Radiology Coding Alert

Plus: Follow CMS' new rules or risk an automatic denial

According to the latest NCCI Edits , effective Jan.1, 2005, radiology codes and the new temporary drug administration G codes just don't mix.

Prep for Massive G Code Edits
 
Codes G0345 (Initial infusion, hydration; initial, up to one hour), G0347 (Intravenous infusion, for therapeutic/diagnostic [specify substance or drug]; initial, up to one hour) and G0353 (Intravenous push, single or initial substance/drug) show up time and again in the edits, but these services won't appear in your CPT manual until 2006.
 
On Nov. 15, 2004, CMS announced in the final Physician Fee Schedule that it would adopt these G codes, considering them interim until 2006, when permanent CPT Category I codes will be added to the manual.
 
For the most part, the G codes are bundled into radiology codes.
 
Stay tuned for next month's issue when we'll explain how these edits could affect your bottom line.
 
Get the background on these codes online at www.cms.hhs.gov/manuals/pm_trans/r129otn.pdf, in CMS Transmittal 129.

Procrastinate and You'll See Denials Soar

You could see more denials if you don't pick up on CMS' recent Program Integrity manual update. The bottom line: Promptly submit requested information or expect to see an increase in rejected claims.
 
According to Transmittal 91, CMS is correcting an inconsistency that's been causing problems for providers.  
 
The newly clarified rule states: When a provider is told to submit additional documentation for medical review purposes to a contractor within 30 days, "if no response is received within 45 days after the date of the request (or extension), the contractor must deny the service as not reasonable and necessary."
 
See www.cms.hhs.gov/Manuals/pm_trans/R91PI.pdf for the full transmittal.