You and your peers have had been losing money for the last four years thanks to denials for spine X-rays, a Part B News analysis shows. Denial rates for five relatively common spine X-ray codes range from 12% to 40% and have stayed flat at those high levels from 2005 to 2008, the analysis shows. Most importantly: more than 80% of the denials were billed in the office setting, according to a breakdown of the examined CMS claims data.

This chart shows you how much money you'll lose once consult codes are eliminated and those services replaced with a combination of new/established E/M office visit codes and initial hospital/nursing facility codes.

We're getting denials for a screening colonoscopy because the patient has a past history of polyps (V12.72). Is there a different code we can used to get this paid as a screening? The patient is reluctant to pay for the service out of pocket, despite concerns about colon cancer.

Providers will bill the appropriate initial hospital care code (99221-99223) in lieu of an inpatient consultation code (99251-99255) starting Jan. 1.

Primary care practices come out on top in the relative value unit (RVU) changes from the final 2010 Medicare Physician Fee Schedule (PFS), an exclusive Part B News analysis shows. Family doctors, internal medicine and general practice all see positive updates ranging from 2% to 4%. NOTE: This data does not account for the 21.2% pay cut set for 2010.

You and your peers providing consultations in an office setting will face drastic decreases in payment for providing the same service in 2010, according to a Part B News analysis. CMS has used a similar crosswalk to calculate budget neutrality in the Medicare Physician Fee Schedule. Below, we've taken the crosswalk and added dollar amounts to the services - including projections for 2010 payments with and without the scheduled 21.2% cut set for Jan. 1. You'll see dramatic differences between payments you received for a consult performed in 2009 and what you'd receive for performing the same service in 2010. CMS notes its crosswalk is not meant to be used as "billing guidance."

I need help billing a surgery with modifier 50 (bilateral procedure). When I bill a bilateral procedure should I put the code on two lines (once on its own and once with modifier 50) or do I just list the code once with the modifier? I've received conflicting information and would like to get this straight.

CMS is keeping telehealth consultation billing in 2010, according to the final Medicare Physician Fee Schedule. The agency has created these three telehealth codes for inpatient consultations to utilize in your practice.

You can thank members of Congress for the latest last-minute Red Flag Rules reprieve, according to an Oct. 30 press release from the Federal Trade Commission (FTC). Enforcement of the rules has been pushed back to June 1, 2010.

Institutional providers will need to be much more careful in using Medicare's Advance Beneficiary Notice of Non-coverage (ABN) form in 2010, thanks to a tough new rule CMS recently unveiled. Transmittal 1840 to the Medicare Claims Processing Manual, released Oct. 29, isn't explicitly clear about whether it applies to hospitals/facilities or physician practices, but CMS does intend for it to affect only institutional claims (i.e. services done in hospitals and facilities), an agency official confirms in an interview with Part B News.