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AAPC July 18, 2007
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Issue #81

Top Stories

Latest HCPCS Update Introduces New Codes and Changes Modifiers

Missed Appointment Fees Can Be Charged to Medicare Patients

Medicare Overpaid $21 Million in Negative Pressure Wound Therapy Pumps

Looking for Kudos!


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Torrey Kim

Torrey Kim, CPC
EdgeBlast editor

Top News

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®.

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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.

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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.

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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 kudos@aapc.com.

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Test Yourself - Earn .5 CEUs

By answering the following questions, 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 number of each EdgeBlast on your submission (example: #81). 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. Which HCPCS code should you now report for a dose of albuterol in concentrated form?

Answer:

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

Answer:

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

Answer:

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

Answer:

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?

Answer:

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