Medicare Compliance & Reimbursement

Plus:  CPT 2007 has new codes for Moh's surgery.

Medicare's detailed reviews of fee-for-service (FFS) claims aren't likely to cease.

The Centers for Medicare & Medicaid Services (CMS) continues to triumph from its intense scrutiny of Medicare FFS claims and has reduced improper payments by $1.3 billion--just in the past year. In 2005, Medicare's error rate for paying improper FFS claims was 5.2 percent, but that rate decreased to 4.4 percent in 2006, according to a recent CMS announcement.

CMS pays more than one billion FFS claims each year and has reduced the amount of improper payments by $11 billion in just the last two years, the agency reports.

"We have been increasing our efforts to reduce improper Medicare claims payments, and for the second year in a row, it's paying off," CMS administrator Mark McClellan said in the announcement. "Because we are able to measure the accuracy of payments more closely now, we are able to target our efforts more effectively with Medicare contractors and providers."

The agency releases its Medicare FFS improper-payment findings every November and posts the report on its Web site at www.cms.hhs.gov/cert.

Don't Lose Reimbursement By Overlooking New Moh's Surgery Codes

Dermatologists need to prepare now for a big change in how they code Moh's micrographic surgery.

CPT 2007 deletes existing Moh's codes 17304-17310 and replaces them with five new codes (17311-17315). The new codes break the procedure down into two categories: for head, neck, hands, feet and genitalia, or for trunk, arms and legs. Where the old codes talked about "specimens," the new codes talk about "blocks."

The old Moh's surgery codes divided the add-on codes into second stage, third stage and each additional stage. But the new codes simply include one add-on code for each additional stage after the first. For Moh's surgery of the trunk, arms or legs, you also have an add-on code for each additional block after the first five blocks.

New CPT 2007 Codes Taking The Medical Billing World By Storm

The following is a list of new codes and coding changes, courtesy of CPT 2007, that you'll need to know:

· You'll have a new code for ablation therapy for reduction or eradication of one or more pulmonary tumors (32998).

· There's also a new code for placement of fiducial markers, dosimeters or other devices in the prostate for radiation therapy guidance (55876).

· And you'll have a new code for revision (including removal) of a prosthetic vaginal graft through an open abdominal approach.

· There are two new codes for resection (tumor debulking) of recurrent malignant ovarian, tubal, primary peritoneal or uterine tumors. One code includes omentectomy (58957) and one includes omentectomy plus pelvic lymphadenectomy and limited para-aortic lymphadenectomy (58958).

· In a couple of months, you'll be using 82107 to bill for alpha-fetoprotein (AFP) L3 fraction isoform and total AFP. You'll also be able to use 83698 for lipoprotein-associated phospholipase A2 (Lp-PLA2), and 83913 for "molecular diagnostics; RNA stabilization."

· You'll be able to bill for more detection methods, including enzyme immunoassay technique detection of Aspergillus (87305). You'll have four new codes for DNA/RNA detection of enterovirus (87498), staphylococcus (87640-87641) and streptococcus group B (87653). And you'll be able to use 87808 to bill for immunoassay detection of trichomonas.

· Intraluminal gastrointestinal tract imaging, such as capsule endoscopy, of the esophagus gained a new code with 91111.

· There's also a new code for computerized corneal topography, unilateral or bilateral (92025).

· You can bill for diagnostic analysis with programming of auditory brainstem implant on an hourly basis, using 92640.

· A physician can administer an intrapulmonary surfactant through an endotracheal tube, and you can use 94610 to bill for it. You can also bill for continuous inhalation treatment with aerosol medication for acute airway obstruction, for the first hour (94644) and each additional hour (94645). Another new code, 95012, covers "nitric oxide expired gas determination."

· There are also new codes for neurofunctional testing during a noninvasive imaging functional brain mapping (96020), genetics and genetic counseling services, for each 30 minutes face-to-face (96040), and whole body integumentary photography (96904).

In Other News...

· Two Houston, TX doctors face prison sentences after they were found guilty of defrauding Medicare of more than $21 million. Prosecutors said Charles Frank Skripka and Jayshree Patel, wrote 30 to 80 prescriptions per day for motorized wheelchairs, in return for $200 per script. The patients received $50 for accepting the prescription, some coming from as far away as Louisiana. Medical equipment company owner Harold "Prince Yellowe" Iyalla plead guilty in May to paying kickbacks to doctors, according to the Houston Chronicle.

· New legislation, the Access to Physical Medicine and Rehabilitation Services Improvement Act of 2006 (S. 3963), would overturn the current Medicare "incident-to" rules and recognize athletic trainers and lymphedema therapists as covered providers under Medicare, according to the American Physical Therapy Association (APTA).

The current Medicare incident-to requirement, clarified in the 2005 Medicare Physician Fee Schedule, stipulates that individuals providing therapy services must be graduates of physical therapy professional education programs. This applies to those who provide physical therapy services incident to a physician's professional services. The legislation, introduced by Sens. Craig Thomas (R-WY) and Arlen Specter (R-PA), would change this situation.

· The American Society of Clinical Oncology (ASCO) updated its clinical practice guidelines for the use of tumor markers in gastrointestinal cancer. ASCO also included additional tumor markers that address a broader range of cancers. Instead of testing for carcinoembryonic antigen (CEA) every two to three months for two years after initial treatment of colorectal cancer, the new guidelines call for CEA testing every three months for three years.