Your Physician Quality Reporting System (PQRS) bonus payment for services rendered in 2011 is at risk if you don’t act by Feb. 24. A total of seven G-codes were inadvertently deleted during CMS’ transition to HIPAA version 5010 last year, affecting 30 PQRS measures. Following is a table listing all meaures impacted by the deleted codes.

Code G0289 (surgical knee arthroscopy with surgery to remove loose/foreign body or chrondroplasty at the time of other arthroscopy on the same knee) has an N1 payment indicator which means it’s bundled into the payment for ambulatory surgical center facility fees and cannot be separately billed.  The Medicare Claims Processing Manual states that you cannot bill codes with N1 status as additional line items since it could lead to improper reimbursement.  If so, what is the purpose of G0289?

Your physician assistants (PAs) may now certify and recertify patients for Skilled Nursing Facility (SNF) services, CMS announced in a transmittal earlier this month.

Rather than wait on the physician to get back to the office to sign off on the SNF transfer, PAs can go ahead and certify on their own, facilitating a much smoother process for the practice and the patient, says Michael Powe, vice president of reimbursement and professional advocacy for the American Academy of Physician Assistants (AAPA).

This chart presents five wound care codes and their corresponding denials as a percentage of overall service count for both physician assistants (PAs) and nurse practitioners (NPs). Data was taken from 2009 and 2010. NOTE: Wound vac codes were excluded from this graph.

CMS is giving you extremely vague instructions in developing your own HRA form to add to the 2012 annual wellness visit (AWV) paperwork. Well rather than do the leg work yourself, use this tool as a template for your practice's HRA form.

Medicare has stopped paying our administration-only injection claims citing that a qualifying procedure code/service is needed. What is the proper way to bill just the administration code for patients who bring in their own medication (e.g., B-12 shots, testosterone injections)? We have only billed 96372 (therapeutic, prophylactic, or diagnostic injection).

You have several big changes to how you code wound care services this year, thanks to new CPT changes aimed to make coding wound care services more precise. There are new codes, deleted codes plus new guidelines to the National Correct Coding Initiative (CCI) manual that governs how you bill multiple codes during the same encounter, Part B News has learned.

You must have an action plan ready in case contract negotiations with your payer sour before an agreement can be made. But first you must recognize the signs negotiations are going badly, so you can to get the talks back on track before you give up, experts say. You must understand why a payer won’t negotiate. It could be a lack of money, a belief that your network is flush with providers and fair rates or the payer is not interested in cooperating.

Recovery Auditor Contractors (RACs) are reviewing physician claims, recouping payments and making mistakes that could result in practices handing over money they should have kept. RAC audits and errors are a growing problem for physicians, which means you'll have to police your RAC and be ready to state your case when it doesn’t follow Medicare’s payment rules.

The following code crosswalk, developed by Regan Tyler, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services shows you how the 2011 skin substitute codes crosswalk to the new 2012 codes. Note that codes with * previously were not broken out by anatomical location, so for the new codes, you will need to select the appropriate code based on location as with the other graft codes (see table below for assistance).