This week's question is answered by John Bishop CPC, PA-C, Senior Consultant for DecisionHealth Professional Services.

Q. We keep getting denials when two providers perform 90801 (mental health initial evaluation, $152.92) for the same patient. One provider provides therapy and the other manages the patient's medication. The assessments are different for each provider. Medicare denies the second claim and states this is "too many services." Can you shed any light on why we're getting the second denial?

CMS warns providers to expect record requests and overpayment demands, says it will work towards getting Recovery Audit Contractors to look for underpayments as avidly as they pursue overpayments. 

An open letter from the HHS Office of Inspector General (OIG) limits what you and your peers can self-disclose to avoid harsher penalties for fraud violations. You can no longer self-disclose a matter involving only liability under the physician self-referral law absent of an anti-kickback statute violation, Inspector General Daniel Levinson says in the March 24 letter.

Use the new Advance Beneficiary Notice of Non-coverage (ABN) to notify patients when they could potentially be personally responsible for the cost of services that exceed Medicare's therapy caps. CMS's Transmittal 1678 to the Medicare Claims Processing Manual instructs providers to use either the newly revised ABN CMS-R-131 or Notice of Exclusion from Medicare Benefits form CMS-20007 to show Medicare coverage under the cap.

Last week we examined how primary care specialties have used imaging services over the last three years (PBN 3/23/09). This chart shows how a select few imaging-related specialties have been using imaging services from 2005 to 2007. The chart shows the number of claims billed for a combination of eight imaging codes representing all the major technologies (X-ray, CT, PET and MRI).

This graph shows denial rates for four high-utilization peripheral vascular catheter placement codes billed to Medicare from 2005 to 2007. The overall trend is uneven - 36200 and 36245 trended upwards in 2007, after a slight decline from 2005 to 2006.

Cutting back on denials for vascular catheter procedures may require a heart-to-heart between physicians and billers.

The $19 billion in health information technology (HIT) incentives found in the latest economic stimulus bill has wide-support in the medical community, but physicians still want to get more out of their electronic medical record (EMR) systems. Physicians attending a HIT forum sponsored by eHealth Initiative and IBM March 20 said EMR systems need to be more "patient-centered" and allow for an information exchange with other systems to improve quality at the point of care.

A Physician Quality Reporting Initiative (PQRI) measure for radiology erroneously contains 22 CPT codes that don't apply to the measure. A senior level CMS official tells Part B News that the agency is not responsible for the error, but is determined to make sure providers will not be adversely affected.

This week's question is answered by John Bishop, senior consultant for DecisionHealth Professional Services.

Q. What has to be documented for a provider to bill the 93010 (electrocardiogram 12 leads $9.02), professional interpretation and report of an EKG? Are the provider's initials on the tracing enough?