Oncology & Hematology Coding Alert

Perhaps because chest X-rays are so common, documentation for these services often isn't as meticulous as it should be. That means the documentation may not match up to payers' policy standards.

Case in point: Palmetto GBA recently completed a review of 71010 and 71020 claims for November 2010 through January 2011 in Southern California. The Jurisdiction 1 Part B MAC reviewed 3,233 claims and denied 1,610 -- a 49 percent denial rate. Here is a look at the most common problems identified and the solutions Palmetto suggested.

Problem/Solution 1: A whopping 42 percent of the denials were due to the service lacking the necessary provider's order. Palmetto suggests that providers be sure to include the order when they're asked to submit documentation to the payer. In addition, you need to be sure the order meets signature requirements.

Problem/Solution 2: More than one-third of the denials were a result of the provider not submitting the requested documentation. If your practice receives a request from your payer for documentation, follow the directions so that your claims are not denied simply because you failed to respond.

Problem/Solution 3: Lack of a radiology report caused 11 percent of the denials. Avoiding this problem may be as simple as double-checking the documentation before you send it to the payer to be sure you've included the necessary signed report.

Problem/Solution 4: Issues with patient identification or the date of service caused 3 percent of the denials. Check that the patient identifiers and date of service have been appropriately and legibly noted on all pages of the documentation and are present in the appropriate fields.

You'll find Palmetto's announcement, "Completion of Prepayment Service Specific Complex Review for CPT® Codes 71010 and 71020, Chest X-ray Services, Southern California" at www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8GQRTD3358?opendocument&utm_source=J1BL&utm_campaign=J1BLs.