Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 18, 2007 PDF

And Synvisc codes change ... again

If you need a way to override a medically unlikely edit, HCPCS offers you a new modifier effective Jan. 1.

Starting in January, the medically unlikely edits (MUEs) will limit the number of units of a particular code that your physician can bill. To avoid MUE-related denials, you can now append new HCPCS modifier GD (Units of service exceed MUE value but represent medically necessary services) to your claim.

CMS has not yet announced whether this modifier will apply to both CPT and HCPCS codes. But assuming it does, modifier GD could come in handy for many practices.

-Suppose the surgeon bills for two appendectomies because the patient has a native one and one attached to his transplanted organ,- says Suzan Hvizdash, CPC, CPC-E/M, CPC-EDS, physician educator for the University of Pittsburgh Physicians Department of Surgery. -This would be a medically unlikely scenario, however, one that happened nonetheless.-

HCPCS will no longer include modifiers QA (FDA investigational device exemption), QR (Item/service provided in a Medicare study) or QV (Item/service provided as routine care in a clinical trial).

Deletions, additions: HCPCS 2008 also moves several codes from the -Q- category to the -J- section. -Any time a HCPCS code goes from Q to J, it means that it used to be a temporary code, and now it's got a permanent code status,- explains Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach for the American Academy of Professional Coders in Salt Lake City.

Immune globulin: For example, since July you-ve been reporting immune globulin injections with Q4087-Q4088 and Q4091-Q4092. But Medicare deletes those codes for Jan. 1, and now you-ll report J1561 for Gamunex injections, J1562 for Vivaglobin, J1568 for Octagam, J1569 for Gammagard liquid, J1571 for Hepagam B, and J1572 for Flebogamma.

Orthopedics: Your head may still be spinning from last year's about face on Synvisc and Hyalgan injections, but HCPCS once again changes the coding guidance for these drugs.

In 2007, CMS changed sodium hyaluronate coding by introducing Q4083, Q4084, Q4085 and Q4086 in place of the previous J codes that HCPCS originally recommended. But on Jan. 1, you-ll be able to toss out those Q codes, and instead report J7321 for Hyalgan or Supartz, J7322 for Synvisc, J7323 for Euflexxa, and J7324 for Orthovisc.