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General Surgery Coding Alert

Medicare Update:

Retroactive Revisions Could Increase Your Payments

Published on Wed Jan 01, 2003

A recent Medicare policy decision could allow you to collect additional reimbursement for claims already filed.

CMS transmittal AB-02-112 (change request 2282), outlining final revisions to the 2002 Medicare Physician Fee Schedule Database, replaces the bilateral surgery indicator "0" (which signifies that no additional payment is appropriate for a bilateral procedure) with a "1" (thereby indicating that a 150 percent payment adjustment applies for bilateral procedures) for the following codes:

  • 36002 Injection procedures (e.g., thrombin) for percutaneous treatment of extremity pseudoaneurysm

  • 36533 Insertion of implantable venous access device, with or without subcutaneous reservoir

  • 36534 Revision of implantable venous access device and/or subcutaneous reservoir

  • 36535 Removal of implantable venous access device and/or subcutaneous reservoir

  • 36820 Arteriovenous anastomosis, open; by forearm vein transposition

  • +37208 Transcatheter placement of an intravascular stent(s), (non-coronary vessel), open; each additional vessel (list separately in addition to code for primary procedure)

  • 38220 Bone marrow aspiration

  • 38221 Bone marrow biopsy, needle or trocar

  • 0005T Transcatheter placement of extracranial cerebrovascular artery stent(s), percutaneous; initial vessel

  • +0006T each additional vessel (list separately in addition to code for primary procedure)

  • 0007T Transcatheter placement of extracranial cerebrovascular artery stent(s), percutaneous, radiological supervision and interpretation, each vessel.

    Prior to the fee schedule revisions, Medicare would provide no additional reimbursement for any of the above, even if coders appended modifier -50 (Bilateral procedure) or modifiers -LT (Left side) and/or -RT (Right side) to indicate that the physician had performed the procedure bilaterally. You may now receive a 150 percent payment adjustment for such procedures provided documentation supports the claim and you append the appropriate modifier(s).

    The fee schedule revisions are retroactive to Jan. 1, 2002, but Medicare has instructed carriers that they "need not search their files either to retract payment for claims already paid or to retroactively pay claims." Therefore, to receive adjusted payment for previously paid claims, you must refile and specifically request additional payment. Based on national averages, for instance, this could mean the difference between $1,284 (61862 performed bilaterally but paid unilaterally) and $1,926 (61862 performed and paid as a bilateral procedure).

    Note: To view CMS transmittal AB-02-122, go to http://www.cms.gov/manuals/pm_trans/ab02112.pdf.

     

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