Neurology & Pain Management Coding Alert

Warning: Missing the surrogate UPIN change guarantees denials

You-ve made it through half the year, but have you made sure to implement all of CMS- 2006 coding changes? Make certain that you have with these three articles.
 
Article 1: Stop using surrogate UPINs at IDTFs. As of January 2006, carriers reject IDTF claims submitted with surrogate Unique Physician Identification Numbers (UPINs), such as OTH000, RES000, VAD000, PHS000, and RET000, according to Medlearn Matters MM4096, related to Transmittal 769, effective Jan. 3 (www.cms.hhs.gov/Transmittals/downloads/R769CP.pdf).
 
Takeaway: Prevent denials by submitting the ordering physician's UPIN.
 
Article 2: Add a fourth -R- to your consult requirements. Consults used to have three R's for documentation: Request, Render and Report. Now you also have to indicate the Reason for the consult in both the requesting and consulting physician's files, per CMS Transmittal 788, effective Jan. 1, 2006 (www.cms.hhs.gov/Transmittals/downloads/R788CP.pdf).
 
Takeaway: Having the consulting physician's report in the requesting physician's file after the fact isn't enough. The request must be in the requesting physician's chart before the consult happens. Consider sending the requester slips similar to the ones your neurologist already uses to keep track of orders.
 
You can also create a form that you can fax to the requesting physician's office for documenting the reason for the request, says Patricia Trites, MPA, CHBC, CPC, CHCC, CHCO, CEO of Healthcare Compliance Resources in Augusta, Mich. The requesting physician can keep this form in the medical record. (See the sample form on page 52.)
 
Article 3: Don't skimp on CMS 1500 item 21. According to CMS Transmittal 735, effective April 1, carriers must start reviewing all diagnosis codes you submit to determine coverage (www.cms.hhs.gov/transmittals/downloads/R735CP.pdf).
 
Takeaway: Stop settling for one diagnosis code. Telling the patient's story with all relevant diagnosis codes will boost your coverage chances.