Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 15, 2008 PDF

Do you avoid unlisted procedure codes? This quiz may change your mind

It's time again to determine whether you're a Medicare ace or if you still need some assistance with your skills.

Last month, you took our Part B challenge seriously. Many of you wrote in with questions for a future quiz, and today we're putting you to the test with a few more reader-submitted questions that will help you understand Medicare's complicated billing and coding rules.

After you review these three Medicare Part B test questions, turn to page 252 to see how you fared.

Question 1: Our physician works with residents every year and it is very time-consuming for him. He does review their documentation and indicate that he agrees with their findings. He doesn't use a rubber stamp -- instead he actually writes, "Seen and agreed" on the chart before he signs it. A consultant told us that this is unacceptable. Why would that be?

Question 2: I just returned from a coding conference, where a speaker said that the OIG told Medicare to institute a Correct Coding Initiative (CCI) claims edit that would allow payment only for specific code pairs when practices appended modifier 59 (Distinct procedural service). This is sure to throw a wrench into our coding practices. When does it begin?

Question 3: We read an article in your publication recently regarding the fact that we should report an unlisted code for procedures that don't have their own CPT codes. Previously, we had been reporting codes that were close to the unlisted procedure, and we accept that we were coding incorrectly.

However, we don't agree with the reimbursement amounts that Medicare is paying us for these unlisted CPT codes. How do we explain to our carrier that what the physician performed warrants as much money as a similar code?

Ready to check your answers? Tally your coding and billing challeng score by turning to page 252 for the answers to these questions.

To submit questions for a future Part B Quiz, you can send an email to Editor Torrey Kim, CPC, at torrey@partbinsider.com.