The window of opportunity for missed C-codes
APCs Weekly Monitor, February 7, 2003
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Friday, February 7, 2003 Vol. 4, No. 5 SUBSCRIBE And now some April Fool's trivia: Which daytime soap opera debuted on April Fool's Day in 1963? The answer will appear in next week's APC Weekly Monitor, or e-mail your answer and win a free cup of coffee!
"Briefings on APCs" is a monthly newsletter devoted entirely to managing under APCs, including tips, charts, and advice from the experts. "APC
Answer Letter" is a question and answer publication - readers supply
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out more.
THE MONITOR'S ADVISORY BOARD Keith Siddel, Cheryl D'Amato, Julie Downey, Carole Gammarino, Julia R. Palmer Valerie Rinkle, MPA, On Himinfo.com
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Don't be fooled when coding Hepatitis B! It's not April Fool's yet, but it probably feels like it to coding professionals: CMS has changed the Hepatitis B vaccine coding procedure again, and all Hepatitis B vaccine claims must be held until April 1, 2003. It started in November, when CMS established new Q-codes to replace CPT codes 90740, 90743, 90744, 90746, and 90747. The changes were made to version V4.0 of the OPPS OCE, but before the codes could become effective January 1, CMS changed its mind and reactivated the CPT codes and the Q-codes became history. However, CMS will not accept the CPT codes until April 1, when the OPPS OCE will be updated to reflect the appropriate Service Indicators for the vaccine and the CPT codes will be back in business.
Still looking for CPT changes?
For those of you unable to track down the CPT 2003 errata on the AMA Web site mentioned in last week's "Monitor," we apologize. It is tricky to find. Here is a direct link.
Check out this month's issue of Briefings on APCs to keep up to date on all the changes presented in recent program memos, including expired pass-through C-codes, new G-codes, and tips on correctly coding knee and shoulder surgery.
Your "APCs Weekly Monitor," is a free weekly e-zine from
HCPro,
publisher of "Briefings on APCs," the monthly newsletter
devoted
entirely
to managing under APCs, and the newsletter, "APC Answer
Letter,"
with
answers to readers' questions about coding for APCs.
The "Monitor" is a complimentary companion publication, with
a
specific
mission: to provide answers to your tough questions about the APC
regulations.
If you have a question about APC coding that you would like
addressed
in the "Monitor," post it on our Web site at himinfo.com.
Each week, our team of experts answers questions that will appeal to
the majority of readers. The elected questions and their
corresponding
answers are delivered to your inbox every Friday. If a physician removes or excises a lesion, can he or she wait until the pathology report comes back before billing for it?
New G-code ends one modifier -59 headache
Question:
How far back can a facility go to re-bill or adjust claims to show
missed opportunities with C-codes through Medicare?
Answer:
Medicare providers have at least 15 months from the date of the service
to submit a claim to Medicare. However, claim payment for assigned
claims will be reduced by 10 percent if the claim is not filed within
one year of the date of service. Providers may not bill the patient for
this reduction.
The list below provides the filing deadline for the
date of service ranges indicated.
The corrected claims must be submitted with a modified bill type.
Correct claims should be billed as Type XX7, replacement of prior claim.
When submitting a corrected claim providers should make all necessary
changes not those with a positive impact to the facility.
Questions from readers are answered by a team
of experts working in the APC area within the health care industry.
Their
answers are provided as advice. Readers should consult the federal
regulations governing OPPS, related CMS sources, and with their
local
fiscal intermediary before making any decisions regarding the
application
of OPPS to their particular situations.
MISSED DIAGNOSIS CODES MEAN MISSED REVENUE OPPORTUNITIES
Getting the diagnosis right is key to getting paid. There is help
available to get a handle on
more than 160 new diagnosis codes and their proper use. Attend a live
audioconference, "The
New ICD-9 Diagnosis Codes: Understanding the Changes and their Use" on
February 26. Get your
questions answered in real time following the presentation.
For more information or to register, CLICK
HERE, or call our
customer service department at 800-650-6787. Be sure to mention source
code EZ8282C.
LIVE AUDIOCONFERENCE
Do you understand the new reimbursement opportunities for APC observation services?
A new year always spells APC and OPPS changes, and 2003 brings you new ways to code and bill observation services for APC reimbursement. Are you getting every appropriate dollar for the work you do?
Learn what you need to know during a 90-minute live audioconference, "Observation Services and APC Payments: Key Coding and Billing Changes for 2003" on Thursday, March 12, beginning at 1 p.m. Eastern.
For more information or to register, CLICK HERE, or, call our customer service department at 800-650-6787. Be sure to mention source code EZ8499B
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