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Issue #110 - October 1, 2008 
AAPC EdgeBlast

CMS Fixing Problem with Quality Data
The Centers for Medicare & Medicaid Services (CMS) apparently has a technical problem at its hospital outpatient quality data clearinghouse.  Hospitals are receiving erroneous feedback reports or submission reports.  CMS is working to right the problem and is keeping in touch with constituencies, but it appears inpatient quality data is unaffected by the problem, AHIMA reports.

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CMS Postpones CAP
Due to contractual issues, CMS posted on its
Web site, Sept. 10, that it is postponing the 2009 Medicare Part B Competitive Acquisition Program (CAP) . The program continues through Dec. 31. Physicians participating in CAP will find guidance for transitioning out of the program on the CMS CAP Physician’s Web page later this fall.

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Pharma Leaders Make Physician Payments Public
Pharmaceutical company Eli Lilly announced in a Sept. 24 press release its intention to establish a national registry of payments to physicians. Following suit,Merck announced in a Sept. 25 press release that it too plans to publicly disclose fees paid to physicians for consulting and speaking.

Both companies endorse pending legislation mandating disclosure of financial relationships between physicians and industry. Sens Charles Grassley, R-Iowa, and Herbert Kohl, D-Wis., introduced the Physicians Payments Sunshine Act (HR 5605, S2029) in September. 2007. It has yet to make it through congress. Read more »

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2009 Medicare Premiums and MPFS Rates Status Quo
The good news is that the standard Medicare Part B monthly premium in 2009 will remain at 2008 rates—$96.40 (for single filers who earned $85,000 or less in 2007). Want the bad news?

Well, there isn’t any bad news … yet.

For the first time in years, premiums will not increase because, in addition to an expected growth in the cost and use of outpatient health care providers and suppliers, the reserve in the Part B account of the Supplementary Medical Insurance (SMI) trust fund has “runneth” over. Read more »

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Unforeseen Medicare Advantage Costs
When lawmakers included a provision in the Medicare Modernization Act (MMA) of 2003 to expand the role of private health care plans in Medicare, they thought it would reduce Medicare spending growth. They were right about one thing: Medicare Advantage (MA) enrollment has increased from 4.8 million in 2004 to 8.7 million to date. What they didn’t anticipate was MA costs exceeding the standard Medicare Fee-For-Service (MFFS) program. Read more »

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Coding Tips
AMA Provides Clarity on Breast Excision/Lymph Node Coding
By John Verhovshek

The most recent CPT Assistant (vol. 18, issue 9, Sept. 2008) now clarifies that when a surgeon performs partial mastectomy with complete axillary dissection, you should report 19302 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy.

Partial mastectomy with anything less than a complete axillary dissection, however, will call for 19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy) and the appropriate lymph node biopsy code 38500 Biopsy or excision of lymph node(s); open, superficial or 38525 Biopsy or excision of lymph node(s); open, deep axillary node(s). Read more »

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CMS Releases October 2008 Update of OPPS
Appending modifier 52 (Reduced Services) to a radiology service procedure code does in fact reduce payment by 50 percent. Don’t let an outdated version of the 2008 Outpatient Prospective Payment System (OPPS) fool you. You’ll find several other corrections and clarifications the CMS made to the 2008 OPPS in the October update. Read more »

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Watch How You Code for Facet Joint Injections
In 2006, the Centers for Medicare & Medicaid Services (CMS) allowed approximately $96 million in improper payments for facet joint injections services and an additional $33 million in improper payments for associated facility claims, according to an Office of Inspector General (OIG) September report. That’s a whopping 63 percent of facet joint injection services allowed by Medicare in 2006 that did not meet Medicare program requirements. This finding and the realization that Medicare Part B payments for facet joint injections have increased from $141 million in 2003 to $307 million in 2006—a 76 percent increase in the number of Medicare claims for facet joint injections—has prompted the OIG’s recommendation for CMS to take certain measures. Read more »

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The Best Way to Avoid an Audit
Time and time again, we hear about how the Health and Human Services (HHS) Office of Inspector General (OIG) has audited another carrier for improper payments. Time and time again, the underlying cause has something to do with improper billing of units. In fact, according to a Medicare Claim Recovery Audit Contractors (RAC) demonstration, excessive/multiple units accounted for 70 percent of outpatient hospital billing errors in the first quarter of this year. Read more »

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Medical News
Dietary Change May Relieve Bladder Pain
A new patient presents with severe pelvic pain and a frequent need to urinate. After a complete exam, the physician’s diagnosis is interstitial cystitis. He prescribes an anesthetic suppository and suggests the patient lay off the pizza. Are the physician’s diagnosis and recommendations on track?  Read more »

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Study Questions Use of MRI to Evaluate Breast Cancer
A physician who orders an MRI scan on a woman recently diagnosed with breast cancer ultimately increases her chance for a mastectomy, according to a new study presented at the American Society of Clinical Oncology (ASCO) 2008 Breast Cancer Symposium, held Sept. 5-7. Read more »

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NCVHS: 2007 Most Fecund
Did it seem you reported more 84702s, 59400s, and 59510s than usual last year?  According to the National Committee for Vital Health Statistics (NCVHS), 2007 was a record-breaking year for births in the United States. Read more »

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Nematodes May Prove Key to RA
Move over maggots. Leap aside leeches. Make room for a worm joining you in the patient room.

Well, maybe not, but a parasitic nematode may provide a more effective treatment for inflammatory types of arthritis and other autoimmune diseases. Read more »

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AMA: Scurvy Sailing into Offices
Scurvy, the vitamin C deficiency disease most often associated with toothless sailors, is popping up around the country among the elderly and other vulnerable patients, according to a recent article in the American Medical Association’s (AMA) AMedNews, and you may find yourself coding it. Read more »

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Featured Items
Problem with Quality Data
CMS Postpones CAP
Physician Payments Public
Rates Status Quo
Medicare Advantage Costs
Coding Tips
Medical News
Coding Job Links
Test Yourself Online


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