Neurology & Pain Management Coding Alert

Descriptor updates and E-prescribing top experts' lists of watch points.

As you move into 2011, don't overlook small modifier and descriptor changes that can have a big impact on your claims and reimbursement. And if your physician hasn't paid much attention to e-prescribing in the past, now's the time to start, says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co.

Prepare for New Modifiers and Descriptor Changes

2011 adds a new modifier to your coding arsenal and updates the descriptors for several others you might often use.

• Get ready for modifier GU (Waiver of liability statement issued as required by payer policy, routine notice). You might have times when it's appropriate to report modifier GU instead of the revised standby modifier GA (Waiver of liability statement on file; individual). Medicare hasn't yet provided instructions for correctly reporting modifier G, but watch for updates in future issues of Neurology and Pain Management Coding Alert.
• Three modifiers now include non-physician providers in the descriptors: 76 (Repeat procedure or service by same physician or non-physician provider), 77 (Repeat procedure or service by another physician or non-physician provider), and 78 (Unplanned return to the operating/procedure room by the same physician or non-physician providerfollowing initial procedure for a related procedure during the postoperative period). In previous years, some payers didn't allow non-physician providers to report their services with these modifiers since they specifically addressed "physician" care. Updating the descriptors should make it easier for you to report situations represented by modifiers 76, 77, or 78 to your payers.

Big change: The 2011 edition of HCPCS deletes G0430 (Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure). Now you'll likely report new code G0434 (Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter) instead. HCPCS 2011 also revises G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter), but few physician offices are CLIA certified to perform high complexity tests.

Practice E-Prescribing

E-prescribing is here to stay -- and is about to be more strictly enforced.

Heads up: Physicians need to e-prescribe at least 10 unique prescribing events for Medicare beneficiaries during the first 6 months of 2011, or they'll be added to the list for a 1 percent penalty hit on all Medicare payments in 2012. "The prescriptions can be for one patient during ten different visits or can be spread out among at least ten different patient visits or any combination in between," Hammer says. "For pain management practices, the prescriptions can be for any type of medications that can be sent electronically," she added.

Report your physician's e-prescribing to Medicare by including G8553 (At least one prescription created during the encounter was generated and transmitted electronically using a qualified ERX system) in the claim.

Face ICD-10 With Confidence

No matter how many years you've been coding, you probably heard that "ICD-10 is on the way" when you entered the profession. Now that it's looming as a reality, take a deep breath and know that you'll be OK. "We learned to use ICD-9, and we'll learn to use ICD-10," said Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla., said during an ICD-10 workshop at the 2011 Coding Update and Reimbursement Conference in Orlando, Fla.

Preparation: Start preparing for ICD-10 codes with new specifics for code digits: The first three characters identify the category or disease chapter; the next three digits describe the anatomic location and the severity;additional digits explain details of the condition.

Bonus: Beginning in 2011, each issue of Neurology and Pain Management Coding Alert will include information about how you'll code some of your most common diagnoses when ICD-10 goes into effect. Save these tidbits for future reference, and you'll have a head start on how to find the diagnoses you'll need.