Correct Coding Initiative Changes
The Correct Coding Initiative version 7.3 that took effect October 1st has a total of 3,105 changes. 3,095 of these changes are comprehensive component edits and 10 are mutually exclusive code edits. The specialties most affected are anesthesiology, urology, and cardiovascular surgery.
In anesthesiology, the edits bundle many non-invasive monitoring procedures with anesthesia codes. Most of theses edits have the “0” indicator meaning a modifier will not override the edit.
The cardiovascular section has many new edits that have a “1” indicator meaning an appropriate modifier might override the edit. For example, cardiopulmonary bypass code 33031, 33020, 33251, 33261, 33305, and 33315 are comprehensive codes that include the component code of 35226 (repair of a blood vessel, other than fistula, lower extremity).
The urinary system includes multiple edits with a “0” modifier indicator. For example, transurethral resection of the prostate procedure codes includes manipulation procedures.
The male genital system has multiple comprehensive component edits. Many of these involve the cystourethroscopy procedures.
The nervous system also saw its share of edits, many of which have the “0” modifier indicator.
There are 10 new mutually exclusive code edits. Remember that mutually exclusive code edits involve codes that cannot be coded together. If they are, Medicare pays for the lesser of the two codes.
The Correct Coding Initiative is published four times a year. When the new version comes out each quarter, the old one is obsolete. This coding tool can be very helpful when coding for Medicare and other insurance carrier. This tool is a ‘must have’ for most offices.
Medicare Changes
Effective October 1, 2001, code 76977 for ultrasound bone density measurement will see about a 40% decrease in reimbursement for both the global and technical component when done in a physician’s office. This is due to a reduction in the Non-Facility Practice Expense RVU.
The globals for codes 11976, 15824, 15825, 15826, 15828, 15829, 15876, 15877, 15879, 17380, 33960, 36468, 36469, 41820, 41821, 41850, and 41870 have been set to 000 days. This means that an Evaluation and Management service provided on the same day usually isn’t payable.
Surgical codes 34800, 34802, 34804, 34808, 34812, 34813, 34820, 34825, 34826, 34830, 34831, 34832, 36870, 43231, 43232, 48554, and 48556 will be allowed co-surgeons of different specialties.
The bilateral payment of adjustment of 150% will not apply for bilateral surgery codes 73718 and 73719. Modifier –50 or listing the codes twice will not increase the reimbursement. Your reimbursement will be based on the fee for a single code.
Team surgeons will now be allowed for codes 48554 and 48556. Carriers will pay by report.
The standard multiple procedure adjustment (100% for the 1st procedure, 50% for the 2nd, 3rd, etc.) will now apply to code 17004 but not to 34826.
New HCPCS Modifiers!
Effective January 1, 2002, two new modifiers will be recognized by Medicare.
- GY – item or service statutorily excluded or does not meet the definition of Medicare benefits.
- GZ – item or service expected to be denied as not reasonable and necessary.
The modifiers will replace the –GX modifier.
Modifier GY is for items and services never covered by Medicare such as routine physicals and cosmetic surgery. You are only billing the service with this modifier to get a denial. Carriers will be allowed to automatically deny services submitted with this modifier.
Modifier GZ is for items and services you expect to be denied due to medical necessity, such as a screening test done more frequently than allowed or a non-covered ICD-9 used. Only use this modifier if no ABN was obtained. Carriers will be allowed to automatically deny items and services with this modifier.
As before, use modifier GA when submitting a claim for a service considered not medically necessary and you have obtained an ABN. Carriers will still have to process these claims.
Skilled Nursing Facility Vs. Nursing Facility… What is the Difference?
Are you confused about the different types of nursing facilities? Medicare says the differences between the two are slight. The benefit seems to be the key here. Skilled nursing facilities (Place of Service code 31) patient stays are paid by Medicare Part A. Nursing facilities (POS code 32) patient stays are paid by Part B.
The June 4th correction to Medicare Carriers Manual transmittal 1690 allow codes 99301-13 to be billed with POS 31, skilled nursing facility; 32, nursing facility; 54, intermediate care facility; or 56, psychiatric residential treatment facility.
Remember that Medicare pays for the SNF under Part A for a stay of up to 100 consecutive days. The time starts over when a patient is discharged. So what do you do after the 100th day and the patient is still there? CMS says change the POS from 31 to 32.
Customer Service
Customer service should be one of your top priorities. How would you rate your clinic when it comes to customer service? Are your patients being treated the same way you would want to be treated? We are not born with customer service skills. Your employees need to be trained on the proper and professional way to treat the patients coming to your clinic.
The Front Desk is the “Heartbeat” of the practice. The Front Desk employee could be the most important employee you have. This is the first person the patient hears when they call your office and the first person they see when they come to your office. First impressions are lasting impressions.
What type of training program do you have for the new employee in your office? Do you train the new employee how to speak to patients? What are the most common questions asked by your patients? Be sure your training program includes the answers to these questions.
Employees should always show good manners. Never let a patient see that you are having a bad day. In the medical clinic, there is no room for rudeness or bad moods. Never let a patient see that you are getting irritated with them. You are dealing with people all day long and most of the time they are not at their best. They might be sick, nervous, or anxious. They don’t feel in control of the situation and for most of us that is scary. The Front Desk employee should be able to put your patients at ease with the tone of her voice and her actions.
Watch how you sound over to phone. If you are irritated or distracted this really shows. Remember the patient can’t see you all they can do is hear you. How do you sound, DEAD or ALIVE? Do you sound pleasant? Do you sound willing to help the patient? Does your smile come shining through the telephone line?
Remember that patients are the reason you are in business. They are not an interruption to your day but the reason for your day.