Orthopedic Coding Alert

If your practice provides physical therapy, there's some Medicare news you need to know, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver.

The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 extended therapy cap exceptions to Dec. 31, 2009. That means you may resume submitting claims with modifier KX (Requirements specified in the medical policy have been met) for therapy services that exceed the cap.

For physical therapy and speech-language pathology services combined, the incurred-expense limit is $1,810 for 2008. For occupational therapy services, the limit is $1,810. How it works: "Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached. Services that meet the exceptions criteria and report the KX modifier will be paid beyond this limit," CMS states (http://www.cms.hhs.gov/therapyservices/).

You can find the list of diagnoses meeting the exceptions criteria, such as V43.61-V43.69 (Joint replacement), in the Medicare Claims Processing Manual, chapter 5 (http://www.cms.hhs.gov/manuals/downloads/clm104c05.pdf).

Action plan: The extension is retroactive to July 1, so if you use the 837 professional electronic claim format or CMS-1500 paper claim and Medicare denied claims for exceeding the cap, request that your contractor adjust the claim so you receive payment.

Don't forget: If your practice told the patient he was liable for charges and the beneficiary paid "for services that now qualify for exceptions," you should give a refund to the patient.