Correct Coding Initiative Research Articles

Letter: Commentary: The Anatomy of Disvalued Codes: The 63047 and the 22633.

Letter: Commentary: The Anatomy of Disvalued Codes: The 63047 and the 22633.

Resource Tables for Modifier Use

These 2 tables provide quick references to modifier use and a guide to which modifiers override National Correct Coding Initiative edits when appropriately reported:

Decoding Billing Practices in Cochlear Implant Programs.

The purpose of this study was to examine current cochlear implant (CI) billing practices across CI audiologists in the United States, to determine if CI audiologists are following the National Correct Coding Initiative (NCCI) edits, and to assess the CI audiologist's exposure to billing education. A 48-question survey was electronically distributed to and completed by audiologists who bill for CI services. Demographic data including work setting, population served, years of experience, number of CI patients managed per week, and exposure to billing education were collected. Data were analyzed to identify codes and modifiers used to bill for commonly performed CI procedures such as unilateral and bilateral CI programming, preoperative and postoperative testing, and objective measures. Data were obtained from 96 audiologists. The majority (86.3%, n = 82) of respondents agreed or strongly agreed they understand billing and coding practices for cochlear implants and 94.7% (n = 89) rated themselves as somewhat to highly efficient when performing these practices. Only 16.8% (n = 16) of respondents reported receiving formal training for practice management, and half of the respondents (51.1%, n = 48) reported unfamiliarity with national billing guidelines. Those who received formal training reported higher billing efficiency. Wide variability was seen for various billing scenarios. Billing questions were presented, and answers were coded as correct or incorrect based on the NCCI edits. Respondents who reported higher agreement with understanding billing and who received formal training scored better on common billing questions related to the NCCI edits. Most CI audiologists rated themselves as efficient in billing; however, wide variance in billing practices was observed. Incorporating practice management and current billing education into daily practice and into audiology training programs is essential to clinic efficiency, practice management, and CI program viability. CI audiologists should be knowledgeable about appropriate billing practices to ensure long-term sustainability of programs.

Know Health Plan Payment Policies to Avoid Lost Revenue

Often, health plans establish payment policies that do not align with Current Procedural Terminology (CPT®) guidance and/or National Correct Coding Initiative (NCCI) edits. It's important to understand these policies to avoid lost revenue and unhappy patients.

National Correct Coding Initiative Policy Change

The Centers for Medicare & Medicaid Services (CMS) has made a significant change to the policy for using distinct service modifiers to override Medicare National Correct Coding Initiative (NCCI) edits. The change will be implemented July 1, 2019.

Current CPT Coding and Payment Policy Implications for Immunohistology Services.

Immunohistology is essential to the practice of modern surgical and cytopathology. There are 3 major types of immunohistologic services provided in clinical practice: traditional immunohistochemistry, morphometric analysis of tumor immunohistochemistry, and immunofluorescence. Proper Current Procedural Terminology coding for these services has been updated to reflect current medical practice. Subsequent to changes in the Current Procedural Terminology coding structure for these services, the valuation of these services have been reviewed by the American Medical Association/Specialty Society Relative Value Update Committee and new valuations instituted by the Centers for Medicare and Medicaid Services. Although valuations for services may be established, the circumstances of payment may be affected by Medicare Contractor's Local Coverage Determinations or service limits imposed by the National Correct Coding Initiative.

Modifier 25 and Minor Procedures

Modifier 25 and Minor Procedures

Inhalation Treatments: Understanding CPT® and Medicaid Instructions (Online Exclusive)

Inhalation treatments for acute airway obstruction are an important element of care for patients with asthma and other respiratory conditions. Coding for these services appears straightforward based on Current Procedural Terminology (CPT®) instruction. However, changes to the National Correct Coding Initiative (NCCI) Policy Manual for Medicaid Services for 2017 remind us that these services must be reported based on payer guidelines when these differ from CPT.

Coding Challenge: Inhalation Treatments

Test your knowledge to determine the correct procedure codes based on instruction from either Current Procedural Terminology (CPT®) or Medicaid National Correct Coding Initiative (NCCI).

Cognitive Treatment: Is It Covered?

Cognitive Treatment: Is It Covered?

Cost-effective approach to the diagnostic workup of B cell lymphoproliferative disorders via optimal integration of flow cytometric data.

The workup of lymphoproliferative disorders (LPDs) involves the combined use of flow cytometry (FC) and immunohistochemistry (IHC). This often results in duplicate immunophenotypic testing and adds costs that may not be eligible for reimbursement based on the Medicare National Correct Coding Initiative. We aimed to establish a cost-effective diagnostic algorithm based on initial FC categorization to reduce repetitive immunophenotyping. We retrospectively reviewed 242 cases of suspected LPDs with concurrent FC and IHC testing over a 12-month period. We correlated FC with surgical diagnoses and evaluated the frequency of repeat IHC testing. Repetitive immunophenotyping was common; overall, 85% of cases had at least one marker repeated. Concordant cases were significantly less likely to have markers repeated than discordant cases. Of concordant B cell malignancies, 57% represented recurrent disease; however, repeat marker usage was not decreased as compared to new diagnoses. The most frequently repeated markers were CD3, CD5, CD10, and CD20. We propose that in concordant cases, CD5 and CD10 should not be repeated by IHC; this would decrease the use of these markers by 80% and 76%, respectively. We developed an algorithmic approach to IHC usage that has improved incorporation of FC data at our institution and may reduce healthcare costs.

Modifier Resources From AAP Pediatric Coding Newsletter™ (Online Exclusive)

Online resources for information about modifiers and The National Correct Coding Initiative.

Procedure Coding Guidance: 2016 Medicaid National Correct Coding Initiative Manual Updates

Often, physicians and coders have questions on the services bundled by National Correct Coding Initiative edits and when it is appropriate to append a modifer that may override an NCCI edit…

Understanding Medicaid Medically Unlikely Edits

The Centers for Medicare & Medicaid Services (CMS) maintains 2 types of Medicaid National Correct Coding Initiative (NCCI) edits: procedure-to-procedure edits and Medically Unlikely Edits (MUEs). Physicians may be most familiar with procedureto-procedure edits…

Do you know how to read and properly interpret the National Correct Coding Initiative Edits?

Do you know how to read and properly interpret the National Correct Coding Initiative Edits?

Back to Basics: The National Correct Coding Initiative

A refresher on NCCI with some basic questions and answers.

Have you read the National Correct Coding Initiative Policy Manual for Medicare Services?

Have you read the National Correct Coding Initiative Policy Manual for Medicare Services?

Staying in Compliance With National Correct Coding Initiative Edits

Integrating coding edits into a compliance program, modifiers, and quarterly review to avoid unexpected claim denials

Immunohistochemistry Cocktails Are Here to Stay

On January 1st, 2012, the Center for Medicare and Medicaid Services (CMS) implemented a policy in conjunction with the National Correct Coding Initiative (NCCI) to pay pathologists and laboratories for immunohistochemistry (IHC) cocktail stains as a single unit of Current Procedural Terminology (CPT) code 88342, regardless of how many individually interpretable antibodies are included in the cocktail. Medicare has, in the past, paid for IHC cocktail stains based on the American Medical Association’s prescription: 1 unit of CPT code 88342 was payable for each separately interpreted and reported antibody (eg, via unique color expression compared with other markers in the cocktail). Knowledgeable sources indicate that this new policy is a reaction by CMS to a dramatic increase in the number of IHC charges on physician and laboratory claims during the past 2 or 3 years. This period roughly corresponds to the observed proliferation of in-office and other histology laboratory arrangements entered into, particularly but not exclusively, by urologists and gastrointestinal practitioners. Overutilization of IHC stains—the application of diagnostic markers in medically suspect situations (eg, staining all of a patient’s biopsy specimens instead of just 1 or 2 tumor-rich samples, applying a stain to rule out a condition not suggested by the H&E slides)—by these physicians, and perhaps by a minority of overly aggressive pathologists as well, is a natural cause for alarm among government payers and private medical insurers alike. As taxpayers and as ethical practitioners of the medical arts, we are highly sympathetic to the goal of CMS and other parties to eliminate waste and abuse in the laboratory industry. Notwithstanding, it is the strong opinion of leaders in the field of IHC testing that the …

Billing Edits for Auditory Processing Disorder In Effect April 1, 2012

You have accessThe ASHA LeaderBottom Line1 Apr 2012Billing Edits for Auditory Processing Disorder In Effect April 1, 2012 Lisa SatterfieldMS, CCC-A Lisa Satterfield Google Scholar More articles by this author , MS, CCC-A https://doi.org/10.1044/leader.BML.17052012.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In As of April 1, 2012, audiologists may not bill certain codes together for the evaluation of (central) auditory processing disorder [(C)APD] for the same Medicare- or Medicaid-eligible patient on the same day. The restrictions are contained in the 2012 National Correct Coding Initiative (NCCI) edits. NCCI edits prohibit billing certain procedure codes on the same day and are intended to promote correct coding methods and to control improper coding leading to inappropriate payment. They are mandatory for Medicare and Medicaid services but optional for private health plans. The Centers for Medicare and Medicaid Services (CMS) develops the NCCI edits based on definitions in the CPT (Current Procedural Terminology, © American Medical Association) manual, national and local policies, standard clinical practice, and current coding practices. Evaluation and Individual Tests Many audiologists administer and bill for (C)APD evaluations and individual tests because of an elaborate history surrounding the codes. In 2005, CMS approved two new (C)APD evaluation codes. It took nearly two years of ASHA advocacy to receive approval for the codes: CPT 92620 (evaluation of central auditory function, with report; initial 60 minutes) and CPT 92621 (each additional 15 minutes). When the codes did receive approval, however, they were undervalued by CMS. Clinicians responded to the low values by requesting that they be allowed to bill the individual test codes—specifically the filtered speech test (92571), staggered spondaic word test (92572), and synthetic sentence identification test (92576), in addition to the timed central auditory function codes. CMS, however, recommended that 92620 and 92621 not be billed in combination with 92571, 92572, or 92576. CMS indicated that the individual tests could be reported only if they are performed in isolation, using the single code representing that procedure. If a battery of tests is performed, the individual tests should not be billed in addition to 92620/92621. CMS reasoned that using the time-valued codes (92620 and 92621) allows the audiologist to capture the time spent on the evaluation for site of lesion and other tests of central auditory function often used to determine the presence of (C)APD. Additionally, billing 92620 and 92621 avoids the suggestion that the three individual tests are required as part of the test battery to evaluate central auditory function, and instead allows the audiologist to determine the tests most appropriate for the patient. Unanticipated Action It was anticipated that NCCI would apply this soon after the CPT codes were published in 2005. The initial NCCI edit, however, did not prohibit billing the individual test codes with 92620 and 92621. Instead, it restricted billing 92506 (evaluation of speech, language, voice, communication, and/or auditory processing) with 92620 and 92621. This edit remains in effect. Seven years later, NCCI is enforcing the edit that prohibits billing individual test codes with the timed codes. Therefore, as of April 1, billing 92620/92621 with 92571, 92572, or 92576 on the same day for Medicare or Medicaid patients is no longer allowed. For updates and additional edits, visit ASHA’s reimbursement webpage. Author Notes Lisa Satterfield, MS, CCC-A, director of health care regulatory advocacy, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 17Issue 5April 2012 Get Permissions Add to your Mendeley library History Published in print: Apr 1, 2012 Metrics Downloaded 99 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2012 American Speech-Language-Hearing AssociationLoading ...