Don’t look for a raise just yet, in most cases.
CMS may talk, but MACs don’t always listen — at least not quickly.
As we told you in last week’s Insider, CMS recently corrected several “technical errors” published in the 2010 Fee Schedu…
RACs are just another tool in the government’s arsenal to collect improper payments.
You’ve got so many compliance acronyms flying at you every day that you may not be able to differentiate your RAC from the OIG. Know these quick facts about RACs to stay better informed.
For more on the RAC program, visit www.cms.gov/rac.
@ Part B Insider. Editor: Torrey Kim, CPC
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Plus: The OIG recovered over $1.5 billion in fiscal year 2009, and is on the lookout to collect more.
With less than two weeks to go before Medicare payments once again threaten to decrease by 21 percent, a new report sheds light on the financial outcome of Congressional actions.
Although the 2010 Physician Fee Schedule originally included a conversion factor that would have been 21 percent lower than the 2009 level, practices haven’t felt that cut yet this year,because legislators have voted several times to freeze payments, which now use the conversion factor of $36.0791. That freeze will expire on May 31, after which your Medicare payments will drop considerably unless Congress steps in once more.
However, one government entity’s calculations show that the freeze is costly. According to a May 7 Congressional Budget Office report, freezing payments at the current levels for the rest of 2010 would cost the government… … $6.5 billion. The AMA has turned up the heat on Congress to replace the current payment method, releasing a print ad aimed at Congress to demonstrate that “more delays of permanent reform now increase the cost for taxpayers,” and that the association “calls on Congress to fix the flawed Medicare physician payment formula now.”
Congress has not yet introduced a bill to extend the payment freeze past May 31. Keep an eye on the Insider for more information as this story develops.
To read the Congressional Budget Office’s calculation sheet,visit www.cbo.gov/budget/factsheets/2010b/SGR-menu.pdf.
@ Part B Insider. Editor: Torrey Kim, CPC
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You have two options depending on how the physician performed the procedure.
Question: Our orthopedist administered a hip injection under fluoroscopy. Can I report both codes?
Wyoming Subscriber
Answer: You can code both the injection and fluoroscopy, but the correct choices depend on how your physician completed the procedure.
Option 1: If your orthopedist injected radiopaque dye and performed the arthrography concurrently, code the procedure with 27093 (Injection procedure for hip arthrography; without anesthesia).
Option 2: If he completed the guidance and injection as separate procedures, submit 20610 (Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) for the injection. Include 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) for the fluoroscopic guidance.
Remember to append modifier 26 (Professional component) to 77002 because your physician performed the service but doesn’t own the fluoroscopy equipment.
SI change: If the physician injects the sacroiliac joint instead of the hip joint, choose either 20610 (Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) or 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid).
@ Orthopedic Coding Alert. Editor: Leigh DeLozier, CPC
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Whether liver neoplasm is primary or secondary will change your coding.
Good news: You can apply many of the same rules you already know for intravenous chemotherapy coding to intra-arterial coding, too. So take your chemo coding expertise to the next level by adding intra-arterial skills to your arsenal.
Start here: For intra-arterial (IA) chemotherapy, you should choose from the following codes, says Gwen Davis, CPC, associate with Washington-based Derry, Nolan, and Associates.
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If you have a question, be sure to ask your physician.
Question: A patient reports to the ER at 8 a.m. on a Sunday morning. He reports a horrible toothache that started on Friday; he says he planned to “tough it out” over the weekend and see his dentist Monday, but the pain was too severe; he reports 10 on a 10-point pain scale. The ER physician performs an “inf. Aveo block,” according to the notes. What condition do the notes reflect, and how should I code this scenario?
Massachusetts Subscriber
Answer: You should double-check with the physician before filing…
You’ll turn to a V code when your neurologist reports ‘no effects,’ however.
When your neurologist sees a patient who had a stroke, either recently or in the distant past, he may record a number of different conditions — which makes your job more difficult. If you remember a few guidelines, you’ll select the proper ICD-9 codes for every cerebrovascular accident (CVA) case your neurologist treats.
Get Specific With 2 CVA Diagnosis Codes
When your neurologist sees a patient who has had a stroke, or CVA, he may document multiple deficiencies, both new and lingering. When the patient presents with…
Plus: Look for an increase in your DEXA scan reimbursement.
The bad news: Your carrier won’t be paying your claims using the conversion factor of $36.0846 anymore.
The good news: CMS is only changing the conversion factor by less than a penny, making it $36.0791, according to CMS Transmittal 700, issued on May 10. MACs will use this 2010 conversion factor to calculate your payments, but keep in mind that after May 31, you’re still due to face a 21 percent pay cut unless Congress intervenes. Keep an eye on the Insider for more information on whether Congress steps in…
If 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…
Don’t be caught asleep: Patient history is one element of proper Dx coding.
Many coders hesitate to report V codes, or simply use them incorrectly, but sometimes this section of ICD-9 most accurately describes the reason for the patient’s condition….