Calculating Medicare Payments From RVUs and GPCIs   (July 2001)

By definition, geographic practice cost indices (GPCIs) differ from region to region. Here is an example of how a single-view chest x-ray would be calculated in Kentucky.
 
Procedure: A chest x-ray (71010-26), performed in a facility (hospital-based); transitional for 2001 (see chart)To calculate the actual fee schedule amount for a single view of the chest, multiple the GPCI-corrected total RVU by the national conversion factor of $38.2581. This reveals that the anticipated Medicare payment would equal [...]

Insert: Example of 2001 National Physician Fee Schedule Relative Value File   (July 2001)

CPT codes and descriptions are copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
 
To view this chart please open the PDF file.

Reader Question: Preventive and Problem-focused Coding   (July 2001)

Question: If an internist performs a complete physical exam (CPE) on a 35-year-old male patient and the patient also presents with a chief complaint of a painful right thumb, would this still be coded as the CPE since 50 percent of the exam was preventive?
 
Wisconsin Subscriber
 
Answer: If the main focus of the exam was preventive, coders can use 99385 (initial preventive medicine, 18-39 years). If a significant problem is found for the thumb and the [...]

Reader Question: Pelvic/Breast Exam Fees   (July 2001)

Question: The current Medicare fee schedule for Vermont allows only $28 for a gynecological checkup  less than what we receive for a focused 99212 visit. The allowed fee for a Pap smear is $27. What is Medicare paying for this exam (which usually takes about 30 minutes) in other states?
Vermont Subscriber 
 
Answer: The correct codes for a screening gynecological exam are G0101 for the pelvic/breast exam and Q0091 for obtaining and preparing the specimen. [...]

How to Use Diagnosis Codes to Support Hypertension, Diabetes and Anemia Claims   (June 2001)

So much attention is paid to CPT codes in regard to billing and reimbursement that it sometimes seems the ICD-9 codes are little more than numerical window dressing on a claim form. However, getting claims paid requires the skillful use of both coding systems.
Think of it this way: CPT codes describe what you do, and ICD-9 codes describe why you do it.
While the amount of money an internist is reimbursed is linked to a [...]

Reader Question: Swing-bed Status   (June 2001)

Question: A hospital inpatient is discharged to swing-bed status but remains in the hospital. Can I use the discharge code 99238 or 99239 and the admission code to swing bed on the same day? Is a modifier needed to report both codes on the same day? Some practices in the area have been using outpatient codes or skilled nursing home codes for swing bed. Which is correct?
Colorado Subscriber
Answer: A swing-bed floor is actually a [...]

Avoid Hospital Admission Coding Errors When Billing For Absent Internists   (June 2001)

There are two arrangements absent internists can make with other providers to get paid for inpatient services on-call billing and reciprocal billing. On-call billing refers to the coverage arrangements internists make within a group practice using a common tax identification number. Reciprocal billing refers to an agreement made with other internists with different tax identification numbers.
One billing dilemma faced by internists within a group practice occurs when two internists provide separate services to [...]

Reader Question: Copayments With Prothrombin Time   (June 2001)

Question: We have just started to bill for Prothrombin Time (PT) in our office for patients who are on Coumadin, and some of these patients must come in two to three times a week. How do I handle the issue of copayment for these patients when theyre being seen more than once a week?
New York Subscriber
Answer: According to Kathy Pride, CPC, CCS-P, coding supervisor at Martin Memorial Medical Group in Stuart, Fla., the issue of [...]

You Be the Coder: Lupron Injections   (June 2001)

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: We give 7.5 mg a month for four months to a patient with prostate cancer. What HCPCS code do I use for the Lupron injection?
Louisiana Subscriber

Answer: The two codes for Lupron are J9217 (leuprolide acetate [for depot suspension], 7.5 mg) and J1950 (injection, leuprolide acetate [for depot suspension], per 3.75 mg), according to Kathy [...]

Reader Question: Partial Dialysis Treatment   (June 2001)

Question: How does our office get paid for performing only a partial month of dialysis? We bill 90925 but Medicare continually denies it. Ive called them and have been given different answers.
Georgia Subscriber
Answer: The Georgia Medicare carriers manual says that 90925 (end stage renal disease [ESRD] related services [less than full month], per day; for patients twenty years of age and over) is correct for partial dialysis reporting, according to Mary Beth Black, senior associate [...]