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Inaccurate coding of surgical prep of acute wounds means lost reimbursement

01/18/2013

If your practice uses the surgical debridement codes (11042-11047) every time a physician surgically removes tissue for a wound debridement case regardless of intention, your incorrect coding shortchanges your pay and sets you up for unnecessary denials, experts say.

CMS changes modifier 24 rules: E/Ms now bundled with 0-, 10-day global codes

01/18/2013

by: Laura Evans and Julia Kyles

You may have fewer opportunities to get paid separately for E/Ms done on the same visits as minor procedures, those with zero- or 10-day global periods, thanks to the latest changes in the National Correct Coding Initiative (CCI) Policy Manual.

Benchmark of the Week: Top denied preventive services, 2011 vs. 2010

01/18/2013

This graph compares the top 10 most-utilized preventive services that saw the highest denial rates from 2010 and 2011, based on an analysis of CMS claims data.

Your TCM questions answered

01/18/2013

by: Roy Edroso

Your peers at practices across the country have asked questions about TCM on Part B News’ listserv. Here are some answers.

Small practices: Decide whether reporting with GPRO is worth your time

01/18/2013

by: Karen Long

Practices of two or more providers can use the group practice reporting option (GPRO) for the physician quality reporting system (PQRS). But only individual measures are approved for the 2013 GPRO program; practices cannot report measures groups under GPRO.

Part B News brief

01/18/2013

News for certain providers in California.

Fiscal cliff bill has some bad news for providers: Longer look-back period, more cuts

01/14/2013

by: Roy Edroso

Be ready for auditors to look at two more years of claims after the American Taxpayer Relief Act extended the look-back period within which CMS can request providers return overpayments to five years.

E/M modifier changes and new TCM code pairs dominate Q1 CCI edits

01/14/2013

by: Lauren C. Williams and Laura Evans

Your coders will have to get familiar with nearly 40,000 new code pairs – far fewer than the 250,000 released in 2012’s fourth quarter – in CMS’ latest National Correct Coding Initiative (CCI) edits effective Jan. 1.

Fiscal cliff bill extends therapy cap changes, medical review through 2013

01/14/2013

by: Karen Long

You’ll have to append the KX modifier when patients exceed $1,900 therapy caps and undergo manual medical review when patients reach $3,700 therapy thresholds in calendar year 2013.

Report codes 30 days after discharge, watch timing of face-to-face visit

01/14/2013

by: Laura Evans

Now that Medicare has announced it will cover the new transitional care management (TCM) codes (99495-99496), primary care practices are assessing the post-discharge services they provide to see whether the new codes’ revenue would be worth the added work needed to bill them.

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