Cardiology Coding Alert

Here's what the agency says about medically unlikely edits

Keeping track of cardiology-related payer news and updates at this time of year is no easy feat. Here's a handy list to cure your information-overload blues.

1. Check Out Imaging Payment Reductions

First, here's a bit of good news. Although CMS was supposed to increase the reduction in the technical component (TC) payment for additional cardiac imaging procedures (furnished on contiguous body parts during the same session), it chose to freeze last year's reduction amount. In other words, when you report two cardiac imaging procedures, you can expect full payment on the first procedure but a 25 percent reduction on the second, instead of the proposed 50 percent reduction in 2007.

But CMS now limits TC payment for most imaging procedures to the amount paid under the OPPS. 

When your service is subject to both the multiple imaging reduction policy and the outpatient hospital cap, CMS first applies the multiple imaging adjustment and then the outpatient cap.

Resource: MLN Matters offers details on the new provisions with SE0665, "Multiple Procedure Reduction on the Technical Component (TC) of Certain Diagnostic Imaging Procedures and Cap on the TC of Imaging Procedures" at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0665.pdf.

Example: If your cardiologist performs the technical component of 71275 (Computed tomographic angiography, chest, without contrast material[s], followed by contrast material[s] and further sections, including image postprocessing) as well as the technical component of 74175 (Computed tomographic angiography, abdomen, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing), these two codes are in the same family. In this case, CMS will pay the TC payment for the first procedure (71275) but a 25 percent reduction for the second (74175).

2. Seek Out Rules on AAA US Screening

For dates of service Jan. 1 and later, Medicare will cover a one-time abdominal aortic aneurysm (AAA) ultrasound screening for patients who receive a referral due to an initial preventive physical exam, receive the ultrasound (US) from an authorized provider, haven't had a previous AAA US screening under Medicare, and either:

• has a family history of AAA or

• is a man 65 to 75 years of age who has smoked at least 100 cigarettes in his lifetime or

• is a beneficiary who manifests other risk factors specified by the secretary of health and human services through the national coverage determination process.

You should report the ultrasound exam with G0389 (Ultrasound, B-scan and/or real time with image documentation; for abdominal aortic aneurysm [AAA] screening).

Resource: MLN Matters covers the basics in MM5235, "Implementation of an Ultrasound Screening for Abdominal Aortic Aneurysms (AAA)" at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5235.pdf.

3. Contend With Unlikely Edits

Beginning January 2007, you'll have to contend with a new set of coding "edits" -- separate from the already-established National Correct Coding Initiative (NCCI) edits -- from CMS.
 
The goal of the new edits is to prevent overpayments caused by gross billing errors, usually due to clerical or billing system mistakes, said Niles R. Rosen, MD, medical director for Correct Coding Solutions LLC, which has worked hand-in-hand with CMS to develop the current edits, during a presentation at the AMA CPT and RBRVS 2007 Annual Symposium.

Rosen cited an example of a single CT scan that a provider billed (and the carrier inappropriately paid) as 10,001 units of service.

"The MUEs [medically unlikely edits] will limit automatically the number of units of service you can bill for a service in any 24-hour period," Rosen said. CMS has not arbitrarily assigned the maximum service units for a given CPT code, but by using common-sense criteria.

Keep in mind: If you do run afoul of the edits, you won't face denial for your entire claim, but only the single line item that violates the MUE guidelines, Rosen said. "Once in a blue moon, I think there will be an issue, but I'm hoping it is easily resolved upon redetermination with documentation," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at a clinic in Mendota Heights, Minn.

Like the NCCI, CMS will update the MUEs quarterly and continually refine them. "CMS and Correct Coding Solutions welcome suggestions and comments from providers," Rosen said.

4. You Can Use 8 ICD-9 Codes

You've been limited to only four diagnosis codes on your Medicare claims, but that limitation will double in 2007. According to an MLN Matters release, Medicare will process up to eight diagnosis codes, effective for claims processed July 1 and later. But you may not find this to be thrilling news. "This will be a pain for those who have to reconfigure practice management systems," Karl says.

Resource: MLN Matters covers this in MM5441:  www.cms.hhs.gov/MLNMattersArticles/downloads/MM5441.pdf.