The Edge Blast E-Newsletter
posted 07/18/2007
Electronic news for July 2007
Read the EdgeBlast and Earn CEUs Toward Your Annual Renewal
Earn continuing education units (CEUs) by reading the EdgeBlast. Simply answer the five questions found in the EdgeBlast Test Yourself at the end and submit your answers at the time of your renewal, using the same process you follow monthly for the Test Yourself in the AAPC Cutting Edge. Each EdgeBlast (there are two issued each month) will feature five questions that are worth .5 CEUs, for a total of 12 CEUs annually.

Latest HCPCS Update Introduces New Codes and
Changes Modifiers

CMS has changed several HCPCS Level II codes effective July 1, 2007, altering the way you'll report inhalation solutions, brachytherapy and breast reconstruction, and revising the descriptors for modifiers GY and KX.

CMS announced that HCPCS codes J7611-J7614 are no longer payable for albuterol and levalbuterol. Instead, coding professionals should report the following codes for these solutions:

Q4093 — Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol)

Q4094 — Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol)

In addition, new code Q4095 has been introduced for Reclast® injections, and coding professionals can continue to use code J3487 for Zometa®.

You'll also find new HCPCS codes for breast reconstruction (S2066 and S2067), non-invasive electrodiagnostic testing with a hand-held device (S3905) and speech therapy re-evaluations (S9152). In addition, coders who have sought a way to report the etonogestrel contraceptive implant system will now benefit from new code S0180. This code includes the implant and supplies used during the procedure.

Keep in mind that Medicare does not cover "S" codes, but some other insurers may reimburse you for these codes.

As for C codes, CMS has deleted brachytherapy codes C1718, C1720 and C2633, replacing them with 16 new C codes, as well as a new device marker placement code for sites other than the prostate (C9728).

In addition, HCPCS will revise modifier GY, which now reads, "Item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, is not a contract benefit."

Modifier KX has also been revised, and its descriptor now says "Requirements specified in the medical policy have been met."

Visit to read the full list of HCPCS codes that were updated as of July 1.

Missed Appointment Fees Can Be Charged to Medicare Patients

Coding professionals who were confused about Medicare's no-show policy will be pleased to read new MLN Matters article MM5613. This article states that physicians, providers and suppliers can charge Medicare beneficiaries a service fee for missed appointments. The caveat is that this policy must apply to both Medicare and non-Medicare patients.

When you charge a Medicare patient a no-show fee, you are charging them for the inconvenience, but you can't charge them for the service itself. For instance, if your no-show fee is $15 and the patient was scheduled for a $65 office visit, you can bill the patient the $15 fee but not the $65 for the missed office visit charge.

You cannot bill the service fee to Medicare, only to the patient, according to the MLN Matters article and Chapter 12, section 30.3.13 of the Medicare Claims Processing Manual.

You can read Medicare's missed appointment policy at either of the following websites: or

Medicare Overpaid $21 Million in Negative Pressure Wound Therapy Pumps

The OIG has pinpointed negative pressure wound therapy pump services as a source of billing errors. In its review of these claims billed in 2004, the OIG found that 25 percent of the claims billed to Medicare did not meet coverage criteria, and Medicare therefore overpaid these claims by $21 million. Medicare also improperly reimbursed an additional $6 million for supplies associated with these services.

One of the biggest errors found was that physicians wrote items on the certificate of medical necessity that were not documented in the medical record.

In its recommendations, the OIG suggested that CMS should create advance coverage determinations for suppliers who have established "a pattern of overutilization." In addition, the OIG has recommended that CMS should increase payment reviews of claims for negative pressure wound therapy pumps, so if you report these services, expect to be on your Medicare carrier's radar in the coming months.

To read the OIG's entire report on this subject, visit

Looking for Kudos

Have you performed your 100th prospective claims audit at your practice? Did you trek across Africa on safari? Have you recently filed appeals that brought in an extra $50,000 in revenue for your facility? We'd love to hear about it! Please submit your Kudos to our editors at

EdgeBlast Test Yourself

Answer the following questions and you can earn .5 continuing education units to apply toward your AAPC certification renewal. Simply answer the questions and send in a copy of your work when submitting your CEU package or enter your CEUs into the CEU Tracker online. Include the issue number (example: #81) off each EdgeBlast on your submission, which is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources, such as your ICD-9-CM, CPT® and HCPCS manuals.

1. Which HCPCS code should you now report for a dose of albuterol in concentrated form?


2. If a patient fails to show up for their scheduled visit, can you bill Medicare for the missed appointment charge?


3. If a physician writes an item on the certificate of medical necessity, where must it also be substantiated?


4. Which code should you now report for Reclast® injections?


5. Can you charge a missed appointment fee to a Medicare patient if you don't charge the same fee to a non-Medicare patient?


CPT® codes copyright 2007 American Medical Association. All Rights Reserved.
CPT® is a trademark of the AMA.
No fee schedules, basic units, relative values or related listings are included in CPT®.
The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use.