Part B Insider (Multispecialty) Coding Alert

Published on Mon Mar 08, 2004 PDF

If you're sending a patient home with an implanted cardiac defibrillator, you won't need to wait until the next visit to check up on his progress.
 
Part B carrier Noridian says it'll cover telephone or Internet monitoring for ICDs, using services such as Medtronic's CareLink that transmit data electronically to a receiving station where it is stored until the physician can evaluate it. These devices also can transmit an unexpected event, "such as a defibrillating discharge of the pacemaker, an episode of lightheadedness, syncope or even a cardiac arrhythmia," says Noridian.

Until there's a more specific code, you should use 93733 to report these services, Noridian says. Report this code with ICD9 Codes V45.02, for automatic ICD, but don't bill it more often than three times per 60 day period unless there's a specific medical reason, Noridian advises. No word on whether other carriers will follow Noridian's lead in covering this form of monitoring.
 

Doctors who routinely bill for more tests than actually provided may find federal investigators curbing their bad habits. The owner/operator of Odessa Allergy Clinic is facing unsettling prospects after just such alleged misconduct.

Dr. Athar Niaz Rana has been charged with a five year run on overbilling Medicare and private insurers. Niaz allegedly sent in $83,000 in fraudulent claims for tests he did not perform on children under 24 months of age, and now a federal grand jury wants him to hand over $26,445.45 in restitution. Niaz also faces additional fines up to $250,000 and 10 years behind bars.
 

A lying witness doesn't automatically void a conviction, ruled the 7th U.S. Circuit Court of Appeals. Psychiatrist Robert Mitrione was sentenced to 23 months in prison for numerous counts of Medicaid and Medicare fraud, including billing for services not provided, upcoding, and billing for services provided by less qualified providers. Mitrione's office manager was sentenced to 15 months.

After the trial, evidence was uncovered that state auditor Deanne Statler had lied on the stand. Statler had allegedly claimed to have counted parts of the audit herself when in fact others had counted them for her, and had misrepresented some of her calculations in the government's favor.

The court's decision, issued Feb. 9, threw out a litmus test adopted 75 years ago that allowed a new trial if the jury "might" be tipped toward a new verdict upon hearing the case, minus the perjury. Absent Statler's testimony, the court ruled, both defendants' records were still not strong enough to "probably" result in an acquittal in a re-trial.