AAPC March 7, 2007
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Issue #72

Top Stories

Stenting Improves Lives of Patients and Manufacturers

Medicare Quality Reporting Program Offers Bonus Pay to Players

Coding is a Step Ahead of Fast Food Danger


Test Yourself

UB-92 Use Ends May 22

The UB-92 will not be accepted by CMS after May 22, 2007.
The National Uniform Billing Committee (NUBC) is replacing the UB-92 with the UB-04 paper form. The Health Insurance Portability and Accountability Act (HIPAA) requires submission of National Provider Identifiers (NPIs) on claims effective May 23, 2007, and the UB-92 does not have a field for reporting of NPIs. During the period March 1, 2007 through May 22, 2007, providers that use paper forms for claim submission will be able to submit either the UB-92 or the UB-04 form.
More information about the transition is available from the NUBC Web site (http://www.nubc.org/). The UB-04 will retain the CMS-1450 designation.


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Chris Fraizer Top News

by Chris Fraizer, MA, CPC

Stenting Improves Lives of Patients and Manufacturers
Medicare beneficiaries and the carotid artery stenting industry stand to make big gains based on a request by stent manufacturers to change Medicare policy for patients at risk for stroke due to the build up of plaque in the carotid artery.

Under the proposed National Coverage Decision (NCD) issued by the Centers for Medicare & Medicaid Services (CMS), Medicare would cover carotid artery stenting (CAS) for patients with sufficiently narrowed arteries, although asymptomatic for carotid artery stenosis.


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Medicare Quality Reporting Program Offers Bonus Pay to Players
The Medicare voluntary Physician Quality Reporting Initiative (PQRI) is up and running, which can only mean two things:
  • Expect more CPT® Category II codes and HCPCS codes for reporting quality measures
  • Prepare to learn new acronyms
The program gives financial incentives to "eligible professionals" willing to report quality measures on Medicare claims. The category "eligible professionals" refers to those getting paid under the Medicare Physician Fee Schedule. Under the PQRI, The voluntary program gives providers the option of reporting on at least three quality measures on 80 percent of their eligible patients in order to receive a bonus that will equal up to 1.5 percent of their total Medicare payments during that given period. The reporting period runs from July 1 to December 31, and the providers will be eligible for a single consolidated incentive payment in mid 2008.


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Coding is a Step Ahead of Fast Food Danger
Once again, the agencies that develop codes are one-step ahead of the public, and this year in relation to the entrepreneur urge to super size our waistlines. According to a study by the US Center for Science in the Public Interest (CSPI), some fast food chains are serving up such outrageous dishes that they could qualify for a full day’s calories packed into one sitting. The CSPI claims the giant size servings and over the edge calorie stuffed courses are only adding to America’s obesity epidemic and weight-related heart disease.


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Test Yourself
By answering the following questions you can earn .5 continuing education units to apply toward your annual Academy certification renewal. Simply answer the questions and send in a copy of your work when submitting your CEU package. Put the number of each EdgeBlast included in your submission. The number 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. The vascular surgeon performs a CAS without distal embolism protection for a patient at risk for a stroke due to plaque build up on the carotid artery, as shown from a bilateral duplex scan. This is an inpatient procedure but what are the surgeon’s diagnosis and procedure codes (exclusive of the scan)?

Answer:

2. Referring to Question #1, what is the code for the scan?

Answer:

3. What is the range of codes in the 2007 HCPCS Level II code set that corresponds to the physician’s voluntary reporting program?

Answer:

4. An adult patient considered morbidly obese (BMI 39.8) had gastric band placed laparoscopically to help in weight reduction. What are the procedure and diagnosis codes?

Answer:

5. Medicare covers open and laparoscopic Roux-en Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB) and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) if certain criteria are met and the procedure is performed in an approved facility. What CPT® codes apply to these procedures?

Answer:

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