Part B Insider (Multispecialty) Coding Alert

Published on Tue May 24, 2005 PDF

CMS Monitoring IVIG Access

Some advocacy groups and providers have complained that patients are having trouble obtaining intravenous immune globulin services (HCPCS codes Q9941-Q9944) due to low rates, the Centers for Medicare and Medicaid Services notes in its latest drug price information.

The Food and Drug Administration hasn't identified a shortage of IVIG, and manufacturers say they have plenty available. But CMS admits that access to IVIG is an important health issue, and the agency promises to monitor availability. For the third quarter of 2005, CMS is raising the payment amount for the powdered form of lyophilized IVIG by 9 percent.

Majority Of Chiropractic Claims Have Documentation Problems

Nearly 94 percent of Medicare chiropractic services in 2001 was missing important supporting documentation, the HHS Office of Inspector General said in a new report, "Chiropractic Services in the Medicare Program: Payment Vulnerability Analysis" (OEI-09-02-00530).

Out of 400 sampled claims, 67 percent didn't meet Medicare coverage criteria. These included "maintenance" treatments, which Medicare doesn't cover, and services that were miscoded, undocumented or billed at the wrong spinal level. Medicare paid $285 million for improper chiropractic claims, the OIG says, and $15 million for upcoded claims. The Centers for Medicare and Medicaid Services should tell the carriers to review chiro claims and put controls on the frequency of chiropractic claims, the OIG insists.