ICD-10: ICD-10 Date Will Be Postponed, HHS Confirms   (February 2012)

Delay could offer practices additional time to prepare for new diagnosis coding system.Just three months ago, CMS representatives firmly told medical practices that the ICD-10 implementation date would not be pushed back beyond Oct. 1, 2013–but what a difference a few months makes.The Dept. of Health and Human Services (HHS) announced on Feb. 16 that the ICD-10 implementation date will indeed be postponed. The agency stated that it “will initiate a process to postpone the [...]

Part B Payment: Congress Reaches Tentative Deal to Avert 27 Percent Medicare Cut   (February 2012)

However, 10 month delay will only push payment formula problems to 2013.If you were biting your nails waiting for news about potential Medicare cuts coming your way on March 1, Congress offered good news and bad news by coming to an agreement just before legislators took a week-long recess, reports out of the Capitol indicate.The good news: Under the agreement (which as of press time had not been finalized), you won’t have to deal with [...]

Compliance: You May Soon Have Only 60 Days to Return Medicare Overpayments–Or You’ll Face Penalties   (February 2012)

New CMS proposal would impact all self-identified overpayments that your contractor sends to you.You’ve always known that it’s improper to hang on to money that belongs to the government–but until now, you haven’t had a strict deadline for returning it. Thanks to the Affordable Care Act, CMS was asked to institute a specific timeframe by which you must return overpayments to the Medicare program. A proposed rule outlining the new deadline process was published in [...]

Part B Coding Coach: Gynecology: Answer 3 Questions to Bolster Your Biopsy Coding Efficiency   (February 2012)

The number of biopsy units doesn’t always go by the number of samples.Are you sure you’re getting the reimbursement your ob-gyn deserves for biopsy procedures? Take this quiz and avoid the many pitfalls of biopsy coding and billing.Background: A biopsy is a tissue sample that the ob-gyn excises from the patient to ascertain the presence of cancer. Ob-gyns will most likely perform biopsies of the vulva, cervix, vagina, endometrium and ovary(s). Ob-gyns usually order a [...]

Physician Note: OIG Offered Practices Second Chance to Submit Required Records, But Most Didn’t Take It   (February 2012)

Plus: If you aren’t ready for 5010 yet, it’s time to kick your efforts into high gear.You have most likely heard the phrase “if it wasn’t documented, it wasn’t done” so many times that it’s old hat–and yet, insufficient documentation remains one of the biggest denial reasons among Medicare contractors. The OIG tried to improve upon that denial rate by offering practices a second chance to turn in required documentation–but the majority passed on the [...]

In other news   (February 2012)

The April 1 enforcement deadline for using 5010 claim standards is fast approaching. “To ensure a smooth upgrade prior to April, you will need to complete both phase I internal and phase II external testing of Version 5010 transactions,” CMS says in a message to providers. “As part of your external testing, you will need to conduct tests with outside trading partners, which include vendors, clearinghouses, billing services, and payers.”You should be collaborating with your [...]

Reader Question: Modifier 59 Isn’t the Only Answer to Bundling Issues   (February 2012)

Question: What advice can you offer for finding a particular code-pair when I am checking through CCI edits? How do I know which among the two is the column-1 code and the column-2 code? Answer: If you are not finding the code-pair in the Correct Coding Initiative (CCI) edit lists, then it can be assumed that the two codes are not bundled. In such a scenario, you will not require the use of a CCI [...]

Reader Question: Medicare Typically Won’t Reimburse You for Self-Administered Drugs   (February 2012)

Question: I do the coding and billing for a urologist who is under the impression that when a patient takes home medicine like testosterone and Glukor injections for erectile dysfunction we should bill the service with the place of service (POS) being the office because the patient came to the office to pick up the injections to administer at home. The patient has come to the office for the E/M service and a urinalysis, and [...]

Reader Question: Technical Clinical Lab Services Fall Under Separate Fee Schedule   (February 2012)

Question: Our laboratory billed the global charge for 84165, but then the pathologist, who is not employed by us, billed 84165-26. I’m concerned that the insurance company won’t pay us both. What’s the correct way to bill this service if our lab performs the test but a separate pathologist interprets it – should we use modifier TC?Answer: No, you should not use modifier TC (Technical component). The insurer should pay for the test the way it [...]

Reader Question: Differentiate Removal From Ablation   (February 2012)

Question: As part of a colonoscopy, the surgeon noted internal hemorrhoids, which he ablated using hot biopsy forceps, and a raised sessile diminutive polyp in the sigmoid colon. Which procedure code(s) should we use?Answer: The answer to your question depends on whether any of the diminutive polyp was removed for pathology analysis, and if so, by what method. If the surgeon used the hot biopsy forceps to ablate the hemorrhoids and take the polyp biopsy, [...]