The Centers for Medicare & Medicaid Services (CMS) has changed billing instructions in Pub. 100-04, chapter 5, section 20.2 of the Medicare Claims Processing Manual. Starting Oct. 1, 2010, providers billing for therapy services don’t have to include the number of visits via the following codes:

50 Physical therapy

51 Occupational therapy

52 Speech therapy

53 Cardiac rehab

The Centers for Medicare & Medicaid Services (CMS) has new, revised and invalid diagnosis and procedure codes that begin Oct. 1. There are 122 new diagnostic and 12 procedure codes.

There are also 11 diagnosis codes and one procedure code that re invalid on Oct. 1. The invalid diagnosis codes are:
275.0 Disorders of iron metabolism
276.6 Fluid overload
287.4 Secondary thrombocytopenia
752.3 Other anomalies of uterus
786.3 Hemoptysis
787.6 Incontinence of feces
970.8 Poisoning by other specified central nervous system stimulants
999.6 ABO incompatibility reaction
999.7 Rh incompatibility reaction
V25.1 Encounter for insertion of intrauterine contraceptive device
V85.4 Body Mass Index 40 and over, adult

Invalid procedure code:
39.8 Operations on carotid body, carotid sinus and other vascular bodies

Errors in the Nov. 25, 2009 Federal Register and its Dec. 10, 2009 correction notice have been clarified in the final 2010 Medicare physician fee schedule rule.

The 2010 conversion factor has been reduced from $28.3895 to $28.3868. For more, read Physician Fee Schedule

It seems modifier 59 is the most incorrectly used one in dermatology, according to ModernMedicine.com.

59 brings the most claim denials because it represents services rendered on the same day and not for bundling. Same day services can be billed if they’re for different sites or lesions, though.

Be sure to get the Correct Coding Initiative released every three months. You can get it at the National Technical Information Service NTIS.gov

For more information, visit ModernMedicine.com

The AMA has the monopoly on medical codes worth millions of dollars annually. Opponents say it increases health care costs.

Who’s right? The Chicago Tribune offers an excellent rundown of both sides.

Chicago Tribune

While we know money is money and you can process claims for everyone, it’s always nice to get a specialty. You tend to work faster by knowing the codes better and health care providers tend to know more people in their type of medicine and can refer you more often.

So what’s the growing trend in health care? Diabetes. The University of Chicago projects Americans with diabetes (including yours truly for 16 years) will grow from 23.7 million today to 44.1 million in 2034. Medicare spending will increase from $45 billion to $171 billion. That’s more than half of Medicare’s budget.

It’s not a bad specialty to go into.

The Centers for Medicare and Medicaid services changed its procedures and you’ll never guess what happened – higher error rates.

Imagine that.

The goal was to improve fee-for-service rates by hospitals, but increased scrutiny over billing has doubled the error rate from 3.6 percent in 2008 to 7.8 percent last year.

Providers must now submit all clinical and medical documents to support the claim, ensure signatures are legible (I remember leaving the hospital after major surgery being forced to sign a paper when I could barely stay coherent so good luck with that) and hospitals can no longer use claims histories to fill in missing treatment information.

Big brother is being a mother.

The American Academy of Professional Coders (AAPC, www.aapc.com) has released its ICD-10-CM online code conversion tool, which is now available online at www.aapc.com/icd-10/codes. This valuable tool allows users to convert (or “map”) ICD-9-CM codes to ICD-10-CM codes (and vice versa) based on the General Equivalency Mapping (GEM) files published by the Centers for Medicare and Medicaid Services (CMS).

The tool is free and available to the public with no access code or password required. Developed by the AAPC, this tool is expected to be a huge resource to medical coders and health care professionals as they begin to transition to the new ICD-10 system.

TO: Members of the ICD-9-CM Coordination and Maintenance Committee
FROM: The American Academy of Professional Coders (AAPC)
RE: AAPC’s position regarding suspension of code changes prior to and following implementation of ICD-10-CM and -PCS

The American Academy of Professional Coders does not support the freezing of changes to ICD-9-CM prior to the Oct. 1, 2013 implementation of ICD-10-CM and ICD-10-PCS. Because changes to other coding systems, specifically CPT and HCPCS Level II, will be required regardless of any change in ICD-9-CM code change scheduling, AAPC can see no benefit to freezing ICD-9-CM. And because medical science is continually evolving, AAPC believes any freeze of updates to diagnostic coding affects reporting accuracy and should be limited.

AAPC supports a freeze in changes to ICD-10-CM and ICD-10-PCS. Because all users will be setting up entirely new systems to accommodate ICD-10-CM and ICD-10-PCS in the year(s) prior to implementation, AAPC supports a freeze on changes to the ICD-10-CM and ICD-10-PCS code sets beginning Oct. 1, 2012 (one year prior to implementation) and continuing until Oct. 1, 2014 (one year following implementation). This will provide a 24-month hiatus from any changes to the new system, which will ease the burden of adoption for all participants.ICD-9

The new ICD-10 coding starts in 2013. Are your clients readying?

Studies show many aren’t. Four years away is forever in some business circles. Health care providers resist spending large sums on technology for fear it will be outdated by 2013. I can see the reasoning behind that, but read over this excellent article on why readying for the coming storm is needed now.

Health care finance news.com

90210.

If you’re older than 30, that number makes you think of the evening soap opera from the ’90s that returned last year in its second generation.

Ironically, it’s almost the billing code for the H1N1 swine flu shot. Go figure. Somebody has a sense of humor. If only Tori Spelling would give me the injection.

The new billing code is 90470. We checked –it’s also  a zip code for Finland. Hmm, Finish actresses on a soap opera. Maybe we can pitch Hollywood that idea

• 90470—H1N1 immunization administration (intramuscular, intranasal), including counseling when performed
• 90663—Influenza virus vaccine, pandemic formulation, H1N1

The Healthcare Billing & Management Association (HBMA), a non-profit educational resource and advocacy group
representing third-party medical billers and billing professionals, has formed an ICD-10 Task Force. The four-year
committee will collaborate with public and industry leaders to
develop an ICD-10 implementation structure and resources to help minimize the
cost, uncertainty and complexity of the transition to the new diagnostic code set.

“The magnitude of this administrative change will be far greater than anything the
healthcare field has seen in our lifetimes,” says Holly Louie, RN, CHBME, PCS and
chair of the ICD-10 Task Force. “If the transition to the new electronic standards and
entirely new coding system is not well-planned, providers and their business partners
could see major disruption. Our group has broad industry representation and we’ve
been focusing on ways to minimize the impact while achieving the intended
benefits.”

Looking for a simple fact sheet on the new ICD-10 rules? So are we. Our friends at Modern Medicine.com have a nifty 4-pager that gets you started.

Modern Medicine face sheet

We recently heard how California’s six largest private insurers reject 22 percent of claims – 47.7 million annually. We’re now seeing how it breaks down.

The California Nurses Association /National Nurses Organizing Committee broke down the data from 2002 through June 30, 2009.

Pacificare:   39.6% denied
Cigna:  32.7% denied
HealthNet:  30% denied
Kaiser Permanente: 28.3% denied
Blue Cross:  27.9% denied
Aetna:   6.4% denied

You do business with these firms. Now be forewarned – you’re not alone dealing with these problem companies. Medical billers are rarely the reason they for rejection, but be sure you’re ready for war.

The Centers for Medicare and Medicaid Services released the World Health Organization’s International Classification of Diseases, 10th edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS).

ICD-10 will be mandatory for all U.S. healthcare organizations on Oct. 1, 2013, but the system has been around since 1983. The current system, ICD-9-CM, is considered inconsistent with modern billing. The new ICD-10 will better target exact treatments.

The new system will use seven digits or letters while the current ICD-9 uses three or four numeric digits.

Good question. It does, well will, on Oct. 1 when Medicare codes are updated. The H1N1 could go under #488 as part of influenza viruses, but a new code should be coming. The good news is the vaccine won’t be widely available until then anyway. And while the federal government has been advocating you get the regular flu shots now, most places won’t have them ready until the usual start around Oct. 1.

Twenty percent of claims to California’s largest private medical insurers were rejected between 2002 and June 30, 2009, says the California Department of Managed Care.

That number is being used to fuel the “death panel” debates in rebuttal to President Obama’s proposed health care overhaul. But, we’re wondering what it means to those of you who bill these insurers?

Twenty percent kickback is way above the industry standard. Your percentage may show how well you’re doing in presenting the claims correctly. If you’re seeing only 5 percent rejected, then you’re doing much better than most.

Take a moment to reflect on your billing practices. A 20 percent rejection rates does nothing but waste your time and money. Are you reviewing codes correctly? Have you take education classes recently? Is your health care provider giving you the right information?

A few minutes of reflections will save hours of rejection.

Sometimes health care providers follow the path of least resistance when it comes to coding. Actually, they do it a lot even at the cost of more revenue.

Code 99213 is an old reliable. One that doesn’t shake the coding police. According to PhysiciansPractice.com using CMS data, family practice physicians used the code 21.5 million times in 2007 while internal medicine physicians did so 26.5 million.

So what’s the big deal with a safe and proven code? It’s not always the right one.

“This is surprising because with Medicare patients, because of their age and the way the health cycle goes, you might expect increasing complexity. I think this means physicians are coding this incorrectly,” coding expert Bill Dacey told Physicians Practice. “The patients I see in the internal medicine waiting rooms aren’t there with tennis elbow. They’re there with diabetes, hypertension, or constant back pain. They have more things going on [that] are better represented by a [99214].”

Click the link on a fascinating story that will help you better advise health care givers on whether 99213 is still No. 1.

http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1373.htm

Denial codes — the bane of our existence — has a new challenger.

The Medical Banking Project recently reported standardization is absent when dealing with denial codes. Yet, there is standardization for remittance codes, meaning it can be done for denials, too. The board wants standard denial codes so everyone can quickly understand why a claim was rejected.

Good luck.