Medical Coding Questionnaire

Where can I find information on Home Health Billing?

noreply@blogger.com (Sonika) — Wed, 01 Jul 2009 09:52:00 +0000

QUESTION: Where can I find information on Home Health Billing?

ANSWER: Comprehensive information on Home Health billing can be found in Chapter 10 of Medicare’s Claims Processing Manual.

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modifiers T5

noreply@blogger.com (Sonika) — Wed, 01 Jul 2009 09:50:00 +0000

QUESTION: If the same procedure was done on the great toe of the right foot and on the great toe of the left foot, how is it coded?

ANSWER: Report the procedure code once and append modifiers T5 (right foot, great toe) and TA (left foot, great toe) to the code. CMS currently accepts up to two modifiers per line.

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modifier -91 be reported under CCI

noreply@blogger.com (Sonika) — Wed, 01 Jul 2009 09:46:00 +0000

QUESTION: How should modifier -91 be reported under CCI?

ANSWER: Modifier -91 should be appended to laboratory procedure(s) or service(s) to indicate a repeat test or procedure on the same day. This modifier indicates to the carriers or fiscal intermediaries that the physician had to perform a repeat clinical diagnostic laboratory test that was distinct or separate from a lab panel or other lab services performed on the same day, and was performed to obtain medically necessary subsequent reportable test values. This modifier should not be used to report repeat laboratory testing due to laboratory errors, quality control, or confirmation of results.

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CPT code 99291

noreply@blogger.com (Sonika) — Wed, 01 Jul 2009 09:38:00 +0000

QUESTION: What services are included in CPT code 99291 (critical care, first 30-74 minutes) and should therefore not be billed separately?

ANSWER: Hospitals must follow the CPT instructions related to CPT code 99291. Any services that CPT indicates are included in the reporting of CPT code 99291 should not be billed separately by the hospital.

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Medically Unlikely Edits (MUEs)

noreply@blogger.com (Sonika) — Wed, 01 Jul 2009 09:35:00 +0000

QUESTION: Is there an appeal process for claim lines denied based on Medically Unlikely Edits (MUEs)?
ANSWER: Since claim lines are denied at Carriers and Part A/Part B Medicare Administrative Contractors (A/B MACs) processing claims with the MCS system and at Durable Medical Equipment Medicare Administrative Contractors (DME MACs) processing claims with the VMS system, MUE-based claim line denials at these contractors may be appealed. However, at FIs and A/B MACs processing claims with the Fiscal Intermediary Shared System (FISS), claims with a claim line with units of service exceeding an MUE value are returned to the provider. No claim denial occurs, and appeals are not available. Appeals should be submitted to local contractors not the MUE contractor, Correct Coding Solutions, LLC

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Medicare to bill for CPT code 96125

noreply@blogger.com (Sonika) — Wed, 01 Jul 2009 09:32:00 +0000

QUESTION: Who is authorized by Medicare to bill for CPT code 96125 (that was added under CPT effective January 1, 2008)?

ANSWER: CPT code 96125 ( standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report) is designated under Medicare as an “always therapy” code. Physical therapists (PTs), occupational therapists (OTs), and speech language pathologists (SLPs) may bill this code for patients only when the patient is under a therapy plan of care. (Please note that CPT Changes: An Insider’s View 2008 suggests that when testing like that performed under 96125 is performed by a physician or a psychologist, a code from the 96101-96103 or 96118-96120 series should be reported.)

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Can hospitals use modifier –51?

noreply@blogger.com (Sonika) — Wed, 01 Jul 2009 07:58:00 +0000

QUESTION: Can hospitals use modifier –51?

ANSWER: Modifier –51 is not used by hospitals.

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How should modifier -59 be reported under the CCI?

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:31:00 +0000

QUESTION: How should modifier -59 be reported under the CCI?

ANSWER: Modifier -59 is used to indicate a distinct procedural service. To appropriately report this modifier, append modifier -59 to the column 2 code to indicate that the procedure or service was independent from other services performed on the same day. The addition of this modifier indicates to the carriers or fiscal intermediaries that the procedure or service represents a distinct procedure or service from others billed on the same date of service. In other words, this may represent a different session, different anatomical site or organ system, separate incision/excision, different lesion, or different injury or area of injury (in extensive injuries). When used with a CCI edit, modifier -59 indicates that the procedures are different surgeries when performed at different operative areas or at different patient encounters.

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Will a health care provider’s National Provider Identifier (NPI) ever change?

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:27:00 +0000

QUESTION: Will a health care provider’s National Provider Identifier (NPI) ever change?

ANSWER: The National Provider Identifier (NPI) is meant to be a lasting identifier, and is expected to remain unchanged even if a health care provider changes his or her name, address, provider taxonomy, or other information that was furnished as part of the original NPI application process. There are some situations, however, in which an NPI may change such as when health care provider organizations determine they may need a new NPI due to, for example, certain changes of ownership, the conditions of a purchase, or a new owner’s subpart strategies. There also may be situations where a new NPI is necessary because the current NPI was used for fraudulent purposes.

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Must providers who submit claims electronically comply with HIPAA if they submit claims on paper?

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:19:00 +0000

QUESTION: If a provider submits claims electronically, must he or she also comply with HIPAA if the practice reverts to submitting claims on paper?
ANSWER: The HIPAA transactions commonly used by providers include claims, eligibility queries, claim status queries, and referrals. It is important to note that a provider cannot avoid the HIPAA requirements by hiring another entity, such as a billing service, to conduct these transactions electronically on the provider's behalf. While you and other health care providers could revert to conducting solely paper transactions, doing so would have many negative effects for most providers. The provider’s business processes would be disrupted by having to prepare paper claims and check eligibility and claim status by phone. Reverting to paper would cause particular problems for those providers who receive Medicare payments. First, these providers would experience delays in receiving payments, because Medicare by law cannot pay paper claims until 28 days after receipt (as opposed to 14 days for electronic claims). Second, effective October 16, 2003, Medicare was prohibited by law from paying paper claims except for those from small providers and under certain other limited circumstances. After that date, any provider that does not meet the “small provider” or other exception would have to return to electronic claims submission in order to continue to receive Medicare reimbursement. At that time, the provider would again be required to comply with the Privacy Rule requirements.

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National Provider Identifier (NPI)?

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:15:00 +0000

QUESTION: Under what circumstances will a claim be rejected when using the National Provider Identifier (NPI)?

ANSWER: Claims will be rejected if:
• The NPI included in a claim or claim status request does not meet the content criteria requirements for a valid NPI (begins with 1,2,3, or 4; 10-digits long with no special characters; check digit is correct); this affects:o X12 837 and Direct Data Entry (DDE) screen claims (DDE claims are submitted to Medicare Intermediaries only);o National Council of Prescription Drug Plan (NCPDP) claims (submitted to Medicare DMERCs only);o Paper claims on the revised CMS-1500 form and on the UB-04 form;o Claims submitted using Medicare’s free billing software;o Electronic claim status request received via X12 276 or DDE screen; ando Non-X12 electronic claim status queries, pending elimination of the HIPAA contingency plan for the HIPAA 276/277 format;
• A submitted NPI reported cannot be located in Medicare files;
• The NPI is located, but a legacy identifier reported for the same provider in the transaction does not match the legacy identifier in the Medicare file for that NPI;
• Claims include the NPI but do not have a taxpayer identification number (TIN) reported for the billing or pay-to provider in electronic claims received via X12 837, DDE screen (FISS only), or Medicare’s free billing software; and
• Claims that do not meet Medicare submission requirements, HIPAA implementation guide requirements, or Medicare program reuirements for reasons unrelated to NPIs.

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What is the purpose of the HIPAA Security Standards rule and why are security standards needed?

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:12:00 +0000

QUESTION: What is the purpose of the HIPAA Security Standards rule and why were security standards needed as published in the Federal Register on February 20, 2003?

ANSWER: The purpose of the Security Rule is to ensure that every covered entity has implemented safeguards to protect the confidentiality, integrity, and availability of electronic protected health information. Standard for security are needed because there is a growth in the exchange of protected health information between covered entities as well as non-covered entities. HIPAA mandated security standards protect an individual's health information, while permitting the appropriate access and use of that information by health care providers, clearinghouses, and health plans.

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Can ICD-9-CM procedure codes be reported on hospital outpatient claims?

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:08:00 +0000

QUESTION: Can ICD-9-CM procedure codes be reported on hospital outpatient claims? If I use HCPCS codes to report hospital outpatient services at the “required” service line level segment for a claim, may I use the ICD-9-CM procedure codes to report hospital outpatient services at the claim level “situational” segment?

ANSWER: NO. ICD-9-CM procedure codes were named as the HIPAA standard code set for inpatient hospital procedures. The ICD-9-CM procedure codes were not named a HIPAA standard for procedures in other settings such as hospital outpatient services or other types of ambulatory services. Hospitals may capture the ICD-9-CM procedure codes for internally tracking or monitoring hospital outpatient services; but when conducting standard transactions, hospitals must use HCPCS codes to report outpatient services at the service line level and the claim level, if the situation applies. Even though an ICD-9-CM procedure code qualifier is available, in addition to a HCPCS code qualifier, at the “situational” claim level segment, the Transactions and Code Sets regulation states that ICD-9-CM procedure codes is the adopted standard code set for hospital inpatient services

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Correct Coding Initiative (CCI) in the Medicare manuals

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:06:00 +0000

QUESTION: Where can I find information about the Correct Coding Initiative (CCI) in the Medicare manuals?
ANSWER: Information about CCI can be found in Section 20.9 of Chapter 23 of the Medicare Claims Manual .

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Physician Quality Reporting Initiative (PQRI)

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:03:00 +0000

QUESTION: Is the primary diagnosis the only diagnosis that is applicable to the quality measure being reported or will Physician Quality Reporting Initiative (PQRI) consider all diagnoses reported on a claim?

ANSWER: All diagnoses and quality-data line items are considered for Physician Quality Reporting Initiative (PQRI) reporting. There is no requirement to sequence diagnoses into primary and secondary categories for PQRI. Quality-data codes (QDCs) should be submitted for any measures that are applicable to each Medicare Physician Fee Schedule (PFS) claim, as determined by all the diagnosis (ICD-9-CM) and service (CPT Category I) codes submitted on the claim line items for payment. Each QDC should point to one of the diagnosis codes already present on the claim for the payable service. Without a diagnosis pointer on the QDC line item, the line item will be rejected and returned to the provider as unprocessable. The PQRI quality measure specifications identify the combinations of diagnosis and service codes making a claim eligible for each measure. The PQRI Quality Measure Specifications Manual is available in a download from the CMS PQRI Measures.

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Recovery Audit Contractors (RAC)s

noreply@blogger.com (Sonika) — Tue, 23 Jun 2009 07:00:00 +0000

QUESTION: Will the timing for appeals by the Medicare contractors be the same for the Recovery Audit Contractors (RAC)s?

ANSWER: Yes. The timeframe for filing an appeal remains the same.

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2009 E/M Coder: Professional Edition

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 09:43:00 +0000

Does your E/M coding make the grade? Get help from the experts at The Coding Institute!

Now you can stay on top of your coding game with 2009 E/M Coder: Professional Edition, published by The Coding Institute. This easy-to-read how-to manual is tailored specifically to help you select the appropriate E/M code every time. Each chapter is packed with practical tips, strategies, and tricks of the trade that you can try immediately to benefit your practice.
You'll learn strategies like:
• 2009 CPT changes that could bust bundles ... get the latest coding tools from AMA and the experts.
• Do you know who can record HPI? If you don't, your history could be discounted.
• These tips will get you out of the 99213 coding rut.
• Before you report 99291, check out these new options.
• Think only a doctor can request a consult? Navigate CPT versus CMS guidelines.
• There are 3 requirements for time-based coding. Will your level withstand an audit?
• Stay compliant when getting "review" credit with EMR check boxes.
• '95 or '97 guidelines?
This could make all the difference in what level you choose.

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2009 Coding Books and Guides

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 09:37:00 +0000

Everything you need to maximize your practice's reimbursement at your fingertips. The Naples based Coding Institute has published the following Coding manuals. These how-to manuals are easy to read, and specifically tailored for selecting the appropriate codes each time. These manuals will help in making your coding compliant without struggle. Chapters are packed with practical tips, strategies and tricks of the trade that one can try immediately to and benefit.So here is just the list of the manuals.

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2008 Coding Manuals

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 09:33:00 +0000

The Naples based Coding Institute has published the following Coding manuals. These how-to manuals are easy to read, and specifically tailored for selecting the appropriate codes each time. These manuals will help in making your coding compliant without struggle. Chapters are packed with practical tips, strategies and tricks of the trade that one can try immediately to and benefit.So here is just the list of the manuals.
For details/availability on each of these manuals do go to http://codinginstitute.com/books/index.html
2008 Modifier Coding Survival Guide
2008 Part B Coder's Rule Book
2008 Cardiology Coder's Survival Guide
2008 E/M Coder: Professional Edition
2008 Gastroenterology Coder's Survival Guide
2008 General Surgery Coder's Survival Guide
2008 Orthopedic Surgery Coder's Survival Guide
2008 Primary Care Coder's Survival Guide
2008 Urology Coder's Survival Guide
2008 CPT Implementation Guide
2008 ICD-9 Update Guide

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ARRA affect the moratorium that the MMSEA placed on new LTCH

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 09:20:00 +0000

QUESTION: How did the ARRA affect the moratorium that the MMSEA placed on new LTCH or new LTCH satellites and expansions in the number of beds in existing LTCHs, effective December 29, 2007?

ANSWER: The ARRA makes one additional exception to the moratorium that will allow existing LTCHs to expand the number of beds in the LTCH or its satellite if the hospital obtained a certificate of need for an increase in beds in a State for which such certificate of need is required that was issued on or after April 1, 2005, and before December 29, 2007. As with the exceptions specified under MMSEA, this additional exception will be implemented, under procedures already established, by State Survey Agencies, CMS Regional Offices, and Fiscal Intermediaries/Medicare Administrative Contractors.

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Cancer Prevention and Treatment Demonstration for Ethnic and Racial Minorities

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 09:16:00 +0000

QUESTION: Please clarify how the various assessment and facilitation services required by the Cancer Prevention and Treatment Demonstration for Ethnic and Racial Minorities will be reimbursed.

ANSWER: Special demonstration billing codes will be established to allow reimbursement for the annual cancer screening assessment for the intervention group, the entrance and exit cancer screening assessment for the control group, and the monthly capitated rates for cancer screening, diagnostic, and treatment facilitation services. The annual cancer screening assessment for the intervention group and the entrance and exit cancer screening assessment for the control group will be reimbursed as separate capitated costs derived from the overall budget specified by the awardee. The cancer screening, diagnosis, and treatment facilitation services delivered to project enrollees will be reimbursed under the capitation payment system.

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Ultrasound Repair

Ceiling Fan

Angioplasty

1115 Demonstration for coverage of Evacuees?

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 07:54:00 +0000

QUESTION:Are there any reporting requirements for the 1115 Demonstration for coverage of Evacuees?

ANSWER: A final report is due to CMS no later than December 31, 2006 describing the impact of this program, including but not limited to, the impact on evacuees, the Host States, etc.

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Content Solutions

Masters Golf Tickets

Vending Machine

Labor-Related Share

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 07:50:00 +0000

QUESTION: What is the labor-related share, effective for discharges on July 1, 2009 through June 30, 2010?
For the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) rate year (RY) 2010, what is the non-labor related share, effective for discharges on July 1, 2009 through June 30, 2010?

ANSWER: The IPF PPS non-labor related share for RY 2010 is 24.11%.

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Wild Blue

Lechuza Planters

Carbide Tooling

Non-labor Related Share

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 07:41:00 +0000

QUESTION: What is the non-labor related share, effective for discharges on July 1, 2009 through June 30, 2010?
For the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) rate year (RY) 2010, what is the non-labor related share, effective for discharges on July 1, 2009 through June 30, 2010?

ANSWER: The IPF PPS non-labor related share for RY 2010 is 24.11%.

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Aprilaire Humidifier

IP PBX

Restaurant Supply

Electroconvulsive Therapy (ECT) rate

noreply@blogger.com (Sonika) — Mon, 22 Jun 2009 07:35:00 +0000

QUESTION: What is the electroconvulsive therapy (ECT) rate, effective for discharges on July 1, 2009 through June 30, 2010?
For the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) rate year (RY) 2010, what is the electroconvulsive therapy (ECT) rate, effective for discharges on July 1, 2009 through June 30, 2010?

ANSWER: The IPF PPS ECT for RY 2010 is $280.60.

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Home Security Systems

Pool Supplies

Refrigerator Water Filters