January/February 2013
You could be reporting incorrect codes and losing money, increasing your AR (accounts receivable) and causing undue claim reworks! ©
Did you know each year CPT , ICD9-CM and HCPCS codes are subject to change, revision and even deletion? (There is a code freeze on ICD9-CM due to the upcoming scheduled transition to ICD10-CM) As a service to you, AACE has a partial list of new, revised, and deleted codes here.
CPT codes for Nuclear Medicine (78000-78011) are not valid for dates of service January 1, 2013 and forward. We have received several inquiries regarding the codes used to describe nuclear medicine imaging services. Below is updated information on the new codes for 2013. NEW Thyroid Imaging Codes for 2013 78012 thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) 78013 thyroid imaging (including vascular flow, when performed) 78014 thyroid imaging (including vascular flow, when performed) with single or multiple uptake(s) quantitative measurement(s)(including stimulation, suppression, or discharge, when performed) Additional information is located here
Patient encounter codes G8447 and G8448 are no longer valid codes effective January 1, 2013. EHR incentive payments require eligible professionals (EP) register and attest that he or she is using EHR technology in a meaningful way such as ® eprescribing. In addition, EPs should report the appropriate Category II CPT codes to report PQRS (Physician Quality Reporting System) measures in order to qualify for PQRS incentive payments. Revised HCPCS Code for 2013 G8553 (Prescription(s) generated and transmitted via a qualified ERX system) should be used to report eRx measures. 1
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To help specialty providers successfully meet meaningful use measure requirements and navigate the EHR Incentive Programs, CMS
A yearlong patient education program, Thyroid Awareness is supported by AbbVie to promote public awareness of thyroid disease, offers a “Same/Same/Same” message and MyPillCheck. The Same/Same/Same message reminds patients that regardless of which thyroid medicine is prescribed, it’s important to check the pills received from the pharmacy and to take the Same medicine, in the Same dosage, at the Same time every day. MyPillCheck lists and identifies the shape, color, and markings on all available prescribed thyroid medicines. . Look for a special Thyroid Awareness issue of EmPower® Magazine and be sure to encourage your patients to visit the Web site, www.thyroidawareness.com.
created the Meaningful Use for Specialists Tip sheet. Tip sheet topics include: • Reporting measure exclusions; • Using other providers' data; • Determining office visits for applicable measures; and • Applying for a hardship exemption. For helpful materials you can also visit the Educational Resources page on the EHR Incentive Programs website. Visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
Any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program potentially may be subject to an audit. More information The AACE EHR SURVEY was designed to address the high points and low points you have encountered either as a current or prospective EHR user with regards to selection and purchase, implementation and training, as well as the pros and cons of your everyday experiences. Take the survey located at AACE Home | American Association of Clinical Endocrinologists.
New OIG report claims millions of dollars’ worth of care to prisoners were improperly paid between 2009 and 2011. Medicare does not reimburse for services to persons who are considered incarcerated. The government defines incarcerated to include convicts who are “under supervised release, on medical furlough, required to reside in mental health facilities, required to reside in halfway houses, required to live under home detention, or confined completely or partially in any way under a penal statute or rule.” In other words, convicts may not have been in jail.
To help you protect and secure health information patients entrust to you when using mobile devices, the U.S. United Healthcare January 2013- Volume 53 Bulletin The Network Bulletin is a bimonthly online/email publication featuring important protocol and policy changes, as well as useful administrative information and clinical resources.
Department of Health and Human Services has gathered these tips and information for Physicians, health care providers and other health care professionals who utilize smartphones, laptops and tablets.
Are you familiar with what CLIA is and the new waived laboratory tests?
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Application of the Multiple Procedure Payment Reduction (MPPR) on Imaging Services to Physicians in the Same Group Practice This MLN Matters® article is intended for physicians and non-physician practitioners submitting claims to Medicare contractors (carriers and A/B Medicare Administrative Contractors (MACs)) for imaging services provided to Medicare beneficiaries.
Intensive Therapy for obesity CMS booklet
To help Medicare FFS providers understand common billing errors and avoid improper payments, CMS has developed a new MLN (Medicare Learning Network) Provider Compliance Fast Fact which is available on the MLN Provider Compliance web page.
The following MLN articles provide information on updates made to the Medicare Physician Fee Schedule and Part B Drug Pricing Files. Click on the links below for additional information. Emergency Update to the Calendar Year (CY) 2013 Medicare Physician Fee Schedule Database (MPFSDB) April 2013 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
The Food and Drug Administration has warned the public that the potentially harmful dietary supplement Reumofan Plus has been relabeled and sold as “WOW.” WOW is being marketed to treat arthritis, muscle pain, osteoporosis, bone cancer, and other conditions. For more information, click here.
FDA Approves Juxtapid to Treat Rare Cholesterol Disorder Juxtapid is a once daily capsule that impairs the creation of the lipid particles that result in LDL. For more information, click here.
To stay abreast of new reason and remarks codes that may affect adjudication of your claims, click on the link below for more information. New Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) for Medicare
To get the most updated information on how to properly bill and submit services rendered by PAs, NPs, CNSs, CPs and CSWs, click on this link MLN Matters® article.
To easily access changes made to Medicare and other federally funded programs, the Medicare Quarterly Provider Updates (QPU) makes it easier for providers to understand the changes being proposed or made to these programs’ regulations and guidelines.
QPU January- March 2013 QPU April – June 2013 QPU July – September 2013
Just a friendly reminder - CMS shares auditing information with private payers…”But by sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped. Public and private payers alike -- we all have a stake in making sure cheaters don’t undermine our health care system.
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Which blood glucose self-testing equipment and supplies are covered for Medicare beneficiaries? In addition, prescription/order requirements, quantities and frequency limits of supplies, and documentation requirements for the beneficiary’s medical record are detailed. This article reinforces information supplied in MLN Matters® article SE0738. This article is informational only and represents no Medicare policy changes.
Amendments, Corrections, and Addenda to Patient Records CGS, a Medicare Administrative Contractor, provides clarification on corrections in a patient’s charts.
Inappropriate Denials of LDL Testing GEHA (Government Employees Health Association) was previously denying CPT® code 83721 (LDL testing) when billed with CPT® code 80061 (lipid panel), inappropriately. Effective 2/7/2013, GEHA reversed the edit and will accept appeals on non-payment for claims processed prior to this date. If you have received denials for these services, contact GEHA Customer Service at (800) 821-6136 for assistance.
Attention provider specialties 01(General Practice), 04 (Otolaryngology), 08(Family Practice), 18 (Ophthalmology), 25 (Physical Medicine/Rehabilitation), 48 (Podiatry) and 66 (Rheumatology) Palmetto GBA J1, a Medicare Administrative Contractor, is performing prepayment review for CPT code 99204 for these provider specialties. Social Media Have you “liked” AACE yet? Are you on Facebook or Twitter? “Like” us on AACE Facebook or “Follow” us on AACE Twitter. Help promote our association by sharing the AACE page!
Having trouble with filing your appeal requests? Novitas Solutions, a Medicare Administrative Contractor offers the “Appeal Submission Helpful Hints. This will help expedite your appeal request and avoid delays.
AMA released the errata listing for corrections in the CPT book for 2013
What are NCDs and LCDs? NCDs (National Coverage Determinations) and LCDs (Local Coverage Determinations) are decisions by Medicare and their administrative contractors that provide coverage information and determine whether services are reasonable and necessary on certain services offered by participating providers. There are NCDs for blood glucose testing, glycated
hemoglobin, thyroid testing, lipid testing, PSA, bone density, etc., here. NEWS FROM NIH/NATIONAL LIBRARY OF MEDICINE MEDLINE PLUS
New Diabetes Guidelines May Lower Patient Medical Bills Whole Grains Linked to Lower Prediabetes Risk Obesity Declining in Young, Poorer Kids Holidays Spell Trouble for Folks Unaware They're Diabetic 4 Many Primary Care Doctors Want Help Treating Obesity
2013 Educational Opportunities for AACE Members and Non-Members
Sign Up Early - Limited Seating for All Courses Courses Designed for Physicians, non-physician practitioners, coders, billers, practice management etc.
Fundamentals and Advanced Endocrine Coding June 20-21 Raleigh, NC December 5-6 Miami, FL
What is an AACE-Certified Endocrine Coder?
Attend this course to gain fundamental and advanced knowledge and resources required to maximize reimbursements, comply with federal and commercial guidelines, and stay compliant with the various state, federal, and commercial regulations. Attendees will gain a foundation of how to accurately code and document your patient encounters. Learning Objectives: Discuss medical records, documentation standards, patient encounters, and appropriate use of signatures ® Define ICD9-CM, CPT , and HCPCS book formats, conventions and guidelines Discuss principles of common endocrine modifiers used with office visit codes and FNAs Discuss coding and documentation principles of infusions, injections, and nurse visits Outline the differences in 1995 and 1997 E/M guidelines used to report office visits Discuss various levels of E/M services and required documentation to report different levels Define the key components (history, exam, and medical decision making) in an office visit Determine appropriate calculations for levels of E/M services using “real life” endocrinology notes Click here for more information or review agenda here.
Bridge the Gaps in Endocrine Coding July 22 Jacksonville, FL August 15 Atlanta, GA
New Information
With ongoing scrutiny from government and commercial insurance payers, physicians and their office staff must stay up-to-date on the most current coding, billing and compliance issues occurring in the health care arena. This goal of this course is to:
Define medical necessity and its importance in the medical record through proper diagnosis coding and specific documentation Interpret the various modifiers commonly used in endocrinology and the required documentation to support their use Provide information on correct coding and documentation of FNAs, slide reviews for adequacy of specimens and multiple nodules aspirated Discuss required documentation elements to report therapeutic and preventive services commonly performed in an endocrinology office Click here for more information. Click here to see the NEW and UPDATED Agenda
E/M Documentation for Endocrinologists: What’s in Your Record? July 23 Jacksonville, FL August 16 Atlanta, GA CMS, OIG and commercial insurance carriers are conducting more medical reviews to determine if providers are documenting, billing and coding E/M services appropriately. By attending this course, you will gain a better understanding of how to properly document these services to avoid some of the common documentation pitfalls. Topics of discussion: What really constitutes a comprehensive history, exam and a high-level medical decision making? How many systems have to be reviewed to equal a comprehensive review of system (ROS)? What is considered “personal history” and who can take the information from the patient? What must be documented in the patient’s chart to meet a “detailed” exam? Click here for more information. Review the agenda.
All course dates, times and locations are subject to change. For more information contact AACE or call 904-353-7878. 5
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.
The “Just Becauses” of Coding… Just because: There is a CPT® code for a procedure does not mean it’s covered. Just because: There is NOT a CPT® code for a procedure does not mean it’s NOT covered. Just because: It is a covered procedure or service does not mean it will be paid. Just because: You were paid does not mean you were paid correctly. Just because: You were paid does not mean you will not be asked to return the reimbursement. Just because: You are asked to return money does not mean you shouldn’t appeal that decision if you feel it’s incorrect or unjust.
Code what is documented in the patient’s chart - do not document the patient’s chart to code!
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 , ICD-9-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. © 6 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 assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.