Read the EdgeBlast and Earn CEUs Toward Your Annual Renewal

Earn continuing education units (CEUs) by reading the EdgeBlast. Simply answer the five questions found in the EdgeBlast Test Yourself at the end and submit your answers at the time of your renewal, using the same process you follow monthly for the Test Yourself in the AAPC Coding Edge. Each EdgeBlast (there are two issued each month) will feature five questions that are worth 0.5 CEUs, for a total of 12 CEUs annually.

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Don't Bank on Proposed Rule as Full Preview of ICD-9-CM

Many people in health care review the Centers for Medicare and Medicaid Services (CMS) proposed rule for inpatient prospective payment system (IPPS), published this April in the Federal Register. Included in the proposed rule are tables showing recommended newly created or changed ICD-9-CM codes, as well as a table that shows all valid codes for the previous year but are invalid for the new year.

That's because this year, the National Center for Health Care Statistics (NCVHS) asked that 125 new codes introduced at the March ICD-9-CM Coordination and Maintenance Committee Meeting be included in the 2009 code set. There wasn't enough time before the March meeting and the April proposed rule to incorporate these codes into IPPS. We will only know if these codes will be part of the final rule when that rule is published in the Federal Register in August.
Among the "fast-tracked" diagnoses:

• A breakout of codes specific to methicillin susceptible staph in categories 038, 041, 482, V02, V09, and V12.
• Fifth-digit codes expanding 780.6 for fevers categorized as caused by other conditions (leukemia, for example), as postprocedural or postvaccination, as well as new codes for chills and hypothermia.
• Expansion of wound disruption codes and significant addition of inclusion terms within 998.3.
• A new code for dural tear occurring as a complication of spinal procedures.
• An overhaul of E codes proposed by the Department of Defense (DoD) involving more than 100 new codes.

These codes are in addition to more than 100 new codes considered for implementation in Oct. 1 for the 2009 ICD-9-CM code set.

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DOL Says Certified Coders Are in High Demand

According to the U.S. Department of Labor (DOL) Occupational Outlook Handbook, employment for medical records and health information technicians is expected to rise; particularly, technicians with a strong background in medical coding will be in high demand. Employment is expected to rise by 18 percent through 2016. This rapid growth is due to the rising number of medical tests, procedures, and treatments that are increasingly scrutinized by health insurance companies, regulators, courts, and consumers. Soon technicians will be vital in entering patient information into computer databases to comply with Federal legislation mandating the use of electronic medical records.

You can view the complete page that points out the importance of compliance and hiring certified coders at:  http://www.bls.gov/oco/ocos103.htm.

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Vaccine Allowance Adjustments for Providers

On March 7,  change request (CR) 5910 clarified CR 5744 "Payment Allowances for the Influenza Virus Vaccine and the Pneumococcal Vaccine When Payment is Based on 95 Percent of the Average Wholesale Price (AWP)," released Oct. 26, 2007. CR 5910 deletes the reference to "institutional providers" on page 2 in the first bullet regarding the use of HCPCS code G0009 Administration of pneumococcal vaccine. The sentence with code G0009 now begins with "providers" rather than "institutional providers," as stated here:

"CPT® Code 90669 – Effective January 1, 2008, FIs, carriers, and A/B MACs will accept claims containing 90669 for pneumococcal vaccine. In order to facilitate appropriate payment for CPT® code 90669 (Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use), carriers and A/B MACs will use a payment indicator of "1" and the deductible indicator of "1". Providers should bill HCPCS code G0009 when billing for services on or after Jan. 1, 2008, for the administration of CPT® code 90669."

All other information remains the same.
This affects providers of influenza and pneumococcal vaccines to Medicare beneficiaries who bill Medicare contractors (fiscal intermediaries (FI), carriers, or A/B MACs): i.e., physicians, hospitals, and other providers.

CR 5910 adds to CR 5744 instructions regarding pediatric pneumococcal vaccine CPT® code 90669, and the updated payment allowance for the nasal influenza virus vaccine CPT® code 90660 Influenza virus vaccine, live, for intranasal use.

Effective Sept. 19, 2007, the Medicare Part B payment allowance for 90660 is $22.031. Billing staff should be aware of these CPT® code updates.

For the complete MLN Matters article on the CMS website, go to: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5910.pdf

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Get Our Legal Advisory Board's Take on RAC

For the Record magazine published a great article that features Timothy P. Blanchard, JD and Julie E. Chicoine, JD, RN, CPC of our Legal Advisory Board. Find out what our experts have to say about the Recovery Audit Contractor (RAC) program in relation to the health care community at: http://www.fortherecordmag.com/archives/ftr_03032008p14.shtml