Medicare Compliance & Reimbursement

CPT continues to add new codes, and the Correct Coding Initiative (CCI) continues to institute edits that tell you what you can -- and cannot -- report together.

CCI's latest version 15.2 takes effect on July 1, and includes over 3,500 new edit pairs, according to Frank Cohen, senior analyst with MIT Solutions, Inc., in a June 17 news release.

CCI makes over 6,000 code pair deletions this time around and makes ten modifier changes. Unfortunately, nine of those modifier changes are bad news for practices,because they change from a "1" (which meant you could append a modifier to separate the code pair) to "0," which means no modifier can separate the edit.

For instance: CCI used to allow a modifier to separate the edits bundling 62290 (Injection procedure for discography, each level; lumbar) and 72295 (Discography, lumbar, radiological supervision and interpretation) into 63030 (Laminotomy, with decompression of nerve roots]...1 interspace, lumbar). You can no longer report these codes together under any circumstances, even with a modifier.

• When CMS announced that providers could get bonuses for demonstrating "meaningful use" of certified electronic health records, a firestorm erupted regarding what the term meant.

CMS aims to quell any confusion following a recent meeting where the Health Information Technology (HIT) committee discussed several potential definitions for "meaningful use."

The agency intends to issue a proposed rule regarding its "meaningful use" definition later this year. In the meantime, you can check out CMS's general HHS HIT site at  http://healthit.hhs.gov.

• Pretty soon, any fraud contractor that's interested

will be able to rifle through your durable medical equipment claims.

"Currently, only one Program Safeguard Contractor (PSC) can access a DME MAC's claims data," CMS notes in June 5 Transmittal No. 501 (CR 6430).

But Zone Program Integrity Contractors (ZPICs) are now taking over fraud-fighting activities from PSCs, and the new ZPIC territories often cover more than one DME MAC's jurisdiction.

CMS "will allow access to a MAC's claims data by multiple PSCs" -- and later ZPICs --  "and for the PSC to extract only data that concerns claims in their service area," the memo says.

• Negative pressure wound therapy research by CMS and the Agency of Healthcare Research and Quality has concluded, but NPWT proponents may not like their findings. "The available evidence does not support significant therapeutic distinction of a NPWT system or component of a system," CMS says.

In other words, no one NPWT system or part deserves its own HCPCS code, CMS says.

CMS will hold a July 9 public meeting to give "stakeholders an opportunity to provide input concerning the preliminary decision," the agency says.The study backing up CMS's decision is at www.ahrq.gov/clinic/ta/negpresswtd/npwtd01.htm.

for patients who received outpatient Part B services in the first quarter of 2009, depending on your carrier.

Due to delays in updating the claims system, "claims for outpatient therapy services provided during the January-March 2009 quarter, that were submitted and processed prior to April 6, 2009, were not applied to the 2009 calendar year (CY) therapy cap limitations," intermediary Cahaba GBA explained in an e-mail to providers.

The free ride means some of your Part B outpatient therapy patients will get some extra room in their caps this year.

CMS won't go back and apply the amounts that have already been billed toward the cap. But it will apply any amounts billed after April 6 to the cap, Cahaba explains.

• The new Swine Flu Task Force is hosting an International Swine Flu Conference in Washington, D.C. Aug. 19-21. Delegates from the United States, as well as Europe, Africa, and Asia Pacific will be attending, according to an email from the Task Force. Breakout sessions will include:

• Mass fatality management planning

• Business continuity planning

• Emergency management services

• Continuity of operations and continuity of government planning

• Law enforcement agencies

• First responders: fire department

• First responders: public works

• 911 Call center services

• Hospital and emergency medical services

• Workplace planning

• School/University pandemic planning

• Airlines, travel, airport, quarantine, and border health services

• Infectious medical waste

• Swine flu: agriculture perspective & interventions.For information or to register, visit http://www.newfields.com/isfc/index.php.