As you might be aware, CMS does not recognize the 80101/80102 codes any longer. HCPCS code G0430 was deleted and was actually broken out into new categories with G0431 and G0434 more accurately describing the work involved in collecting and testing the urine samples.
In 2011, G0431's descriptor was changed to: "Drug screen, qualitative; multiple drug classes by high complexity test method (e.g.
From AMA Practice Management Alerts:
Free AMA resource helps physicians put prevention into practice for Medicare patients
New law limits "creditors" subject to Red Flags Rule
Many physicians will avoid being subject to the Red Flags Rule enforcement date because a new law, the Red Flag Program Clarification Act of 2010, limits the d
By David Waldman, CPC, CPC-H, Deb Carr, CCS and Leslie Johnson, CCS-P, CPC
November 2010 CPT Assistant Article, stated that for CPTs 62270-62273, 62280-62282, and 62310-62319 were codes in which fluoroscopic guidance (CPT 77003) was an inclusive component and should not be billed separately.
It was questioned: “Did something change?” and if there was a change, when did it happen? We sent the question directly to the AMA's CPT Network via electronic inquiry: November 2010 CPT Assistant indicated that something has changed in regards to reporting for example 77003 in addition to 62310-62319. Or has this been a misinterpretation of CPT's traditional stance on reporting fluoroscopic guidance (CPT 77003) separately with, for example, CPT codes 62310-62319?
We received our direct response in writing from the AMA on Jan 4, 2010. Part of their response stated: “Based solely upon the information provided in your electronic inquiry, from a CPT coding perspective, please be advised that a correction will be published on our AMA CPT website and in the next edition of the CPT Assistant. For certain spinal procedures, fluoroscopy is NOT considered inclusive of the procedure (eg, 62267, 62270-62282, 62310-62319) and is indeed separately reportable, when performed.”
It should also be noted that CCI Edits do not indicate that a bundle edit exists for the code pairs of 62310 through 62319 with 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction).
It is our recommendation to continue coding and reporting these codes as we have always done and if any denials occur due to the November 2010’s of CPT Assistant article error, appeals should be made.
From Frank Cohen:
As some of you may know, CMS released an ‘emergency’ fix to the RBRVS yesterday. It’s quite amazing, actually, that only four days before the new fee schedule it to become effective, CMS is still making changes, which all but guarantees that neither vendors nor providers will have enough time to get the changes implemented on time.
Home Health Face-to-Face Encounter;
A New Home Health Certification Requirement
A new Medicare home health law goes into effect on January 1st that affirms the role of the physician as the person who orders home health care based on personal examination of the patient. Effective in January, a physician who certifies a patient as eligible for Medicare home health services must see the patient. The law also allows the requirement to be satisfied if a non-physician practitioner (NPP) sees the patient, when the NPP is working for or in collaboration with the physician.
American Medical News - Gov't
OIG Criminal & Civil Enforcement
- Cenla Community Action Committee's Financial Management Practices and Systems Did Not Always Meet Federal Requirements
- Rhode Island Hospice General Inpatient Claims and Payments Did Not Always Meet Federal and State Requirements
- Massachusetts Medicaid Payments to Calvin Coolidge Nursing and Rehabilitation Center for Northampton Did Not Always Comply With Federal and State Requirements
- Wyoming Incorrectly Claimed Enhanced Reimbursement for Medicaid Family Planning Sterilization Costs
- The Medicare Contractor's Payments to Maryland Providers in Jurisdiction 12 for Full Vials of Herceptin Were Sometimes Incorrect