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2014 CCI policy manual: Review how to bill modifier 59, post-op E/M visits and drug tests

March 06, 2014 - By Julia Kyles and Laura Evans
Carefully evaluate your use of modifier 59 (Distinct procedural service) for services that would otherwise be inclusive when billed on the same patient for the same date of service now that Medicare has made changes to Chapter 1 of the 2014 National Correct Coding Initiative (CCI).  ... Read More

You may be able to bill for both biopsy and lesion destruction

March 06, 2014 - By Laura Evans
Question: A dermatologist performs a biopsy (11100) on a patient with a lesion and subsequently also performs a destruction of the lesion. The destruction code (17261) has a higher reimbursement and RVUs than the biopsy code. However, the doctor doesn’t want to bill for the destruction ev... Read More

When coding HIV in ICD-10, follow the same rules with different codes

March 06, 2014 - By Laura Evans
For your patients with human immunodeficiency virus (HIV), you’ll need to adjust only to new diagnosis codes — the coding rules you’ll have to follow in ICD-10 are effectively identical to those in ICD-9.  For example, in ICD-10, you’ll still need to know whether a pati... Read More

PQRS 2014: Your EPs can use individual reporting to meet value-based modifier rules

February 20, 2014 - By Karen Long
Now that Medicare has extended its value-based payment modifier policy to practices with 10 or more eligible professionals (EPs), practices can explore how their EPs can use this policy to take advantage of a 2% incentive bonus. You may be eligible for the payment if at least half of your EPs meet p... Read More

Report the date the physician interpreted when billing test professional component

February 20, 2014 - By Laura Evans
Question: CMS so far has allowed the local Medicare administrative contractors (MACs) to set their own policies for the date of service of the professional component of diagnostic tests. Our MAC is requiring us to use the date the physician interprets the test. This creates problems for us some... Read More

Code scenario: Report UTI and cause of infection if known in both ICD-9 and ICD-10

February 20, 2014 - By Laura Evans
A patient presents with a known urinary tract infection (UTI) that tests previously had traced to E. coli. The good news for this common diagnosis is that in ICD-10, you’ll have a near one-to-one match for both the codes and the coding guidelines. In ICD-9, you’d select 599.0 ... Read More

Common coding challenges: Ensure documentation, modifiers support EKG claims to avoid denials

February 13, 2014 - By Jennifer Clampet
With CMS and its contractors now focusing on computer-generated electrocardiograms (EKGs) and multiple EKGs performed the same day, you’ll want to make sure your providers’ documentation supports these services and that you append the appropriate modifiers to avoid Medicare audit recover... Read More

Look for Medicare LCDs with ICD-10 codes in April, CMS says

February 13, 2014 - By Laura Evans
Now that we’re less than a year out from the transition to ICD-10, you may be wondering when you’ll get to see your Medicare administrative contractor’s (MAC’s) local coverage determinations (LCDs) with ICD-10 diagnosis codes.  CMS has an answer to that question: April... Read More

Report measures groups via registry to be successful with PQRS in 2014

February 13, 2014 - By Laura Evans
Question: I read an article stating that claims-based reporting will no longer be an option for measures groups in 2014, and I’d like some clarification. The CMS 2014 PQRS implementation guide states that claims-based reporting is still an option for individual measures in 2014. Is it tru... Read More

CCI Version 20.0: Guard against new transitional care management code bundling edits

February 06, 2014 - By Laura Evans
If you plan to report a surgical or medical procedure on the same date as a transitional care management (TCM) code (99495-99496), check first to see whether the TCM codes are bundled or you may face denial of the 30-day service code. Version 20.0 of the National Correct Coding Initiative (CCI), ef... Read More


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