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Issue #103 - June 18, 2008 
AAPC EdgeBlast
Changes Revoked for Incident-to Billing
The Centers for Medicare and Medicaid Services (CMS) retracted a recent incident-to billing guidance transmittal, Transmittal 87, and intends to release a new transmittal at a later date.

Transmittal 87’s purpose was to clarify incident-to billing rules; however, it would have changed them significantly. With little notification of the changes and education for providers, the repealed transmittal included:

  • A greater reliance on Medicare contractors to determine whether a service by a nonphysician provider can be billed incident-to a physician's care.
  • A limited definition of "clinic," which restricted incident-to services in clinics not physician-owned and operated.
  • Onerous documentation requirements, such as detailed information in patient medical records about credentials of clinical personnel performing incident-to services.

CMS is examining its incident-to billing guidance to ensure incident-to billing rule changes will provide enough notice and education before a new policy takes effect.

The rescinded transmittal can be found here R87BP.pdf and MM5288.pdf

Thanks M.A. Lucas, CPC-A for emailing this story to EdgeBlast.

Medicare Chooses PQRI Vendors
CMS announced the vendors and health care organizations it will work with to evaluate enabling electronic reporting for 2008 PQRI participants. This year’s incentive includes two pilots that will evaluate various electronic health records (EHR) systems and patient registry technologies to facilitate such reporting.

The EHR vendors are Allscripts, Anceta, Cerner Corp, DocSite, eClinicalWorks, and. NextGen Healthcare Information Systems.  The patient registry vendors and organizations are American Osteopathic Association, Cedaron, Cielo Medical Solutions, General Electric, ICLOPS, the National Cardiovascular Data Registry, Phytel, Rush Health Associates, the Society of Thoracic Surgeons, University of Wisconsin Medical Foundation, Wellcentive, and Wisconsin Collaborative for Healthcare Quality.

Thank to Julie Orton Van, CPC, CPC-P, PCS, CSP for contributing this to EdgeBlast.

Gas Prices Skyrocket: CMS Allows Laboratory Travel Expenses
Gas prices affect the price of everything, including the clinical laboratory fee schedule. To help compensate for travel expenses of laboratory technicians, CMS has factored in gas costs in the clinical laboratory fee schedule for clinical laboratory services provided to Medicare beneficiaries.

Change Request (CR) 5996 clarifies payment of travel allowances, either on a per mileage basis (P9603 Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled) or on a flat rate basis (P9604 Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge) for calendar year (CY) 2008.

Medicare Part B covers specimen collection fee and travel allowances for a laboratory technician who draws the specimen from either a nursing home patient or homebound patient, and payment is made based on the clinical laboratory fee schedule. For more information, see Section 1833(h)(3) of the Social Security Act.

The per flat rate trip basis travel allowance (P9604) is $9.55. The per mile travel allowance (P9603) is 95.5 cents per mile where the average trip to the patients’ homes is longer than 20 miles round trip, and is pro-rated when specimens are drawn or picked up from non-Medicare patients in the same trip. The rate of 95.5 cents per mile was computed using the federal mileage rate of 50.5 cents per mile for automobile expenses plus an additional 45 cents per mile to cover the technician’s time and travel costs. If local prices justify a higher mile rate, Medicare contractors can increase the per mile rate.

For official instruction, visit the CMS Web site.

For further details, see the Medicare Learning Network (MLN) Matters article.

New Waived Tests for CLIA
Effective July 1, the Food and Drug Administration (FDA) waives newly approved tests under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). For a laboratory with a valid, current certificate of waiver to bill for these tests, the assigned CPT® codes must have a QW modifier. CMS CR 6021 clarifies the new FDA approved waived tests under CLIA, CPT® codes, and effective dates for each. They are:

CPT® Code


Dates of Service


Basic metabolic panel (Calcium, ionized)

on or after Jan.1


Basic metabolic panel (Calcium, total)

on or after Jan.16


Electrolyte panel

on or after Oct. 30, 2007


Comprehensive metabolic panel

on or after Jan.16


Albumin; urine or other source, quantitative, each specimen

on or after Oct. 4, 2006



on or after Oct. 4, 2006


Bilirubin; total

on or after Oct. 4, 2006


Glutamyltransferase, gamma (GGT)

on or after Oct. 4, 2006


Phosphatase, alkaline

on or after Oct. 4, 2006


Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)

on or after Oct. 4, 2006


Urea nitrogen; quantitative

on or after Oct. 4, 2006


Infectious agent antigen detection by immunoassay with direct optical observation; trichomonas vaginalis

on or after Jan. 1, 2007


Unlisted microbiology procedure

On or after July 1, 2007

Billing staff should be aware of these newly approved FDA waived tests under CLIA.  Medicare carriers and Part A/B Medicare administrative contractors (A/B MACS) will not search files to retract payment or retroactively pay claim processed prior to implementation of CR 6021, but they will adjust such claims brought to their attention.

For the complete transmittal, download R1527CP.pdf.

For further details, see the Medicare Learning Network (MLN) Matters article.

New "K" for Interface Material
Effective April 1, the following HCPCS Level II code, K0672 Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each is added for replacement interface material. The official details are explained in CR 6075.

More Changes for DMEPOS
Competitive Bidding Program

CR 6119 is the second installment of the chapter 36 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program in the Medicare Claims Processing Manual. CR 5978 provided the first installment of Chapter 36 and details the initial requirements of this program, which manualizes policies and instructions for Medicare contractors on the DMEPOS competitive bidding program. Subsequent installments may follow providing additional sections to the chapter.

CMS redesigned the DMEPOS competitive bidding Web page. Medicare providers, suppliers, and referral agents can find current and reliable information on this new program there. For the latest announcements and communications sent to the Medicare provider community go to: DMEPOS Competitive Bidding.

Download the CR 6119 PDF.

View the MLN Matters article for CR 6119 and its companion MLN Matters article to CR5978.

Coding Tips
Medically Unlikely Edits Remain a Puzzle to Providers spotlights this week’s article.

In June 4’s EdgeBlast we featured "Six Top Coding Tips" from the Medical Economics Web site. In the article, the author considered taking vital signs (height, weight, and blood pressure) to be a review of systems. A correction was posted by the editor of Medical Economics under "Vital signs are not part of review of systems" to fix the error.

Call for EdgeBlast Writers
Do you have timely coding news, coding tips, or coding expertise you'd like to include in the EdgeBlast? If so, email them to We'll give you credit for any articles we use.

Medical News
Medicare updates its source list of covered anti-cancer chemotherapy drugs
CMS announced additional updates to sources it uses to determine the list of drugs covered under Medicare Part B for patients undergoing cancer treatment through chemotherapy. CMS recognizes the Thomson Micromedex DrugDex ® compendium as an additional source of information.

InGenesis Medical Staffing Gets $7.7 Million Contract
InGenesis Medical Staffing of San Antonio has been selected to provide medical coding services for the patient administration division of William Beaumont Army Medical Center (WBAMC) in Fort Bliss, Texas and associated sites in El Paso, Texas.

Washington Post Examines Medicare's "Growing Fraud Problem"
The Washington Post examined Medicare's "growing fraud problem and the need to devote more resources to theft prevention." Law enforcement officials estimate that health care fraud costs taxpayers more than $60 billion annually.
Initiative to Reduce Unnecessary ED Visits is Launched
The Bureau of Managed Health Care at the Utah Department of Health will launch a program for state Medicaid beneficiaries to "reroute patients to personal physicians who can provide better continual care at a lower cost," the Salt Lake Tribune reports.

Pilot Project Launched to Provide Physicians with Health IT Incentives
HHS Secretary Mike Leavitt announced 12 cities and states chosen to participate in a $150 million Medicare pilot program to encourage physicians to use electronic health records, CQ Today reports.

Loss of Data Worrisome for Utah Health Center
A box containing the billing records of approximately 2.2 million patients was stolen June 2 from the car of a courier transporting the information from the University of Utah Hospitals and Clinics to a vault. The billing records included patient names, demographic information, and diagnostic codes. A subset included Social Security numbers.

The complex of hospitals and regional clinics serves five western states, drawing patients from a one-million square mile area. For more information, check out the following Web links:

Coding Job Links
AAPC Job Database

AAPC Employment Forums

Test Yourself Online
The Test Yourself questions can be accessed online at Once you go there and take the test, you can automatically grade your answers, correct any mistakes, and have your CEUs automatically added to your CEU Tracker for submission.

Featured Items
Changes Revoked
Medicare & PQRI Vendors
Gas Prices Skyrocket
FDA Waives New Lab Tests
Replacement Interface
Changes for DMEPOS
Coding Tips
Call for EB Writers
Medical News
Coding Job Links
Test Yourself Online

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