Part B Insider (Multispecialty) Coding Alert

Published on Tue Mar 15, 2011 PDF

Plus: CMS announces new specialty code for advanced diagnostic imaging accreditation.

If some of your Medicare Part B claims are rolling in more slowly than usual, CMS has the reason why. On April 8, CMS announced that it discovered several claims processing errors that MACs are in the process of correcting, as follows:

• Preventive services codes and surgical codes billed on the same date as a colonoscopy, flexible sigmoidoscopy, or barium enema "that were initiated as colorectal cancer screening services with dates of service on and after Jan. 1, 2011 were suspended due to deductible and coinsurance being erroneously applied," the announcement said. CMS began correcting this problem on April 4.
• Outpatient claims for Hepatitis B vaccine codes 90740-90747 submitted on type of bill 13X for dates of service Jan. 1 or thereafter "are suspending if they are the only service on the claim," CMS noted. "Also, claims containing Hepatitis B vaccine services are not being paid when other services are billed on the same claim." MACs are holding claims impacted by this problem until CMS corrects the issue.

If you have any specific questions regarding claims for these services, contact your MAC's provider assistance department.