Medicare Compliance & Reimbursement

If you've become accustomed to collecting additional reimbursement when you report endometrial ablation bilaterally, you can wave goodbye to that extra money as of July 1.

Effective for dates of service starting July 1, Medicare has changed the bilateral indicator for 58353 (Endometrial ablation) and 58356 (Endometrial cryoablation) from "1," which indicates that bilateral payment is allowable, to "0," which means that "bilateral payment will not be allowed with these codes," says Heather Corcoran of CGH Billing.

CMS outlined the information in Transmittal 1528, which includes several changes that take effect in July.

In addition, Medicare will no longer recognize multiple-procedure payment with 51797 (Intra-abdominal voiding pressure) and +15847 (Excess skin excision).

Although these codes previously had multiple-procedure indicators of "2" (meaning that Medicare paid 100 percent for the highest-paying procedure and 50 percent for the others), CMS now assigns them indicator "0," allowing no payment adjustment.

CMS Introduces New Codes

Starting July 1, Medicare will recognize several new codes that CMS recently added to the Fee Schedule. CPT 2009 will include these codes.

You'll find several new Category III codes to report, such as 0190T (Intraocular radiation applicator placement) and 0191T-0192T (Ant. segment insertion drainage without reservoir), all of which will be carrier-priced.

Critical care: CMS debuts two new Category III codes to report videoconferenced critical care. You can submit 0188T for the first 30-74 minutes of critical care videoconferencing, and 0189T for each additional 30 minutes. "These codes could be helpful, but CMS currently assigns them a status indictor of 'N,' meaning it's currently noncovered," says Jay Neal, a coding consultant in Atlanta.

You can read CMS' Transmittal at http://www.cms.hhs.gov/Transmittals/downloads/R1528CP.pdf.