Part B Insider (Multispecialty) Coding Alert

Published on Thu Jan 10, 2013 PDF

Question: I read your article about Medicare’s new policy of applying the Multiple Procedure Payment Reduction (MPPR) to the technical component (TC) of diagnostic cardiovascular and ophthalmology procedures for services done on the same day with the same patient. Our clinic performs both of these types of service, and we are wondering how we’ll know which claims our contractor reduced?

Answer: You’ll know which technical components were hit with the discounts when you receive a Claim Adjustment Reason Code of 59 (Processed based on multiple or concurrent procedure rules [For example, multiple surgery or diagnostic imaging, concurrent anesthesia]), CMS notes in MLN Matters article MM7848, effective Jan. 1, 2013.

You can also find out which codes are subject to the MPPR if you look at the Medicare Physician Fee Schedule. If the value "6" is shown in Field 21, that is a cardiovascular code subject to the discount, while value "7" denotes diagnostic ophthalmology services subject to the MPPR methodology. Or, you can view the codes subject to the discounts in attachments 1 and 2 of CR7848, available at www.cms.gov/Regulations-and-guidance/Guidance/Transmittals/Downloads/R1149OTN.pdf.

Background: Medicare contractors now make full payment for the TC cardiovascular service with the highest payment under the Fee Schedule. Payment is made at 75 percent for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice, (i.e., same Group National Provider Identifier [NPI]) to the same patient on the same day. For ophthalmology services, you’ll get full payment for the TC service with the highest payment, and then you’ll collect 80 percent for subsequent TC services furnished by the same physician to the same patient on the same day, the MLN Matters article notes. You can read the complete text at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7848.pdf.