The Edge Blast E-Newsletter
posted 10/03/2007
Electronic news for October 2007
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 .5 CEUs, for a total of 12 CEUs annually.



Contrast Medium No Longer Included in MRI Procedure

The cost of the contrast media used in magnetic resonance imaging (MRI) procedures is no longer included in practice expense (PE) relative values units (RVUs) of CPT® imaging codes. Therefore, if your physician performs MRIs, you may be able to separately report the contrast media used.

In addition to the CPT® code representing the imaging procedure, you may be able to additionally bill an HCPCS Q code (Q9945-Q9954, Q9958-Q9964) for the contrast medium used in performing the service.

Note: The TC RVUs for MRIs that specify “with contrast” include payment for paramagnetic contrast media and are not separately billable under code A4643.

Limitations are also set for high-dose contrast MRIs. This technique involves first performing an MRI of the brain or spine without contrast material, and then performing another MRI with a standard dose of contrast material. If necessary, a third MRI is performed with an additional double dosage of contrast material to obtain a better image. To submit payment for the double dose of contrast material in the third procedure, report CPT® codes 70553 (without contrast material, followed by with contrast material(s) and further sequences), 72156, 72157, and 72158. You can then separately report  the contrast material given for the third MRI procedure through supply code Q9952 (the replacement code for A4643). Do not report the third MRI procedure using CPT® code 70551 (Magnetic resonance (e.g., proton) imaging, brain (including brain stem; without contrast material) as 70553 includes all further sequences.

The Centers for Medicare and Medicaid (CMS) rendered this recent change in policy effective Jan. 1, 2007. However, FIs and carriers do not have to retroactively process prior claims. It’s up to the provider to reprocess claims with dates of service on or after Jan. 1, 2007. Although the Centers for Medicare and Medicaid Services  (CMS) did not implement the recent change in policy  until October 22, 2007, it is effective retroactive back to January 1, 2007.

Go to http://www.cms.hhs.gov/MLNMattersArticles/ for a provider education article on this instruction.



CMS Awards WPS as Third MAC

Wisconsin Physicians Service Health Insurance Corp. (WPS) is the third carrier to be selected as a Medicare Administrative Contractor (MAC) with the CMS. WPS signed a five-year contract with CMS to administer Part A and Part B Medicare claims payment in its four-state jurisdiction (A/B jurisdiction 5)—Iowa, Kansas, Missouri, and Nebraska—beginning no later than Sept. 9, 2008.

WPS will take claims payment work currently performed by four fiscal intermediaries and three carriers in the four states. Under the current system, fiscal intermediaries process claims for Medicare Part A providers, such as hospitals, skilled nursing facilities, and other institutional providers.  Carriers process claims for physicians, laboratories, and other practitioners under Medicare Part B.

CMS awarded the first MAC contract in July 2006 to Noridian Administrative Services, LLC headquartered in Fargo, N.D. In addition to North Dakota, Noridian covers Arizona, Montana, South Dakota, Utah, and Wyoming (A/B jurisdiction 3). The second contract was awarded on Aug. 3, 2007 to TrailBlazer Health Enterprises, headquartered in Richardson, Texas. TrailBlazer will cover its home state as well as Colorado, New Mexico, and Oklahoma (A/B jurisdiction 4).

CMS’s stated objectives for MACs include enhanced provider customer service, increased payment accuracy, and improved provider education and training. When contracting reform—under the Medicare Modernization Act of 2003 (MMA)—is fully implemented in 2011, all the fiscal intermediaries and carriers will be replaced by 15 MACs—giving both beneficiaries and providers a single point of contact with the Medicare program. Section 911 of the MMA requires HHS to fill the MAC positions with companies that can marry Part A and Part B claims to more effectively fight fraud.

For more information, see www.cms.hhs.gov/MedicareContractingReform.




Capitalize on PSA Bonuses While You Still Can

If your provider is a doctor of medicine or osteopathy who renders services in a designated physician scarcity area (PSA), you may qualify for a 5 percent bonus … but not for long. The requirement for Medicare to pay the 5 percent bonus to physicians working in a PSA—as written in section 413(a) of the Medicare Modernization Act 2003 (MMA)—started on Jan. 1, 2005 and ends Dec. 31, 2007.

Medicare pays qualifying physicians an additional 5 percent bonus on the amount that is actually paid, not the amount Medicare approves for each service.

When submitting a claim, remember to report modifier AR (physician providing services in a physician scarcity area). Additional modifiers may be required, depending on locality and service.

For complete details regarding this issue, see the official instruction (CR5711) issued to your Medicare carrier, FI or A/B MAC on the CMS website at www.cms.hhs.gov/Transmittals/downloads/R1321CP.pdf. You can also find a wealth of information about HPSA/PSA as well as zip code downloadable files at www.cms.hhs.gov/HPSAPSAPhysicianBonuses.




Latest NCD for PTA Clarifies Who Qualifies for Coverage and When

The Centers of Medicare and Medicaid (CMS) recently reaffirmed the NCD for percutaneous transluminal angioplasty (PTA) of the carotid artery. In the CMS Manual System, Pub 100-03 Medicare NCD, Transmittal 77 released Sept. 12, CMS clarifies coverage of PTA.

The NCD states that PTA coverage continues to be limited to procedures performed by certified facilities using Federal Drug Administration (FDA) approved carotid artery stents and embolic protection devices.

The transmittal also states that PTA continues to be covered when used under the following conditions:

  1. Treatment of atherosclerotic obstructive lesions.
  2. Concurrent with carotid stent placement in FDA-approved category B Investigational Device Exemption (IDE) clinical trials.
  3. Concurrent with carotid stent placement in FDA-approved post approval studies.
  4. Concurrent with carotid stent placement in patients at high risk for carotid endarterctomy (CEA).
Facilities must recertify every two years in order to maintain Medicare coverage. Read the complete guidelines on the CMS website at www.cms.hhs.gov/transmittals/downloads/R77NCD.pdf.



EdgeBlast Test Yourself

By answering the following questions, you can earn .5 continuing education units to apply toward your annual AAPC CEU renewal every two years. Simply answer the questions and send in a copy of your work when submitting your CEU package. Do put the number of each EdgeBlast included in your submission. The number is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources, such as your ICD-9-CM, CPT® and HCPCS manuals.

1. Name the act of Congress that ensures fiscal intermediaries and carriers will be replaced by 15 MACs by 2011.

Answer:

 

2. For qualifying physicians providing services on or after Jan. 1, 2005 to receive a 5 percent PSA bonus, which modifier must they report when submitting claims?

Answer:

 

3. Does CMS allow FIs and carriers to apply the payment criteria for low osmolar contrast media in 30.1.2 to billings for Q9952?

Answer:

 

4. If deployment of the distal embolic protection device is not technically possible, will Medicare still cover PTA?

Answer:

 

5. Which CPT® code should you use in order to bill separately for the double dose of contrast material used in a high-dose contrast MRI procedure?

Answer:

 

CPT® codes Copyright 2006 American Medical Association. All Rights Reserved.
CPT® is a trademark of the AMA.
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.