Pulmonology Coding Alert

Although nebulizers are the most pressing open RAC issues for pulmonology practices, these auditors have announced dozens of other review issues within the past two months as well, indicating that they are stepping up their audits of the following services.

Your practice should take note of these audit areas to ensure that you aren’t at risk of scrutiny for these visits, which auditors under the purview of RAC contractors Cotiviti and Performant Recovery are reviewing:

• Add-on Codes Paid Without Primary Code and/or Denied Primary Code: When CPT^® designates a particular code as an “add-on procedure,” it must be reported with another procedure. These codes “are only payable when an appropriate primary service is also billed,” Cotiviti says.
• Global Surgery: Pre- and Postoperative Visits: Overpayments associated with minor and major surgeries are under the microscope, including E/Ms billed during 10-day or 90-day global periods without modifiers, and E/M services billed the day of a minor (0-day) surgery without a modifier.
• Excessive Units of Hospital Services: Both initial hospital care and subsequent hospital care codes “are per diem services and may be reported only once per day by the same physician(s) of the same specialty from the same group practice,” Cotiviti said.
• Hospital Discharge Day Management Service: Medicare only pays one hospital discharge day management service per patient per hospital stay, which is billed by the attending physician of record only.
• Office Visits Billed for Hospital Inpatients: If you see a patient in the inpatient hospital setting, you should use a code from the 99221-99233 (Initial hospital care…) or 99238-99239 (Hospital discharge day management…) series, not a code from the 99201-99215 (Office or other outpatient visit…) range, since these are reserved for outpatient visits.
• New Patient Visits: “Claims are recouped when a provider bills a new patient visit code and the same provider or a provider from the same group practice and with the same specialty has performed any other E/M services within a three-year period of time,” Performant says.

Resource: To read the audit issue detail on the RAC page, visit http://www.cotiviti.com/healthcare/who-we-serve/cms-approved-issues and https://www.dcsrac.com/IssuesUnderReview.aspx.