Radiology Coding Alert

Target issues offer a good idea of what to watch so your future claims are compliant.

At least two Recovery Audit Contractors (RACs) are reviewing transforaminal epidural injection claims.

Keep ICD-9 in Mind for Connolly

For physicians, Connolly is checking for supporting diagnoses on "transformational" epidural injection claims from 2007 to the present.

The RAC audit is data mining to determine whether any claims were paid for diagnoses (ICD-9 codes) that were not included in the local coverage determinations (LCDs) for the relevant Medicare contractors, explains Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Colo.

Affected states are Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia, as well as Puerto Rico and the Virgin Islands.

Connolly has posted its approved issues at www.connolly.com/healthcare/pages/ApprovedIssues.aspx.

Health Data Insights Is Checking for Imaging Codes

Health Data Insights is checking another potential coding problem for transforaminal epidural injections. This RAC is checking to see whether physician claims improperly reported imaging guidance codes 77001-77003 or 77012 alongside 64479-+64484. Claims that have a "claim paid date" less than three years prior to the Demand Letter date are fair game for review.

States affected include Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, and Wyoming, as well as Guam, American Samoa, and the Northern Marianas.

You can review issues at http://racinfo.healthdatainsights.com/Public1/NewIssues.aspx.