Medicare Compliance & Reimbursement

If you’re ready to make the ICD-10 conversion, Congress appears to have your back — at least for now. On Feb. 11, the House Energy and Commerce Committee held a hearing in which healthcare experts urged Congress to ensure that the Oct. 1 deadline stays put.

Only one witness, a physician from Alabama, asked for a reprieve from the October requirement, but members of Congress did not appear to be sympathetic. Representative Kathy Castor of Florida urged the panel to stop delaying the transition to ICD-10, which was echoed by other members of Congress.

Resource: To view the testimony from the hearing, visit energycommerce.house.gov/hearing/examining-icd-10-implementation.

Differentiate Preventive Medicine Visit From IPPE

When CMS first started allowing coverage for the initial preventive physical exam (IPPE), many practitioners trumpeted the fact that Medicare would finally allow coverage for a routine physical — but that has not been the case.

Although CMS does allow payment for the IPPE, it’s a different service from a physical, and Medicare still considers routine physical exams (99381-99397) to be non-covered services. Part B MAC NGS Medicare issued an article to differentiate between the two on Feb. 13, reminding practices about the non-reimbursable status of physicals, as well as the obvious similarities between the two.

“CMS does recognize that the IPPE may have substantial overlaps in service elements with the routine physical examinations, such as body measurement, blood pressure, and the identification and review of health status and risk factors,” NGS says in the brief.

With the IPPE, the physician furnishes education and counseling, and instigates health referrals as well as furnishing a written plan so the patient can get appropriate screenings and other services. “The IPPE is best furnished to a beneficiary when their health status is stable and they are open to discussing preventive and screening services available in Medicare,” NGS says.

To read the complete article, visit www.ngsmedicare.com

This MAC Updates Its Modifier 51 Rules — Reminding You NOT to Use It

Both CPT® and CMS create modifiers to make your coding easier—but sometimes those modifiers aren’t actually necessary. Such is the case with one specific modifier, according to a recent transmittal by Part B MAC NGS Medicare.

On Feb. 6, NGS Medicare issued new policy education for modifier 51 (Multiple procedures) explaining that it “denotes more than one medical/surgical procedure is being performed by the same physician on the same day during the same encounter.”

However, the MAC adds, “Medicare does not recommend reporting modifier 51 on your claim submission.” The MACs’ systems contain “hard-coded logic to add the 51 modifier to the correct procedure code,” so you don’t have to add it again, NGS says.

To read the complete guidance from NGS, visit www.ngsmedicare.com.

Don’t Take ‘Credit’ For Toxic Drug Management If You Aren’t Monitoring It

As most E/M coders are aware, drug therapy requiring intensive monitoring for toxicity is considered a high risk management option in the table of risk, and applies to the physician’s work ensuring that patients’ drug levels stay at safe levels.

However, if you’re giving yourself extra points on the table of risk just because your patients are on drugs likely to cause toxicity (for instance, chemotherapy), you may want to re-check the doctor’s documentation to ensure he deserves the points.

“In order to receive ‘credit’ for drug therapy requiring intensive monitoring for toxicity, you must manage/monitor the drug,” Part B MAC Palmetto GBA says in a Feb. 6 E/M Weekly Tip. In other words, the patient merely being on the drug isn’t enough to qualify for the points — you must be the practitioner actually managing and monitoring it.

Palmetto expects to see “documentation in the medical record of drug levels obtained at appropriate levels” to demonstrate your work monitoring the patient to prevent toxicity, the payer says in its article “Drug Therapy Requiring Intensive Monitoring for Toxicity.”

To read more about Palmetto’s requirements, visit the MAC’s website at www.palmettogba.com.