic injection site...
Until now, you could not code for the additional service — and hence not get the pay — when your general surgeon placed interstitial devices for radiation therapy guidance during a distinct open or laparoscopic abdominal procedure. But two new CPT 2011 codes for the procedure help you capture all the pay you deserve.
Open, Lap, or Percutaneous Approach Distinguish Placement
Last year, you had one code to use when your surgeon placed an abdominal interstitial device for radiation therapy guidance — 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic [except prostate], and/or retroperitoneum, single or multiple).
“If your surgeon performed the device placement during an open or laparoscopic procedure prior to 2011, you had no way to capture the service,” says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.
Now CPT 2011 adds two new add-on codes to describe interstitial device placement during another procedure, as follows:
Choose +49327 for a laparoscopic approach, and +49412 for an open procedure. “Note that these are add-on codes, which means you can report them only in addition to a primary procedure,” Bucknam advises.
Continue to report 49411 for percutaneous interstitial device placement as a stand-alone procedure.
Use codes 49411, +49412, and +49327...
Many of the new code pair additions involve CPT codes that debuted on Jan. 1, with CCI now halting payment if you report certain procedures together.
For instance, you’ll find vaccine administration codes 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid])and 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) bundled into new vaccine administration code 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component), and no modifier can separate these edits. This edit prevents mixing and matching the new immunization administration codes with the old, established immunization administration codes when delivering multiple vaccines at the same visit.
In addition, CCI bundles the new subsequent observation care codes 99224-99226 into inpatient neonatal and pediatric critical care codes 99468-99476.
CCI Has Good News on the Modifier Front
Not all news coming out of the new edition of CCI is bad. Effective Jan. 1, you’ll be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the newly-revised debridement codes 11042-11044. In the past, if your pediatrician performed both procedures on the same date of service, you could not collect for both no matter what, but now you will be able to if your documentation demonstrates the separate and distinct nature of the services and you append the appropriate modifier.
Swapped pairs: In addition, CCI did an about-face on several edits this round. In the past, if you reported 94660 (Continuous positive airway pressure ventilation) or 94662 (Continuous negative pressure ventilation) with an outpatient E/M code (99201-99215), CCI would reimburse you for the pressure ventilation and deny
...
Capture additional pay by separating wound care management codes 97597-97602 from the newly revised debridement codes.
Every year, just when you’re trying to get used to new CPT codes, the Correct Coding Initiative (CCI) comes along and limits how and when you can use the new codes you’ve been given. This year is no exception with CCI 17.0 adding edits involving new Renessa and posterior tibial neurostimulator (PTNS) codes, among others.
The CCI released version 17.0, revealing 19,822 new active pairs and 9,778 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in a Dec. 14 announcement.
Many of the new code pair additions involve CPT codes that debuted on Jan. 1, 2011 with CCI getting ready to halt payment if you report certain procedures together. Get a grip on the new bundles with this urology-focused rundown.
CPT 2011 deleted Category III code 0193T (Transurethral, radiofrequency microremodeling of the female bladder neck and proximal urethra for stress urinary incontinence), replacing it with a new Category I code 53860 with the same descriptor. CCI targets 53860 with several edits.
When your urologist performs the Renessa procedure, you’ll report 53860, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.
As of Jan. 1, when 53860 became an active code, CCI 17.0 created edit pairs with the following column 2 codes that Medicare considers usual and necessary parts of any surgery:
“In general CPT code 53680 would include catheter placement for temporary postoperative urinary drainage at the conclusion of the procedure, and therefore, these latter...