Coding Strategy

CMS announcement is triumph for physicians who haven’t collected in the past.

If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.

In the past, CMS only covered 99406-99407 (Smoking and tobacco use cessation counseling visit…) for a beneficiary with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with them to help them stop using tobacco.”

“For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling,” said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. “Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence.”

The new tobacco cessation counseling coverage expansion will apply to services under Medicare Part B and Part A. “The new benefit will cover two individual tobacco cessation counseling attempts per year,” CMS indicated in an Aug. 25 news release. “Each attempt may include up to four sessions, with a total annual benefit thus covering up to eight sessions per Medicare patient who uses tobacco.”

“We know that older adults and other Medicare beneficiaries can be successful in their struggles to stop using tobacco, as long as they have the right resources available to them,” said HHS’s Howard Koh, MD, MPH in an Aug. 25 statement. “Today’s decision will assure that beneficiaries can access that help from qualified physicians and other Medicare-recognized practitioners.”

To stay up to date on Medicare coverage issues, subscribe to Part B Insider, written by Torrey Kim, MA, CPC.

AMA corrects vestibular test codes to allow partial reporting.

The Correct Coding Initiative (CCI) came down hard on practitioners who perform vestibular testing earlier this year, but a new correction, effective Oct. 1, should ease the restrictions and help the otolaryngology, neurology, and audiology practices that report these services.

The problem: CCI edits currently restrict practices from reporting 92541, 92542, 92544, and 92545 individually if three or less of the tests are performed, notes Debbie Abel, Au.D., director of reimbursement and practice compliance with the American Academy of Audiology.

The solution: Starting October 1, 2010, “if two or three of these codes are reported for the same date of service by the same provider for the same beneficiary, an NCCI-associated modifier may be utilized to bypass the NCCI edits,” CMS wrote in a decision to alter the edits.

The American Speech-Language-Hearing Association (ASHA) has requested “clarification regarding the correct NCCI-modifier to use when reporting the codes to Medicare,” noted Lemmietta G. McNeilly, PhD, CCC-SLP, CAE, chief staff officer of Speech-Language Pathology with ASHA, in a July 29 announcement.

Look for Changes to Vestibular Testing Descriptors

The root of the CCI problem began when the 2010 CPT manual was published, including new code 92540 (Basic vestibular evaluation …) and the subsequent codes following it, which make up the individual components of 92540. “The clarification that resulted in the NCCI edits being lifted should be included in upcoming versions of the manual,” Abel tells Part B Insider.

According to the AMA’s Errata page, code descriptors should read as follows, effective Oct. 1:

• 92540 — Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording (Do not report 92540 in conjunction with 92541, 92542, 92544, or 92545)
• 92541 — Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording (Do not report 92541 in conjunction with 92540 or the set of 92542, 92544, and 92545)
• 92542 — Positional nystagmus test, minimum of 4 positions, with recording (Do not report 92542 in conjunction with 92540 or the set of 92541, 92544, and 92545)
• 92544 — Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording (Do not report 92544 in conjunction with 92540 or the set of 92541, 92542, and 92545)
• 92545 — Oscillating tracking test, with recording (Do not report 92545 in conjunction with 92540 or the set of 92541, 92542, and 92544).

CMS says keep patient medical records for 6 years.

Medical practices often hear conflicting advice regarding how long they must hang on to a patient’s medical records, but CMS intends to clear up any misinformation with new MLN Matters article SE1022, issued this month.

Although many physicians follow state laws when determining whether they can discontinue retaining a patient’s records, it’s important to keep in mind that you must hang into the patient’s records for at least six years, according to HIPAA laws. If your state requires a period longer than that, you must extend the length of time to meet state laws, but six years is the federal minimum.

“HIPAA administrative simplification rules require a covered entity, such as a physician billing Medicare, to retain required documentation for six years from the date of its creation or the date when it last was in effect, whichever is later,” the MLN Matters article states. “HIPAA requirements preempt state laws if they require shorter period. Your state may require a longer retention period.”

If you submit cost reports, you must retain the original or copies for at least five years following the cost report’s closure, and Medicare managed care program providers must retain records for ten years, the article notes.

Keep your records compliant with advice from Part B Insider’s editor Torrey Kim, MA, CPC.

Don’t assume separate coding for J0670, anymore.

The latest Correct Coding Initiative (CCI) edits contain plenty of anesthesia and pain management pairs you should check — and straight away. They went into effect July 1. CCI 16.2 encompasses 16,843 new edit pairs, according to analyst Frank Cohen, MPA, of MIT Solutions, Inc., in Clearwater, Fla. With 11 percent of all active edits affecting anesthesia procedures, you can’t afford to miss any of the changes.

Other Work Includes Paravertebral Facet Injection

Although the current CPT book doesn’t include them, you could begin using several new codes for paravertebral facet joint injections in January 2010. Now CCI edits bundle two of the new codes with every anesthesia code (00100-01999) and many nerve destruction procedures. The paravertebral injection codes affected are:

• 0213T — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
• 0216T — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.

Procedures paired with 0213T and 0216T range from 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) to 64650 (Chemodenervation of eccrine glands; both axillae). Most of the edit pairs carry a “0” modifier indicator, but CCI lists a few with modifier indicator “1.” Check the full CCI file to verify whether you can use a modifier to break specific edits.

ME Edits Also Hit 0213T-0218T

Paravertebral facet joint injection codes 0213T-0218T come into play as part of mutually exclusive (ME) edits, as well.

CCI 16.2 pairs each choice with corresponding codes involving fluoroscopy or CT guidance: 64490-64492 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic …) and 64493-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral …). Each edit carries a “0” modifier indicator, so you can’t use modifier 59 to override the bundling.

Steer Clear of Separate Mepivacaine HCL

Your provider might rely on Mepivacaine HCL for nerve or tendon injections, but you can no longer separately report the medication for some procedures. CCI edits now bundle J0670 (Injection, mepivacaine HCL, per 10 ml) with many common injections such as:

• 20552 — Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
• 20600 — Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes)
• 64400 — Injection, anesthetic agent; trigeminal nerve, any division or branch
• 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level.

Good news: CCI 16.2 classifies the J0670 edits with a modifier indicator of “1.” When justified, you can report both codes and append modifier 59 (Distinct procedural service) to unbundle the pair.

No-Go for Telehealth Reporting

Anesthesia services include pre- and postoperative visits with the patient. CCI 16.2 clarifies that telehealth consultations and follow-ups fall under standard anesthesia services: the edits bundle every anesthesia code with G0406-G0408 (Follow up inpatient telehealth consultation …) and G0425-G0427 (Initial inpatient telehealth consultation …).

Each edit pair carries a modifier indicator of “0,” so you cannot report a modifier to break the bundle and report both services.

CCI 16.2 includes more than 16,800 edits. Check the latest version at www.cms.gov to ensure you correctly report procedures.

Stay up to date on CCI changes with denial busting info from Anesthesia & Pain Management Coding Alert.

By: Leigh Delozier, BA, CPC, editor of Anesthesia & Pain Management Coding Alert, 2010, Volume 12, Number 7.

Don’t assume separate coding for J0670, anymore.

The latest Correct Coding Initiative (CCI) edits contain plenty of anesthesia and pain management pairs you should check — and straight away. They went into effect July 1. CCI 16.2 encompasses 16,843 new edit pairs, according to analyst Frank Cohen, MPA, of MIT Solutions, Inc., in Clearwater, Fla. With 11 percent of all active edits affecting anesthesia procedures, you can’t afford to miss any of the changes.

Other Work Includes Paravertebral Facet Injection

Although the current CPT book doesn’t include them, you could begin using several new codes for paravertebral facet joint injections in January 2010. Now CCI edits bundle two of the new codes with every anesthesia code (00100-01999) and many nerve destruction procedures. The paravertebral injection codes affected are:

• 0213T — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
• 0216T — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.

Procedures paired with 0213T and 0216T range from 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) to 64650 (Chemodenervation of eccrine glands; both axillae). Most of the edit pairs carry a “0” modifier indicator, but CCI lists a few with modifier indicator “1.” Check the full CCI file to verify whether you can use a modifier to break specific edits.

ME Edits Also Hit 0213T-0218T

Paravertebral facet joint injection codes 0213T-0218T come into play as part of mutually exclusive (ME) edits, as well.

CCI 16.2 pairs each choice with corresponding codes involving fluoroscopy or CT guidance: 64490-64492 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic …) and 64493-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral …). Each edit carries a “0” modifier indicator, so you can’t use modifier 59 to override the bundling.

Steer Clear of Separate Mepivacaine HCL

Your provider might rely on Mepivacaine HCL for nerve or tendon injections, but you can no longer separately report the medication for some procedures. CCI edits now bundle J0670 (Injection, mepivacaine HCL, per 10 ml) with many common injections such as:

• 20552 — Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
• 20600 — Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes)
• 64400 — Injection, anesthetic agent; trigeminal nerve, any division or branch
• 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level.

Good news: CCI 16.2 classifies the J0670 edits with a modifier indicator of “1.” When justified, you can report both codes and append modifier 59 (Distinct procedural service) to unbundle the pair.

No-Go for Telehealth Reporting

Anesthesia services include pre- and postoperative visits with the patient. CCI 16.2 clarifies that telehealth consultations and follow-ups fall under standard anesthesia services: the edits bundle every anesthesia code with G0406-G0408 (Follow up inpatient telehealth consultation …) and G0425-G0427 (Initial inpatient telehealth consultation …).

Each edit pair carries a modifier indicator of “0,” so you cannot report a modifier to break the bundle and report both services.

CCI 16.2 includes more than 16,800 edits. Check the latest version at www.cms.gov to ensure you correctly report procedures.

Stay up to date on CCI changes with denial busting info from Anesthesia & Pain Management Coding Alert.

By: Leigh Delozier, BA, CPC, editor of Anesthesia & Pain Management Coding Alert, 2010, Volume 12, Number 7.