According to an email from WPS GHA, some practices forgot to take a very important step at the start of the year -- and the omission could be costing them money.
Just a reminder, the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are updated in January of every year. Please verify you are using the most current codes for your services January 1, 2018, and after. Numerous claims are denied or paid incorrectly when not using the most current codes.
Denials are the likely outcome of using deleted code, but an alert that claims were improperly paid should set practices searching for any overpayments they may have received. Remember that practices are subject to stiff penalties if they don't return overpayments in a timely fashion, as mandated by the 60-day overpayment rule.
Practices should keep in mind that some reimbursement mistakes caused by revisions to codes may not be caught during the claims processing cycle. For example, the bone marrow aspiration code 38220 was revised in 2018 and should only be used for diagnostic procedures. A new add-on code (20939) was created for use when the doctor harvests bone marrow for use with a spine procedure, and a note in the CPT manual instructs coders to report unlisted code 20999 when bone marrow is harvested for other therapeutic procedures.
However, a provider who is harvesting bone marrow for a therapeutic procedure could continue to report — and be paid for — 38220, unless someone at the practice catches the mistake, or the issue is revealed during an audit.
Category III codes are another area that could snarl claims processing or revenue. A number of codes received a Category I code this year, opening up revenue opportunities for practices. For example, 0438T (Transperineal placement of biodegradable material, peri-prostatic [via needle], single or multiple, includes image guidance) was deleted and should now be reported with 55874 (Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection[s], including image guidance, when performed). Other Category III codes were deleted and should be reported with an unlisted code. For example, high energy extracorporeal shock wave for integumentary wound healing codes 0299T-0300T were deleted, and should now be reported with unlisted code 28899.
By the same token, practices should not use unlisted codes when there is a Category III code that describes the procedure.
And don't overlook changes to the HCPCS code set, which include new codes for drugs.
The most common cause of billing and payment errors are with drug codes where the dosage or route of administration may have changed, new codes, changes in descriptions of the current codes, and codes for new services where the Center for Medicare & Medicaid Services (CMS) have assigned codes.
Changes included the deletion of Q codes for drugs such as the contraceptive Kyleena (Q9984) and the introduction of replacement J codes (J7296). CMS also deleted a number of G codes and adopted CPT codes. For example, psychiatric and behavioral health care management codes G0502-G0505 and G0507 should now be reported with new CPT codes 99483, 99492-99494 and 99484.