Medicare Compliance & Reimbursement

Physicians billing for lung volume reduction surgery - which will be covered by Medicare starting Jan. 1, 2004 - should use CPT code 32491, the Centers for Medicare & Medicaid Services says in a Nov. 4 "one-time notification" update to the CMS Manual System (change request 2688). Physicians should add modifier KZ on claims for LVRS performed on Medicare beneficiaries who are enrolled in a Medicare+ Choice plan. In other recent updates to the Manual System, CMS:      lays out six new portable x-ray Level II HCPCS modifiers reportable with HCPCS R0075 (CR 2928);      outlines Clinical Laboratory Improvement Amendments-related policies for fecal leukocyte examination (CR 2856);      clarifies the use of the GY modifier to identify clinical diagnostic laboratory services that aren't covered by Medicare (CR 2924);      updates the list of waived tests under CLIA (CR 2933);      lays out changes to the laboratory national coverage determination edit software (CR 2935);      updates policies relating to the Comprehensive Error Rate Testing program (CR 2824);      updates the list of HCPCS codes used for skilled nursing facility consolidated billing enforcement (CR 2926);      lists 2004 Medicare deductible, coinsurance and premium rates (CR 2969); 

    announces the release date of the next quarterly update to the Correct Coding Initiative edits (CR 2938);      implements recent corrections to the hospital inpatient prospective payment system rule (CR 2971);      updates the durable medical equipment, prosthetics, orthotics and supplies fee schedule for 2004 (CR 2957);      updates payment rules under the outpatient PPS (CR 2908);      schedules release dates for Medicare contractor software updates (CR 2972); and      updates the Provider Statistical and Reimbursement system (CR 2953).     To see the updates, go to http://cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp.