1 handy chart offers all the details on 7 can't-miss updates
Keeping up with all the coding news at this time of year is a real chore, but don't despair. The summaries below will help make sure you don't miss a radiology coding beat. 1. 2007 Multiple Exam Payment Reduction: Imaging centers will find some good news in CMS' 2007 Medicare Physician Fee Schedule proposed rule. CMS is keeping the 25 percent technical-component payment reduction of additional related imaging exams performed on the same day, instead of increasing the discount to the proposed 50 percent. (Example: You perform a CT of the abdomen and pelvis on the same patient. The carrier covers the pelvis at 100 percent and discounts the lower-paying abdomen by 25 percent.)
See the CMS press release on these changes at
www.cms.hhs.gov/apps/media/press/release.asp?Counter=1943.
2. ICD-9 Red Alert: You may not switch out your CPT and HCPCS manuals until Jan. 1, but make sure you grab the 2007 version of ICD-9, starting Oct. 1. See proposed ICD-9 changes on the CMS Web site at
www.cms.hhs.gov/AcuteInpatientPPS/downloads/cms1488p.pdf in table 6A, and in the June 2006 Radiology Coding Alert article "ICD-9 Update: Be the First to Know Next Year's New Codes."
3. Help for Modifier 25: You can never get enough information when it comes to properly using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
CMS recently clarified how to use 25 during a surgery global period. The gist: Carriers won't pay for an E/M service reported with a procedure that has a global fee period unless you append modifier 25 to the E/M service, designating it as a "significant and separately identifiable E/M service from the procedure." With the exception of arteriograms and venograms, most interventional radiology procedures have global periods.
You'll find the MLN Matters article MM5025, "Payment for Evaluation and Management Services Provided During Global Period of Surgery," at
www.cms.hhs.gov/MLNMattersArticles/downloads/MM5025.pdf.
4. Make Room for MUEs: CMS almost scrapped the controversial medically unbelievable edits (MUEs) but instead renamed them medically unlikely edits.
The approximately 2,800 new edits are designed to test particular codes against a maximum number of units of service. These edits will auto-deny or auto-suspend any claims in which the units exceed the maximum.
Note: You can't bill your patient for any excess charges denied by the MUEs, CMS says. You also won't be able to appeal these denials.
5. Brachytherapy: CMS proposes to give brachytherapy codes 77781-77784 (Remote afterloading high-intensity brachytherapy ...) "XXX" global periods to allow you to bill separately for each treatment session. But CMS will lower the work RVUs for those codes to reflect that you can bill separately [...]
