Part B Insider (Multispecialty) Coding Alert

Published on Tue Aug 28, 2007 PDF

Look back through your imaging claims for missing -Q- codes

If you-ve been having trouble accessing the National Provider Identifier (NPI) database, you-re  not alone.

The Centers for Medicare & Medicaid Services (CMS) has been having -instability- with the NPI registry as well as the database, according to carrier announcements. CMS is working on changes that should eliminate the problem, but the NPI registry may remain down until the changes are complete.

You can still download the complete file of NPIs at nppesdata.cms. hhs.gov/cms_NPI_files.html.

In other news:

- Since January, you should have been reporting contrast material used in MRIs separately, CMS cautions in MLN Matters article MM5677. You can bill codes Q9945-Q9954 and Q9958-Q9964 and receive payment separately, says CMS. If you-ve neglected to bill these codes in any claims for the past 10 months, you should go ahead and resubmit them. The carriers won't search on their own for claims where Medicare owes you money for contrast materials.

- You-re still getting paid too much for Part B drugs, the HHS Office of Inspector General (OIG) insists. In the latest in a long series of reports on drug payments (OEI-03-07-00530), the OIG says that 34 out of 191 drugs cost Medicare at least 5 percent more than the Average Manufacturer Price (AMP).

And 20 of those 34 drugs have appeared on the OIG's hit list in previous reports. Medicare would have saved $9 million by basing its payments on AMP in the third quarter of 2007, the OIG claims. For more info: Go to www.oig.hhs.gov and click on -Reports.-

- Doctors often ignore patients- complaints that could show side effects from commonly-prescribed statins, according to an article in August's Drug Safety. Doctors dismissed the possibility of adverse drug reactions nearly a third of the time when their patients reported muscle weakness or pain, cognitive problems, or other likely symptoms.

- Annual physical exams may not help patients, according to a new study in the Annals of Internal Medicine. The problem: The $8 billion per year which insurers spend on physical exams includes $350 million for unnecessary tests, such as urine analyses and echocardiograms, which preventive health experts don't recommend. But the physical exams don-t include recommended services, such as cholesterol screening and smoking cessation counseling, reports the Philadelphia Inquirer.

- You can view a chart listing all the preventive services that Medicare covers in the -Welcome To Medicare- exam by going to www.cms.hhs.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf.