Ob-Gyn Coding Alert

Good News! You Wont Have to Pay Refunds to Medicare

Due to the delayed implementation of the 2003 Medicare Physician Fee Schedule, Medicare carriers overpaid some ob-gyn practices for January and February claims using a higher conversion factor rate, which did not actually take effect until March 1. CMS initially announced that carriers would request reimbursement from these practices by using an automatic mass adjustment. Fortunately, on June 27, CMS announced that it will not require Medicare carriers to collect such overpayments.

On the other hand, if you bring an incorrect payment for January and February to a Medicare carriers attention, the payer will still process such an adjustment, CMS says.

Dont Forget Those ICD-9 Codes

If you submit a screening mammography claim after Oct. 1, be sure to include the proper diagnosis code. CMS announced June 10 that Medicare carriers will no longer be able to enter missing diagnosis codes on claims. The ICD-9 codes must be entered on electronic and paper claims by the submitter, the agency stated in Program Memorandum B-03-046.

Screening mammograms are not the only procedures affected. In fact, you must include the diagnosis codes for all procedures submitted for payment. Further, if you know the diagnosis, assign an ICD-9-CM code that provides the highest degree of accuracy and completeness, CMS suggested, adding that you should code the fifth digit when possible.

On the other hand, if you dont know the diagnosis when submitting a claim, you should report the condition(s) to the highest degree of certainty for that encounter/visit such as signs, symptoms, abnormal test results, exposure to communicable disease, or other reason for the visit, according to the memo. But dont use probable, suspected, questionable, rule-out or working diagnoses as though they exist, CMS warned.