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AAPC Dec. 19, 2007
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Issue #91

Top Stories

Watch MQSA for Mammography Billing

Correction to OPPS, ASC Pay System

Legislation Tables MPFS Cut Until June

NPI Deadline Draws Near

DMEPOS 2008 Fee Schedule Updated

Test Yourself - Earn 0.5 CEUs

Renée  Dustman

Renée Dustman
EdgeBlast Editor

Top News

Watch MQSA for Mammography Billing

For mammography services, the nature of the billed HCPCS code (i.e., film or digital) must correspond to the FDA certification status listed on the Mammography Quality Standard Act (MQSA) file for the billing mammography facility. If it doesn’t, effective April 1, 2008, the claim will be denied.

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Correction to OPPS, ASC Pay System

Effective Jan. 1, 2008, hospitals and ambulatory service centers (ASCs) are required to report HCPCS modifier FC Partial credit received for replaced device on the procedure code when the device being implanted is on the list of creditable devices, the procedure code for which the device is used is on the list of creditable Ambulatory Payment Classifications (APCs), and the hospital received a credit of 50 percent or more of the cost of the new replacement device. The July change request 5668, transmittal 1297 erroneously specified the provider device credit threshold was 20 percent. See www.cms.hhs.gov/HospitalOutpatientPPSfor the lists of APCs and devices to which this policy applies, and also the hospital outpatient perspective payment system (OPPS) offset amounts. The complete transmittal on which this story is based is on the CMS website at http://www.cms.hhs.gov/transmittals/downloads/R1383CP.pdf.

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Legislation Tables MPFS Cut Until June

The New Year is looking a little brighter for physicians since the Senate unanimously agreed yesterday, Dec. 18, to pass legislation that postpones the 10.1 percent reduction in Medicare Part B payments slated to begin Jan. 1 2008. The Medicare, Medicaid and SCHIP Extension Act of 2007 (S. 2499) instead gives physicians a 0.5 percent increase for the first six months. The House is expected to vote on the legislation today, Dec. 19.

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NPI Deadline Draws Near

Beginning March 1, 2008, physicians must submit paper and electronic claims to Medicare using their National Provider Identifier (NPI). Legacy provider numbers will no longer be permitted as the sole form of identification. The deadline for using NPI numbers on all public and commercial claims is May 23, 2008.

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DMEPOS 2008 Fee Schedule Updated

Providers and suppliers who submit claims to Medicare for durable medical equipment, prosthetics, orthotic and supplies (DMEPOS) should note important changes recently made to the 2008 DMEPOS fee schedule.

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Red-faced about EdgeBlast Error
Editor’s note: In the EdgeBlast, No. 90 news item “Time to Update Your Therapy Code Lists,” two of the therapy modifiers were transposed. The sentence should have read: Code 96125 is considered “always therapy” regardless of who performs the service and requires a therapy modifier (GN – speech-language pathology, GO – occupational therapy, GP – physical therapy).

Test Yourself - Earn 0.5 CEUs

By answering the following questions, you can earn 0.5 continuing education units to apply toward your annual AAPC CEU renewal every two years. Simply answer the questions and list this as one of your itemized CEUs on your CEU form. If you are chosen for verification, we will then ask you to send in a copy of your work.  Please 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 Level II manuals.

1. According to the 2008 DMEPOS fee schedule, when billing for the full replacement of HCPCS power wheelchair interface codes E2373 and E2313, suppliers should submit which modifier?

Answer:

2. After the compliance date for the NPI, can a covered health care provider who sends covered transactions electronically continue to use other numbers, such as legacy or proprietary identifiers, in addition to its NPI to identify itself?

Answer:

3. What does the acronym HIT stand for?

Answer:

4. Which modifier should you append to the procedure code that reports the services provided to replace a device that is subject to a warranty or recall adjustment and a partial credit of 50 percent of the cost of the new replacement device?

Answer:

5. Contractors use what weekly-updated file to verify that the billing facility is certified by the FDA to perform mammography services, and has the appropriate certification to perform the type of mammogram being billed (film and/or digital).

Answer:

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2008 Coding Updates Audio Conferences

PhySourceEdu offers AAPC-approved CEU programs

BC Advantage - Medical Billing and Coding magazine

Thomson Delmar Learning

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