Part B Insider (Multispecialty) Coding Alert

Published on Thu Jul 19, 2007 PDF

If you-re not up to date on codes, you could be losing cash

Facing hard times in your practice? You-re not alone.

Many practices are coping with tight reimbursement and declining revenues (see the Insider Vol. 8., No. 26). Reasons include high-deductible health plans, the quick growth of Medicare Advantage and a cut to most work RVUs, says Joan Gilhooly with Medical Business Resources in Barrington, IL.

In this tough environment, you can't afford to make mistakes. Cindy Parman, principal and co-founder of Coding Strategies Inc. in Atlanta, offers the following tips:

1) Understand the code definition. If the coder or biller doesn't really understand what a specific code means, you could be missing out on revenue. And bear in mind that even if a code remains the same, the code description could change from year to year.

2) Update new codes immediately. This includes adding them to your charge tickets and software. Bear in mind that codes can change throughout the year. For example, Medicare replaced Intravenous Immune Globulin (IVIG) code J1567 with new codes Q4087-Q4092 in June. Also, Medicare sometimes adds new Category II codes mid-year.

3) Keep track of your denials. Parman sometimes encounters practices where the -payment posting- department automatically writes off the amount that the payor didn't reimburse. You should be appealing these denials where necessary. 

4) Review ancillary codes. Parman works with oncology practices. Sometimes she-ll see a practice which has performed and documented tobacco cessation counseling. But the practice hasn't billed Medicare for G0375-G0376, the codes for this service.

5) Analyze your managed care contracts. Many practices sign managed care contracts that promise a percentage of Medicare reimbursement. So when Medicare slashes RVUs, or makes a 9.9 percent payment cut, your managed care pay will drop automatically.

6) Understand modifiers. You shouldn't ever overuse modifiers or report them automatically, and you should always be wary of modifier 59, Parman cautions. At the same time, you should be aware of when it's appropriate to use a particular modifier and be willing to add it when necessary. (See The Insider, Vol. 8, No. 17, for 59 modifier tips.)