Excessive Lithotripsy Services Tip OIG Hat

George Washington University Hospital received overpayments totaling $32,000 for 39 outpatient lithotripsy services, according to an Office of Inspector General  (OIG) report. The OIG concludes in the April report that the Washington, D.C. hospital received these overpayments because it billed for the same lithotripsy service using multiple revenue codes.

The OIG reviewed 37 payments totaling $93,009 that the intermediary (Wisconsin Physicians Service) paid the hospital for 76 lithotripsy procedures from Jan. 1, 2003, through Dec. 31, 2007.

Of the 37 claims, the OIG says, the hospital received payment for excessive treatments because the hospital billed Medicare at least twice for the same lithotripsy service on numerous occasions. The hospital correctly billed the lithotripsy service using the extracorporeal shock wave therapy revenue code 0790 with CPT® code 50590 Lithotripsy, extracorporeal shock wave and incorrectly billed for the same service using the operating room revenue code 0360 with code 50590. The hospital received $93,009 for these lithotripsy services, rather than the allowable amount, $61,170, resulting in overpayments totaling $31,839.

George Washington University Hospital reviewed the 37 claims and agreed that the claims included duplicate lithotripsy charges. During the review, the hospital identified two additional claims. The hospital attributed the incorrect payments to an isolated problem that the hospital fully remedied.

Source: OIG April 2010 report: “Payments for Outpatient Lithotripsy Services Provided at the George Washington University Hospital, Washington, D.C.”


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