Part B Insider (Multispecialty) Coding Alert

Published on Thu Nov 08, 2007 PDF

ASCs boast low error rates, general practices show the highest

If the latest CERT report is any indication, you could have made a lot more money last year.

According to the Comprehensive Error Rate Testing (CERT) results that CMS released last week, Medicare carriers discovered more than $259 million in undercoding billing errors, which means that medical practices shorted themselves that much last year.

For example, the report highlights a practice that billed 40 units of J1756 (Iron sucrose, 1 mg). CMS discovered, however, that the practice actually injected 200 mg, which would have allowed it to have billed 200 units. That practice shorted itself over $200.

The only non-E/M CPT codes on the list of the top 20 -underpayment coding errors- were 20610 (major joint aspiration/injection) and 92012 (eye exam), which puzzled some practices.

Potential rationale: Some practitioners may have performed joint injections bilaterally, but only billed them unilaterally, suggests Leslie Follebout, CPC-ORTHO, coding department supervisor at Peninsula Orthopaedic Associates in Salisbury, Md. Or the physician may not have indicated the injection on the charge document or encounter form, even though he performed and documented it, she says.

General practices are error-prone: Error rates among the different provider types showed that general practices had an alarming 27 percent error rate, with ob-gyns close behind at 24 percent.

The lowest error rates were found in claims from ASCs, CRNAs, interventional radiologists, mass immunizers and public health agencies.

-I think the error rate is lower in ASCs because we have less to worry about than most clinics do,- says Christopher Felthauser, CPC, CPC-H, ACS-OH, ACS-OR, a coding consultant in Seattle. -Most of what we do are surgical procedures, and we do not deal with E/M coding at all, which makes a huge difference.-

Avoid this $1,000 mistake: The CERT report offers examples of claims that contained errors. For example, one Part B payer reimbursed a physical therapist $1,120, but the claim reviewer couldn't find documentation of the physician's order, therapy evaluation or plan of care, causing the reviewer to count the entire payment as an error.