March/April 2013
Exciting Opportunities Available at the AACE Endocrine Careers速 Expo! The AACE Endocrine Careers速 Expo will be held in conjunction with the AACE 22nd Annual Scientific & Clinical Congress, May 1-5, 2013, at the Phoenix Convention Center, in Phoenix, AZ. Exciting new events and opportunities are will be available to participants this year, including a special networking event on Wednesday, May 1. This event will provide an opportunity for employers and candidates to meet in person and identify their common interests prior to the beginning of the AACE Annual Meeting, allowing valuable additional days on-site to continue discussions. This unique event is included as part of your Career Expo registration and is unlike any previous AACE offering. For more information and to register, please visit http://careers.aace.com or e-mail endocrinecareers@aace.com. We look forward to seeing you in Phoenix!
AACE Diabetes Resource Center On January 30, 2013, AACE launched the new AACE comprehensive inpatient/outpatient Diabetes Resource Center, a Web site designed to help AACE members and other healthcare professionals improve the care of diabetes patients in their communities. The Web site is an easy-to-navigate, dynamic tool with two portals: the Inpatient Resource Center (http://inpatient.aace.com) and the Outpatient Resource Center (http://outpatient.aace.com). The inpatient portion of the Web site describes the rationale for controlling hyperglycemia in the hospital setting, suggests strategies and targets for achieving glycemic control, offers tools for implementing glucose control protocols and provides information on making the transition to outpatient care. The outpatient section offers extensive, up-to-date information on the diagnosis and care of ambulatory patients with all major forms of glucose abnormalities, including prediabetes, type 1 diabetes, type 2 diabetes and diabetes in pregnancy. Click here to read the press release. The
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ALERT! CMS identified a problem with the calculation of payment rates for purchased diagnostic tests. This issue resulted in lower payment amounts than appropriate for claims processed by contractors in certain payment localities for dates of service on and after January 1, 2013. CMS expects the problem to be resolved within the next 2-3 weeks. No action on the part of providers/suppliers is necessary. Affected claims will be identified and automatically reprocessed by the appropriate Medicare claims administration contractors.
Which EHR works best for endocrinology offices? We would like the opportunity to provide this information to our members. This survey addresses the high and low points encountered as a current or prospective EHR user about selection and purchase, implementation and training, as well as the pros and cons of your everyday experiences.
Medicare Fee For Service claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2% reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.
A new CMS edit will cause ordering and referral claims from non-Medicare-enrolled physicians to be denied. This MLN article The US Government’s Occupational Safety and Health Administration (OSHA) require all medical offices to keep a copy of the Material Safety Data Sheets (MSDS) for each chemical used or stored in an office. On June 1, 2015, the Hazard Communication Standard (HCS) will require SDSs (Safety Data Sheets) formerly (MSDS) Master Safety Data Sheets to be in a uniform format.
indicates these edits will apply to eligible providers “who order or refer items or services for Medicare beneficiaries,” including DMEPOS, radiology services, etc. The new system will kick out claims starting May 1, 2013. Physicians with a valid opt-out affidavit on file are excused. Others must have a valid enrollment on file, either on paper via 855-O or electronically via PECOS, or claims will be rejected.
ALERTS!
Novitas processed advanced diagnostic imaging (ADI) services incorrectly on January 9. The problem was corrected and Novitas will pursue identification and adjustment of impacted claims.
Additional information here.
Dial-Up Submitters Must change the Way They Connect to Cahaba GBA by July 1, 2013. All electronic transactions must go through a Cahaba GBA approved Network Service Vendor (NSV) or through a billing service or clearing house. For a list of approved Cahaba GBA vendors, visit the approved vendor list on their website.
Novitas Claims Modifier Issues - Incorrect Processing for 2013 Services for dates of service 1/1/2013 through 1/11/2013. Certain claim scenarios failed to suspend on this systems hold, and incorrectly completed processing. As a result of this system issue, Novitas has identified the following issues: •Claims containing procedure codes with non-payable Medicare Physician Fee Schedule (MPFS) statuses finalized with the incorrect denial message •Modifiers 26, 50, 51, 54, 55, 78, 79, and TC were incorrectly removed and therefore may have denied or paid incorrectly Novitas will identify and correct the affected claims. The provider community requires no action. 2
Look out for post payment medical reviews from Recovery Auditors. These reviews determine improper under and over payments made by CMS. Click here to see the how the recovery audit program works.
Confused on what year you will meet Stage 1, 2, or 3 of meaningful use in the Medicare and Medicaid EHR Incentive programs? Check out this new web resource tool from CMS and make sure to visit the EHR Incentive Programs website for the latest news and updates!
REVISION ®
This MLN Matters Article affects Non-physician practitioners (PA, NP, CNS, CP, CSW) who submit claims to Medicare contractors for services to Medicare
United Healthcare March 2013 Network Bulletin
ICD-10-CM goes October 1, 2014.
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CMS released new checklists and timelines for small, medium, and large provider practices. The resources provide a high-level understanding of what the ICD-10 transition requires and how your preparations compare with the recommended timeframes.
Behind on ICD-10 happenings? Click here to see a complete list of Pre-recorded ICD-10 National Provider Calls.
Includes information on: Improved Process for claim Reconsideration Requests New Pre-Certification Requirement for nonpreferred diabetes medications and test strips for Oxford Members Sign Up to receive the Network Bulletin
HbA1c Comment Period for Palmetto GBA, the Part B Medicare Administrative Contractor for NC, SC, VA, & WV, welcomed comments about the Local Coverage Determination (LCD) for the HbA1c laboratory testing procedure. The comment period for this LCD commenced on February 28, 2013, and became effective on April 15, 2013. To view this LCD, go to the LCDs and NCDs Web page under the Medical Policies section of the J11 Part B website. Choose the active link located under your appropriate state and then select the 'Active LCDs' category under 'Select LCD Type:' section. Click the 'Submit' button, and then select the HbA1c LCD link. Please share with your staff and review this information for your future references.
Are you or one of your staff new to Medicare? ®
The Medicare Learning Network (MLN) offers a three-part series of web-based training courses to teach health care professionals and administrative staff the fundamentals of the Medicare Program. Other web-based training courses available: Your Office in the World of Medicare Understanding the Remittance Advice for Professional Providers Medicare Secondary Payer Provisions
Codes subject to and excluded from the CLIA edits This article informs Medicare contractors about the new procedure codes for 2013 that are subject to and excluded from the Clinical Laboratory Improvement Amendments (CLIA) edits. [MM8162]
Don’t make the same mistake twice! Here are the top EDI claim rejections for Alabama, Georgia, and Tennessee from CAHABA, a Medicare Administrative Contractor.
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The auditors are coming to your door - will you be ready?
In 2010, the government spent $269.6 million to recoup improper payments and spent $580.6 million last year. That’s a 215% increase in just two years! It is becoming a necessity for physicians and their staff to gain foundational and advanced coding knowledge as well as resources to stay compliant with the various state, federal, and commercial regulations. With ongoing scrutiny from government and commercial insurance payers, physicians and their office staff must stay up-todate on the most current coding, billing and compliance issues occurring in the health care arena. Attending one or more of AACE’s educational opportunities can help show the auditors you are trying to keep up with the latest and greatest coding challenges! All classes are designed to assist physicians, non-physicians, coders, billers, and collectors, practice managers, etc. in obtaining all allowable reimbursement and complying with federal and commercial guidelines.
Fundamentals and Advanced Endocrine Coding
Register
This activity has been approved for AMA PRA Category 1 Credit™
June 20-21 ● Raleigh, NC
Raleigh Agenda
September 19-20 ● Las Vegas, NV
Las Vegas Agenda
December 5-6 ● Miami, FL
Miami Agenda
Bridge the Gaps in Endocrine Coding
Register
This activity has been approved for AMA PRA Category 1 Credit™
July 22 ● Jacksonville, FL
Jacksonville Agenda
August 15 ● Atlanta, GA
Atlanta Agenda
Evaluation and Management (E/M) Documentation for Endocrinologists “What’s in your record?” Register This activity has been approved for AMA PRA Category 1 Credit™
July 23 ● Jacksonville, FL
Jacksonville Agenda
August 16 ● Atlanta, GA
Atlanta Agenda
Contact Endocoding@aace.com or 904-353-7878 for additional information. All courses, dates and locations are subject to change. Cancellations must be received in writing to the AACE office 48 hours in advance of the course in order to receive a full refund. Noshows or cancellations received after this time are not eligible for a refund. AACE reserves the right to cancel the course with a minimum 48-hour notification. Participants will have the option to attend in an alternate course (if available) or request a full refund. 4
We want to hear from you! Tell us what you think of Endonomics! Please take a few minutes to take this survey. Your feedback is very important to us as we strive to assist you with a profitable and compliant business office. o Is Endonomics™ valuable and useful for your office? o What other topics would you like to see offered in Endonomics™? o Other comments… AACE's Socioeconomics and Member Advocacy Department's goal is to reach out to the endocrinology business world and become the onestop- shop, not only for endocrinology clinicians, but their support staff as ™ well. Currently, Endonomics is currently a free newsletter for both members and non-members. Interested parties should send an email to Endonomics@aace.com with their name, phone and fax numbers, location and preferred email address to be added to our Practice Support Network database.
Coding TRAC Tips on Reimbursement And Coding Six Common Payment Errors: • A service is reduced. The adjudicator may have down coded the claim for lack of documentation or coding may not have been coded to the highest level of specificity. • Reimbursement is made at a much-reduced rate. ® Possibly a data entry error. Compare the CPT code submitted to the code paid. Check contract to make sure the code was negotiated. • Low or no reimbursement. Insufficient documentation to establish medical necessity. Modifiers not utilized at all or used inappropriately. Check contract ® to make sure CPT code was negotiated. • Multiple units are paid as one unit. The insurer “missed” the number in the units column. Collectors and/or payment input specialists should review contracts to determine if write-offs and adjustments are correct based on documentation. • The reimbursement for a procedure suddenly drops. This could mean an error in claims calculation. Check contract to make sure the code was negotiated as an allowable code. Contact the payer. • Multiple procedures were not paid. The insurance company either ignored the additional procedures or lumped them in with the primary procedure. A modifier may need to be appended to the claim based on the documentation or possibly an incorrect modifier was used.
KNOW YOUR COMMERCIAL CONTRACTS AND THEIR CODING AND DOCUMENTATION EXPECTATIONS. When was the last time you reviewed your contracts? Please submit comments or questions to Endocoding@aace.com.
All medical coding must be supported with documentation and medical necessity. **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and ® ® documentation recommendations. As CPT , ICD-9-CM and HCPCS codes change annually, you should reference the current CPT , ICD9-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information. This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only and should not be deemed as legal advice, which should be © obtained from competent local counsel. Current Procedural Terminology (CPT ) is copyright and trademark of the 2012 American Medical © Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT . The AMA 5 assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
CPT® Codes Used by Endocrinologists for Biopsies 10021 Fine needle aspiration (FNA); without imaging guidance 10022 Fine needle aspiration (FNA); with imaging guidance (for radiological supervision and interpretation, see 76942, 77002, 77012, 77021) 60100 Biopsy thyroid, percutaneous core needle
What is the difference between an FNA and a percutaneous needle biopsy? Percutaneous needle biopsy is when tissue is obtained by puncture of a tumor, the tissue within the lumen of the needle being detached by rotation, and the needle withdrawn. Fine needle aspiration is a procedure where a biopsy specimen is aspirated through a needle.
Modifiers commonly used with FNAs RT- This location modifier indicates right LT- This location modifier indicates left 59- This modifier indicates a procedure is distinct and separate from others.* 76- This modifier indicates a repeat procedure *CMS indicates modifier -59 should “only be used if no other modifier more appropriately describes the relationship of two or more procedures.” See this article from CMS.
Coding Tips for FNAs
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o
Always code to the highest level of specificity with diagnosis and CPT codes. This may decrease the need for records to be submitted.
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When modifiers RT/LT are reported with the FNA code, the need to submit records to the carriers may decrease.
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A scheduled FNA does not justify an E/M service code be reported as well. All pre and post-operative work is captured in the FNA code (10021/10022).
Examples: Patient comes in for a scheduled FNA with ultrasound guidance of a right and left nodule. *76942
10022-RT
10022-LT
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*For CMS CPT code 76942 should be reported one time per date of service regardless of the number of nodules. Please check with your commercial carriers to determine if they follow CMS’ National Correct Coding Initiative (NCCI edits. See these Medically Unlikely Edits from CMS at this website.
Patient comes in for a scheduled FNA with ultrasound guidance of a right nodule and 2 left nodules. 76942
10022-RT
10022-LT
10022-LT/59
Rationale: Modifier 59 indicates the left sided nodule was separate and distinct and not a repeat procedure (modifier 76) of the same nodule.
~The examples are of correct coding based on coding conventions and guidelines. Always check the contracts of your commercial carriers for administrative guidelines to determine what modifiers they expect to be reported. There may be various modifier combinations based on individual commercial and federal guidelines. All coding is based on documentation and medical necessity. 6