Coding Strategy

Sometimes CCI compliance requires looking beyond the edit pairs.

Correct Coding Initiative (CCI) edits don’t bundle SPECT (78803) and planar (78070) parathyroid imaging codes, but coding experts often tell you not to code the two together for SPECT and planar parathyroid imaging on the same date.

Add some method to this madness by looking at the information offered by two coding resources, the Society of Nuclear Medicine (SNM) and the NCCI Policy Manual for Medicare Services (CCI Manual).

1. SNM Singles Out 78803

SNM’s online Practice Management Coding Corner features a Q&A that recommends reporting 78070 (Parathyroid imaging) for planar imaging alone, but 78803 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; tomographic) for parathyroid SPECT imaging with or without planar, says Jackie Miller, RHIA, CCS-P, CPC, vice president of product development for Coding Metrix Inc. in Powder Springs, Ga.

Support: “Choose the single code that describes the protocol and procedure performed,” states the Q&A, located at http://interactive.snm.org/index.cfm?PageID=2442&RPID=1995. SNM “would NOT recommend coding both CPT codes,” the article notes.

2. CCI Makes the Case for SPECT Code

Although there is notyou won’t find any a specific edit bundling 78070 and 78803, CCI does address the SPECT/planar issue in the CCI Manual, says Miller.

CCI Manual, Chapter 9, Section E.2, explains that you may not report a SPECT study and planar study of the same limited area because “Single photon emission computed tomography (SPECT) studies represent an enhanced methodology over standard planar nuclear imaging. When a limited anatomic area is studied, there is no additional information procured by obtaining both planar and SPECT studies.”

Bonus tip: The manual indicates you may report both planar and SPECT codes only when the size of the scanned area makes both sets necessary, such as with whole body bone scans with SPECT studies, says nuclear medicine coding expert Denise Merlino, MBA, CNMT, FSNMTS, CPC, president of Merlino Healthcare Consulting in Magnolia, Mass. Also keep an eye out for vascular flow studies. If the radiologist performs planar vascular flow studies alongside SPECT studies, you should report the vascular flow combined code, not the flow, planar, and SPECT studies independently, Merlino says.

@ Radiology Coding Alert. Editor: Deborah Dorton, JD, MA, CPC

Sign up for the upcoming live audio conference, Top 5 Non-Vascular Interventional Radiology Coding SNAFUs Solved, or order the CD/transcripts.

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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 to avert that reimbursement drop.

The CMS transmittal also announces …

… increased payment for dual-energy x-ray absorptiometry (DEXA) scan imaging, making the new non-facility total RVU 2.70, whereas the original 2010 fee schedule listed the transitioned non-facility total RVU for this code as 1.71.

When combined with the conversion factor of $36.0791, that makes DEXA pay about $97.00, a $36.00 increase over the previous payment of approximately $61.00.

Keep in mind: DEXA payment is subject to frequency rules. In some cases, you may notknow when the patient last had a DEXA scan. In these cases, “I would, along with the patient, make the call to Medicare to see if we could find out if or when there was a previous DEXA,” says Kim French, CIRCC, with Crouse Radiology Associates in Syracuse, N.Y.

“It’s worth the extra effort for good patient care (you can then obtain the previous results for comparison) and public relations. These days, there is a lot of competition and with reimbursement decreasing, little things like this are critical for survival.”

If you cannot locate the date of the previous DEXA scan, you’ll want to ask the patient to sign an advance beneficiary notice (ABN), says Barbara J. Cobuzzi, MBA, CPC, CPCH,CPC-P, CENTC, CHCC, with CRN Healthcare Solutions in Tinton Falls, NJ.

Plus: CMS corrected several “technical errors” published in the 2010 Fee Schedule, and thanks to these corrections, Medicare will increase payment for several cardiology-related testing codes, including codes 75571-75574 (Heart CT) and 78451-78454 (Heart muscle SPECT imaging).

For instance, you’ll find a 28 percent increase in pay for code 78451 (SPECT image, heart muscle), from $222 to $312, based on an analysis featured on the American College of Cardiology’s Web site.

For more information on DEXA payment and the conversion factor, subscribe to the Part B Insider. Editor: Torrey Kim, CPC

Sign up for the upcoming on-demand Webinar, 5 Steps to Optimize Your Office’s Coding & Billing Practices, or order the CD/transcripts.

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Record visual fields interpretation and report the right way.

Visual fields are a compliance hot spot. Optometrists should use the visual field interpretation and report (I&R) to record what their thinking process was at that moment by recording any changes noticed, how the field compares to other testing like OCT (92135, Scanning computerized ophthalmic diagnostic imaging, posterior segment, [e.g., scanning laser] with interpretation and report, unilateral), their plan for treatment (or not) and when the field needs to be run again.

Do this: Do the I&R so that you can pick it up in one year and know exactly what you were thinking and seeing at that point without having to re-analyze the field and previous fields. Use the form below to keep your records complete.

@ Optometry Coding Alert

Hurry! Reserve your spot in these popular ophthalmology and optometry conferences: ENCORE: 2010 Ophthalmology & Optometry Coding Update and Frames, Lenses and CLs: File Right, Get Paid, Protect Your Practice.

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Plus: Say goodbye to two perfusion codes.

If you’ve ever wondered whether Medicare actually pays attention to CPT’s Category III codes, the AMA offers an answer with the release of the new codes included in CPT 2010.

First and foremost, CPT will delete the Category III cardiac computed tomography (CT) imaging codes 0144T-0151T and replace them with new, permanent Category I codes, as follows:

• 75571 — CT, heart, without contrast material, with quantitative evaluation of coronary calcium

• 75572 — CT, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)

• 75573 — CT, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV structure and function, and evaluation of venous structures, if performed)

• 75574 — CT angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed).

CPT 2010 deletes the myocardial perfusion add-on codes +78478 and +78480, despite the fact that coders often leaned on those codes. “Codes +78478 and +78480 are used often in our practice,” says Debby Simmons, CPC, with Cumberland Cardiovascular Associates.

“My opinion on this is that they are trying to eliminate the use of multiple codes to describe procedures that are normally performed in one session,” Simmons says. “Eliminating these ‘add-on codes’ saves on keystrokes and space. I don’t think the elimination of these codes is due to them not being reported, but for efficiency,” she suggests.

And CPT also debuts new code 75565 (Cardiac magnetic resonance imaging for velocity flow mapping [List separately in addition to code for primary procedure]), but deletes all of the previous codes that specified flow/velocity quantification (75558, 75560, 75562, and 75564).

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If your practice does lab panels, sleep studies, hospice visits and more, take heed.

The HHS Office of Inspector General has published its 2010 Work Plan, which should give us all a heads up on what the watchdog agency will be auditing and evaluating this year.

Why you should care: The 115-page document is like a map for what regulators will be looking at this year, and what potential problems they’ll be passing to MAC, RAC and private payer auditors. Don’t worry. Physician issues are clustered around page 15. However, if you code for other things in your health system besides physician services, you should have a look at the table of contents.

Here’s a summary of what the OIG wants to know about physician reimbursement:

Modifier GY: By law, Medicare excludes some medical treatments, such as many screening tests, and you might want to inform patients of this fact. Although you’re not required to issue a notification to patients for excluded procedures, doing so is a courtesy to the patient and may help the process of collecting from the patient. In these cases, modifier GY applies. Medicare denied over $820 million in modifier GY claims in fiscal year 2008, and the OIG wants to further research “patterns and trends for physicians’ and suppliers’ use of modifier GY,” the Work Plan notes.

Place-of-service errors continue to be a hot-button issue for the OIG. Reimbursement for certain procedures is higher when a physician performs them in the office than when she performs them in an ambulatory surgical center or hospital outpatient department.

POS errors sometimes occur because new billers assume that every setting the physician works in is an ‘office.’ And sometimes billing software errors cause them, Dr. Bruce Rappaport told attendees at the Coding & Reimbursement Conference his past July.

Self-audit tip: Pinpoint codes you know your physician doesn’t perform in the office, and check claims for POS errors, Rappaport recommends. For example, if your office does colonscopies in the ASC, check those claims.

Caution: Make sure you understand how to properly disclose and correct any billing problems you discover during a self-audit.

Physician visits to hospice patients: If your physician has an employment arrangement with a hospice, the Part A hospice benefit should pay for part of his services. The OIG wants to make sure physician visits to hospice patients aren’t being double billed - once to Part A and once to Part B.

For certain Medicare Part B imaging services, OIG will “determine whether Medicare payment reflects the actual expenses incurred and whether utilization rate reflects current industry practices.”

Polysomnography Payments: The OIG will study why sleep study reimbursement Medicare reimbursement rose from $62 millinon in 2001 to $215 million in 2005.

Self-Audit Tip: Check your ICD-9 coding and documentation for sleep studies, because medical necessity is a big issue here.

Improperly unbundled laboratory profiles or panels.

E-prescribe incentive payments: Interestingly, the OIG will be reviewing Medicare incentive payments made in 2010 to health care professionals for their 2009 e-prescribing activities.

The OIG will assess “whether, and, if so, the extent to which incentive payments for e-prescribing activities in 2009 were made in error.” If the OIG finds that Medicare made erroneous e-prescribing payments, it will investigate how CMS remedied the overpayments.

Because the e-prescribing incentive program is just getting rolling, the investigation is an attempt for the OIG to “identify potential vulnerabilities to assist in CMS’s oversight preparations.”

AUDIO TRAINING EVENT: OIG Work Plan Explained … for Physician Practices.

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