Part B Insider (Multispecialty) Coding Alert
Make Sure You're Up To Speed On How To Report 29873
PDF
Bad news: Expect less payment than what you're used to
As of July 5, 2005, Medicare implemented special coding rules for multiple-endoscopic- procedures when you bill the procedure with another endoscopy in the same family. Here's a reminder about the change and why you may be surprised by your payment.
Remember: The "arthroscopic base code" column in the Fee Schedule determines if your arthroscopies fall under one of the base codes. "If they do, then you have to follow the multiple-endoscopy rule," advises Angela Daniels, RN, office manager for Thomas Daniels, MD, in Seattle.
Old way: In the past, if you reported 29873 (Arthroscopy, knee, surgical; with lateral release) with another arthroscopic knee procedure, such as 29880 (...with meniscectomy [medical AND lateral, including any meniscal shaving]), Medicare payors applied the "multiple procedure rule" to the lower-valued procedure. Medicare paid the first procedure at the full RVU allowable rate, but discounted the procedure by 50 percent.
New way: Now, if you report 29873 with any other code in the 29870-29887 group, you will encounter Medicare's multiple-endoscopic procedure rule, not the multiple procedure rule. Using the old payment rules, you would have collected the full $797 for 29883, and about $248 for 29873 (50 percent of the $496 allotted for 29873). Under the new rules, you'll lose more than $140 if you report 29873 with other codes in the 29870 base family.
Rule of thumb: "For multiple endoscopic procedures, use the full value of the highest valued endoscopy plus the difference between the highest and the base endoscopy," instructs the Medicare Carriers Manual. Explanation: The knee family's base code (29870) carries 10.81 RVUs, so if you bill 29873 with 29883 (Arthroscopy, knee, surgical...), your Medicare carrier will reimburse you using the full RVU allocation for 29883 (22.04 RVUs or about $797.00).
The numbers: The payor will then pay you just 2.91 RVUs for 29873. The insurer calculates this figure by subtracting 29870's 10.81 RVUs from 29873's 13.72 RVUs. Medicare carriers then multiply the RVUs by 36.177, which is the conversion factor listed in the 2006 Fee Schedule, to come up with the procedure's value: about $105.
Part B Insider (Multispecialty) Coding Alert
- CCI EDITS:
5700 Drug Administration Edits Are Heading Your Way
Make sure your documentation justifies separate services
Brace yourself for a new [...] - CCI EDITS:
You Can't Use A Modifier To Unbundle Radiology Codes With E/M Visits
New nursing home, domiciliary care codes hit with hundreds of edits
Radiologists will find life especially [...] - CAPITOL HILL WATCH:
Heads Up--Budget Discussions May Continue Into 2006
And a pay freeze, not a pay hike, may be the best you can hope [...] - CERT Program Not Consistent, OIG Says
If the Comprehensive Error Rate Testing auditor didn't do a good job of following up [...] - MODIFIERS:
Prepare For Audits Of Modifiers 25 And 59
Pitfall: A quarter of modifier 59 claims didn't have enough documentation
The HHS Office of Inspector [...] - E/M SERVICES:
You May See More Reimbursement For The E/M Coding You're Already Doing
MedPAC considers a 2.7 percent increase in your payments for 2006 and 2007
- RADIOLOGY:
Avoid These PET/CT Coding Pitfalls
Find out 3 important documentation must-haves
You can expect claims denials if [...] - OPHTHALMOLOGY:
Opt For Accurate OPT Coding With This Advice
Lesions' appearance will affect your claim alternatives
Medicare recently changed the conditions [...] - GYNECOLOGY:
You Be the Coder--Attain Vaginal Suspension Coding Victory With This Advice
Question: I have documentation that the ob-gyn performed a vaginal vault suspension at the same [...] - CARDIOLOGY:
Reader Question--Don't Have A Heart Attack Over Bundled Angioplasty Codes
Question: The recent National Correct Coding Initiative edits for angioplasty coding have me confused. How [...] - Got something to say? Look who's talking...
The PBI Discussion Group is your resource for connecting with coding and billing [...] - INTERNAL MEDICINE:
Lessen ABPM Coding Pressure With These Ideas
Key: ICD-9 code 796.2 can get you $67
The code you report for ambulatory [...] - NEUROSURGERY:
Uncover How 2 Non-Covered Services Can Pay Off
Hint: ABN/modifier combo will guarantee payment--and protect you
When it comes to reimbursement for non-covered procedures, [...] - ORTHOPEDIC:
Make Sure You're Up To Speed On How To Report 29873
Bad news: Expect less payment than what you're used to
As of July 5, 2005, [...] - Part B Coding Coach:
Brace Yourself For 2006 Injection And Flu Shot Coding With 4 Need-to-Know Tips
Warning: You may be over-reporting 99211 and sending up a red flag to Medicare
A long-standing [...] - 3 Steps Pinpoint the Right Flu Shot Code
Selecting the right codes for a flu shot visit is as easy as 1-2-3. Follow [...] - PHYSICIAN NOTES:
Physicians 'Skeptical' Or 'Hostile' About Quality-Reward Systems
Not much money, lots of extra work, in pay for performance
There's "lots of buzz," but [...]