Part B Insider (Multispecialty) Coding Alert

Published on Sat Sep 12, 2009 PDF

Plus: CMS plans to debut two new physician specialty designations for hospice providers and geriatric psychiatrists.

Warning: Don't append modifiers PA, PT, or PC to your claims unless you've performed the wrong surgery, or treated the wrong patient or body party. That's the word from CMS, which indicated during an Oct. 6 Open Door Forum that providers are incorrectly appending these modifiers.

CMS issued Transmittal1819 on Sept. 25 to let providers know how to submit claims when a physician performs the wrong surgery or treats the wrong patient or site. "We've come to learn that a number of physicians and other providers are incorrectly using the modifiers from this transmittal and that could in fact delay payment of your claims or hinder the processing of claims," CMS's Stewart Streimer said during the Oct. 6 call.

To review, the appropriate modifiers you should use should be:

• PA -- Surgery wrong body part

• PT -- Surgery wrong patient

• PC -- Wrong surgery on patient

Streimer reiterated that practices should "remind your billing staffs to make sure they use these modifiers correctly or you may find your claims are being denied inappropriately."

The CMS staffers on the call reminded providers that MACs will  be imposing two new edits on Part B claims that report ordering and referringproviders. "The new edits will check to see if the provider has a current enrollment record with Medicare and if he or she is of a specialty to order and refer," said Patricia Peyton from CMS's provider supplier enrollment office, during the call.

(See the Insider, Vol. 10, No. 33 for more on this issue.)

A caller asked how the new edit will affect services referred by resident  physicians, since they don't enroll in Medicare.

"A resident with a medical license can enroll in Medicare, but  they traditionally never did because they couldn't get paid by Medicare,"Peyton said. "The same goes for public health doctors and VA doctors who traditionally ordered and referred but didn't enroll because they wouldn't get a payment from Medicare." Those physicians are entitled to enroll in Medicare, Peyton said, and an upcoming MLN Matters article on this topic will help clarify the issue, she indicated.

If the resident physician is still in training and doesn't yet have a medical license, then the teaching physician would be listed as the ordering and referring doctor on the claim, Peyton said.

Peyton also noted that CMS is making improvements in two areas of internet-based PECOS. One will be that the PTAN will be captured in the screen if the doctor already has one, and it will be easier for providers or suppliers to view their enrollment records in PECOS.

Currently that process is "not exactly straightforward," Peyton said. CMS will notify providers when these improvements are completed.

Effective Oct. 9, CMS introduced a new specialty for hospice and palliative care, which will be designated as specialty code 17. "In 2010 we'll have another new physician specialty, which will be geriatric psychiatry," Peyton said.