CODING CORNER – FEBRUARY 2014

By Lisa Kropp, Coding and Credentialing Manager

2014 DELETED HCPCS CODES:

Below, you will find a listing of all the 2014 deleted HCPCS codes.  Please see your HCPCS books for revisions or additions.  This information will be available to you, upon request.

*Highlights:  G8553 (Prescription(s) generated and transmitted via a qualified ERX system) is a DELETED HCPCS code for 2014.  With implementation of Meaningful Use Stage 2 came the end in reporting for the eRX incentive.

Code Description Deleted Date Cross-Reference
C1204 Technetium Tc 99m tilmanocept, diagnostic, up to 0.5 millicuries 1/1/2014 To report, see A9520
C9130 Injection, immune globulin (Bivigam), 500 mg 1/1/2014 To report, see J1556
C9131 Injection, ado-trastuzumab emtansine, 1 mg 1/1/2014 To report, see J9354
C9292 Injection, pertuzumab, 10 mg 1/1/2014 To report, see J9306
C9294 Injection, taliglucerase alfa, 10 units 1/1/2014 To report, see J3060
C9295 Injection, carfilzomib, 1 mg 1/1/2014 To report, see J9047-
C9296 Injection, ziv-aflibercept, 1 mg 1/1/2014 To report, see J9400
C9297 Injection, omacetaxine mepesuccinate, 0.01 mg 1/1/2014 To report, see J9262
C9298 Injection, ocriplasmin, 0.125 mg 1/1/2014 To report, see J7316
C9736 Laparoscopy, surgical, radiofrequency ablations of uterine fibroid(s), including intraoperative guidance and monitoring, when performed 1/1/2014
G0275 Renal angiography, nonselective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins (ostia) of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation (List separately in addition to primary procedure) 1/1/2014
G8459 Clinician documented that patient is receiving antiviral treatment for hepatitis C 1/1/2014
G8462 Clinician documented that patient is not an eligible candidate for counseling regarding contraception prior to antiviral treatment; patient not receiving antiviral treatment for hepatitis C 1/1/2014
G8463 Patient receiving antiviral treatment for hepatitis C documented 1/1/2014
G8553 Prescription(s) generated and transmitted via a qualified ERX system 1/1/2014
G8556 Referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation 1/1/2014
G8557 Patient is not eligible for the referral for otologic evaluation measure 1/1/2014
G8558 Not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given 1/1/2014
G8588 Most recent systolic blood pressure < 140 mm Hg 1/1/2014
G8589 Most recent systolic blood pressure >= 140 mm Hg 1/1/2014
G8590 Most recent diastolic blood pressure < 90 mm Hg 1/1/2014
G8591 Most recent diastolic blood pressure >= 90 mm Hg 1/1/2014
G8592 No documentation of blood pressure measurement, reason not given 1/1/2014
G8596 LDL-C was not performed 1/1/2014
G8603 Score on the spoken language comprehension functional communication measure at discharge was higher than at admission 1/1/2014
G8604 Score on the spoken language comprehension functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8605 Patient treated for spoken language comprehension but not scored on the spoken language comprehension functional communication measure either at admission or at discharge 1/1/2014
G8606 Score on the attention functional communication measure at discharge was higher than at admission 1/1/2014
G8607 Score on the attention functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8608 Patient treated for attention but not scored on the attention functional communication measure either at admission or at discharge 1/1/2014
G8609 Score on the memory functional communication measure at discharge was higher than at admission 1/1/2014
G8610 Score on the memory functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8611 Patient treated for memory but not scored on the memory functional communication measure either at admission or at discharge 1/1/2014
G8612 Score on the motor speech functional communication measure at discharge was higher than at admission 1/1/2014
G8613 Score on the motor speech functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8614 Patient treated for motor speech but not scored on the motor speech comprehension functional communication measure either at admission or at discharge 1/1/2014
G8615 Score on the reading functional communication measure at discharge was higher than at admission 1/1/2014
G8616 Score on the reading functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8617 Patient treated for reading but not scored on the reading functional communication measure either at admission or at discharge 1/1/2014
G8618 Score on the spoken language expression functional communication measure at discharge was higher than at admission 1/1/2014
G8619 Score on the spoken language expression functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8620 Patient treated for spoken language expression but not scored on the spoken language expression functional communication measure either at admission or at discharge 1/1/2014
G8621 Score on the writing functional communication measure at discharge was higher than at admission 1/1/2014
G8622 Score on the writing functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8623 Patient treated for writing but not scored on the writing functional communication measure either at admission or at discharge 1/1/2014
G8624 Score on the swallowing functional communication measure at discharge was higher than at admission 1/1/2014
G8625 Score on the swallowing functional communication measure at discharge was not higher than at admission, reason not given 1/1/2014
G8626 Patient treated for swallowing but not scored on the swallowing functional communication measure at admission or at discharge 1/1/2014
G8642 The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5) (a) of the Social Security Act 1/1/2014
G8643 The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption for the application of the payment adjustment under section 1848(a)(5) (a) of the Social Security Act 1/1/2014
G8644 Eligible professional does not have prescribing privileges 1/1/2014
G8741 Patient not treated for spoken language comprehension disorder 1/1/2014
G8742 Patient not treated for attention disorder 1/1/2014
G8743 Patient not treated for memory disorder 1/1/2014
G8744 Patient not treated for motor speech disorder 1/1/2014
G8745 Patient not treated for reading disorder 1/1/2014
G8746 Patient not treated for spoken language expression disorder 1/1/2014
G8747 Patient not treated for writing disorder 1/1/2014
G8748 Patient not treated for swallowing disorder 1/1/2014
G8790 Most recent office visit systolic blood pressure < 130 mm Hg 1/1/2014
G8791 Most recent office visit systolic blood pressure, 130-139 mm Hg 1/1/2014
G8792 Most recent office visit systolic blood pressure >= 140 mm Hg 1/1/2014
G8793 Most recent office visit diastolic blood pressure, < 80 mm Hg 1/1/2014
G8794 Most recent office visit diastolic blood pressure, 80-89 mm Hg 1/1/2014
G8795 Most recent office visit diastolic blood pressure >= 90 mm Hg 1/1/2014
G8796 Blood pressure measurement not documented, reason not given 1/1/2014
G8799 Anticoagulation ordered 1/1/2014
G8800 Anticoagulation not ordered for reasons documented by clinician 1/1/2014
G8801 Anticoagulation was not ordered, reason not given 1/1/2014
G8812 Patient is not eligible for follow-up CTA, duplex, or MRA (e.g., patient death, failure to return for scheduled follow-up study which will meet numerator criteria has not yet occurred at the time of reporting) 1/1/2014
G8813 Follow-up CTA, duplex, or MRA of the abdomen and pelvis performed 1/1/2014
G8814 Follow-up CTA, duplex, or MRA of the abdomen and pelvis not performed 1/1/2014
G8827 Aneurysm minor diameter <= 5.5 cm for women 1/1/2014
G8835 Asymptomatic patient with no history of any transient ischemic attack or stroke in any carotid or vertebrobasilar territory 1/1/2014
G8919 Most recent systolic blood pressure < 140 mm Hg 1/1/2014
G8920 Most recent systolic blood pressure >= 140 mm Hg 1/1/2014
G8921 Most recent diastolic blood pressure < 90 mm Hg 1/1/2014
G8922 Most recent diastolic blood pressure >= 90 mm Hg 1/1/2014
G8945 Aneurysm minor diameter <= 6 cm for men 1/1/2014
G8954 Complete and appropriate patient data were reported to a qualified clinical database registry 1/1/2014
J0152 Injection, adenosine for diagnostic use, 30 mg (not to be used to report any adenosine phosphate compounds; instead use A9270) 1/1/2014 To report, see J0151
J0718 Injection, certolizumab pegol, 1 mg 1/1/2014 To report, see J0717
J1440 Injection, filgrastim (G-CSF), 300 mcg 1/1/2014 To report, see J1442
J1441 Injection, filgrastim (G-CSF), 480 mcg 1/1/2014 To report, see J1442
J3487 Injection, zoledronic acid (Zometa), 1 mg 1/1/2014 To report, see J3489
J3488 Injection, zoledronic acid (Reclast), 1 mg 1/1/2014 To report, see J3489
J9002 Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg 1/1/2014 To report, see Q2050
L0430 Spinal orthotic, anterior-posterior-lateral control, with interface material, custom fitted (DeWall Posture Protector only) 1/1/2014
Q0090 Levonorgestrel-releasing intrauterine contraceptive system, (Skyla), 13.5 mg 1/1/2014 To report, see J7301
Q0165 Prochlorperazine maleate, 10 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0168 Dronabinol, 5 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0170 Promethazine HCl, 25 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0171 Chlorpromazine HCl, 10 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0172 Chlorpromazine HCl, 25 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q0176 Perphenazine, 8 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen 1/1/2014
Q0178 Hydroxyzine pamoate, 50 mg, oral, FDA approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 1/1/2014
Q2027 Injection, Sculptra, 0.1 ml 1/1/2014 To report, see Q2028
Q2033 Influenza vaccine, recombinant hemagglutinin antigens, for intramuscular use (Flublok) 1/1/2014 To report, see
Q2051 Injection, zoledronic acid, not otherwise specified, 1 mg 1/1/2014 To report, see J3489
Q3025 Injection, interferon beta-1a, 11 mcg for intramuscular use 1/1/2014 To report, see Q3027
Q3026 Injection, interferon beta-1a, 11 mcg for subcutaneous use 1/1/2014 To report, see Q2038
S3625 Maternal serum triple marker screen including alpha-fetoprotein (AFP), estriol, and human chorionic gonadotropin (HCG) 1/1/2014
S3626 Maternal serum quadruple marker screen including alpha-fetoprotein (AFP), estriol, human chorionic gonadotropin hCG) and inhibin A 1/1/2014
S3833 Complete APC gene sequence analysis for susceptibility to familial adenomatous polyposis (FAP) and attenuated fap 1/1/2014
S3834 Single-mutation analysis (in individual with a known APC mutation in the family) for susceptibility to familial adenomatous polyposis (FAP) and attenuated FAP 1/1/2014

 

ICD-10 READINESS

Practicefirst would like to provide you with an update regarding our plans to be ready for ICD-10.

With regards to our Coding Clients, it is Practicefirst’s policy to employ Certified Professional Coders to code your documentation.  We will ensure that all of our coders are ICD-10 trained and ready by the end of the 2nd Quarter of 2014.  Each coder will participate in an overview class of Anatomy & Physiology, formal training in ICD-10 guidelines/conventions and be required to pass AAPC’s ICD-10 proficiency exam.

Beginning in June 2014, Practicefirst will assist our non-Coding Clients in this transition by offering the following:

  • Reporting of the 20 most common ICD-9’s billed by your practice in 2013 with any direct ICD-10 mappings that may be applicable.  The purpose of this is to assist you in identifying the impact to your practice.  In many cases, there are direct mappings (ICD-9 to ICD-10).  In other cases, where more complex conditions & manifestations are present, there are NOT direct mappings and you will have to investigate these further.  These reports will be available to you beginning June 2014 or earlier upon request.
  • Assist in revising office fee slips/super-bills that list ICD-9 codes to make them ICD-10 ready as of 10/1/2014.

Below are suggested links you should begin using now as ICD-10 transition nears:

Helpful Hints/Tips regarding ICD-10:

  • ICD-10 CM specificity and detail have significantly expanded more than 68,000 codes.
  • ICD-10 uses 4-7 digit alpha-numeric codes instead of the 4-5 digit numeric codes used in ICD-9.
  • ICD-10 provides new tabulation lists.
  • ICD-10 transfers conditions among the classifications. It may be necessary to search for conditions in various sections.
  • ICD-10 utilizes “includes notes” and two types of “excludes notes”.

Advantages of ICD-10:

  • Introduction of codes with details on socioeconomic conditions, family relationships, ambulatory care conditions, problems related to lifestyle, and screening test results.
  • Introduction of new categories for post-procedural disorders.
  • Introduction of laterality (right, left, bilateral).
  • Creation of combination diagnostic codes with symptoms in order to reduce the number of codes needed to describe the condition.

Differences between ICD-9 & ICD-10

Feature

ICD-9-CM

ICD-10-CM

Min. # of digits/characters

3

3

Max. # of digits/characters

5

7

Number of chapters

17

21

Supplemental Classification

V codes & E Codes

Included in the classification

Laterality

No

Yes

Alphanumeric vs. Numeric

Numeric (except V & E codes)

All codes are alphanumeric

Excludes Notes

Yes

Excludes 1 & Excludes 2 Notes

Placeholders

No

“X” Serves as a dummy placeholder

Total # of codes

14,567

69,832

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfirst.com

 

COMPLIANCE UPDATES – FEBRUARY 2014

By Becky Amann, Compliance Manager

BLUE CROSS TRAINING REQUIRED FOR FALSE CLAIMS ACT

Blue Cross continues their requirement to educate providers about Fraud, Waste and Abuse as referenced in their letter dated December 19, 2013, regarding the Deficit Reduction Act.

The letter instructs providers to review their Fraud, Waste and Abuse Laws in Health Care. Providers need to comply with Blue Cross’s fraud prevention and detection policies and programs when providing services to their members.

What providers need to do:
Access Blue Cross’s website at: https://securews.bcbswny.com/web/content/WNYprovider/contact/about-us.html

Scroll down and click on the Deficit Reduction Act (DRA) banner. This will provide you with five links, beginning with “Fraud, Waste and Abuse Laws in Health Care” that Blue Cross is required to provide you.

Review the first link and ensure your processes comply with Blue Cross’s fraud prevention and detection policies and programs when providing services to their members.

CY 2014 PHYSICIAN FEE SCHEDULE FINAL RULE
One of the provisions included in the CY 2014 Physician Fee schedule final rule includes amendments to the “Incident To” provisions.

These provisions indicate that a new condition of payment has been imposed that will require “Incident To” services comply with state law, whereby the individual personally performing the service (ex. mid-level), must possess the required license or certification according to State laws, regulations and/or Medicare rule to perform the service.

Revisions for the “Incident To” guidelines are reflected in the Federal Register, published on December 10, 2013 and are located at: http://www.gpo.gov/fdsys/browse/collection.action?collectionCode=FR
Access 2013 → December 10th → CMS → Medicare Program Revisions to Payment Policies under the Physician Fee Schedule….and open the PDF.

For Compliance questions, please contact Becky Amann at 716-348-3902 or beckya@pracfirst.com

 

 

 

BILLING UPDATES – FEBRUARY 2014

By Sarah Howarth, Billing Manager

IRS INSURANCE COMPANY PAYMENT SUMMARY

PF will aggregate your IRS Form 1099’s through February 15th.  These forms (1099-Misc) represent all of the payments made to you during calendar year 2013.  The IRS matches the aggregate of all 1099’s to the appropriate line of your entity’s tax return, to make sure recipients properly report their income.  In addition, any interest paid on claims is separately reportable on IRS Form 1099-Int.  This information is also matched and it is critical to properly report this income on the correct line of your tax return to avoid IRS scrutiny for under reporting income.

By law, insurance payers should mail them by January 31st.  However, our past experience indicates that they do not comply by the due date and therefore they are not all received until the third week in February.  At that time, we will send them to you by mail or through our courier service.

INDEPENDENT HEALTH

Effective February 28, 2014 Independent Health will no longer offer MediSource in Niagara County.  Patients will be notified of options to continue Medicaid managed care coverage through Fidelis Care New York and United Healthcare of New York.

If a provider does not participate with a patient’s new plan, the following circumstances will allow for reimbursement according to the fee schedule and policies of the new plan:

Patient is currently receiving ongoing care for a serious condition.  The new plan will reimburse you for services up to 60 days after enrollment in the new plan.

If the patient is three or more months’ pregnant as of February 28, 2104, the new plan will reimburse you for treatment of the patient until the baby is born and through post-partum care.

FLU VACCINES

Please notify Practicefirst of any changes to the type of flu vaccine administered at your office.  We will confirm the appropriate CPT code is applied based on the brand, dosage and source of the vaccine.

COLLECTION AGENCY CHANGE

Effective February 1, 2014 HoganWillig will no longer be providing collections services to clients of Practicefirst.  Unless you tell us otherwise, all collection accounts formally placed with HoganWillig will be transitioned to Tice Associates, Inc.  Should you have any questions or concerns regarding this transfer, please contact Practicefirst prior to February 15, 2014.

PQRS

Medicare has released the 2014 requirements for PQRS reporting.  To avoid the 2016 payment adjustment, individual providers must report a minimum of 3 measures for at least 50% of eligible Medicare fee for service patients throughout the reporting period.  Providers interested in obtaining the 2014 PQRS payment incentive must report on 9 measures for at least 50% of Medicare fee for service patients throughout the reporting period. The reporting period begins January 1 and ends December 31, 2014.

  • Measure requirements are driven by diagnosis and procedure codes.
  • Providers may opt to report through a 3rd party registry, an EMR or by adding appropriate coding to their claims when billed.
  • Billing clients who select claim reporting must add the appropriate numerator quality-data code to the claim.
  • Providers must meet the requirements of the measure, add the appropriate numerator to the claim and ensure supportive documentation has been completed.

Medicare has a dedicated service line to answer questions specific to PQRS: 1-866-288-8912.  Additional information may be found at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html

Practicefirst will be happy to provide billing clients with the following upon request:

  • Summary of Medicare payments from 2013 to estimate the impact of the 1.5% payment reduction.
  • A report of ICD-9 and CPT codes billed in 2013 for cross-reference with the qualifying requirements of each measure.

Additional assistance in determining appropriate measures and claims reporting is available.  Please contact Practicefirst for more information.

VERIFYING PATIENT COVERAGE IN A HEALTH INSURANCE MARKETPLACE PLAN

As mentioned in last month’s client memo, it is the beginning of the New Year and you’ll be verifying your patient’s insurance status when they come to your office. With the beginning of the Health Insurance Marketplace, also known as Health Insurance Exchange, over a million people will have a new insurance plan. In many cases, this will be the first time they have had insurance in years.   Many of these people will have signed up for their plan within the past few days. They may not have received their card yet or they may be unaware of the need to carry their insurance information. You may find your office needing to verify their coverage.

How do you verify their coverage?

If the marketplace in your state is run by the Federal government, it is best to call their plan’s customer service line, a list of all plans and their customer service numbers can be found at: https://data.healthcare.gov/dataset/QHP-Customer-Service-Phone-Numbers/vryg-tdzf

A fact sheet can be utilized for using the data base which is located:  http://marketplace.cms.gov/getofficialresources/publications-and-articles/contact-health-plan.pdf

If you can’t find the number, call the Marketplace Call Center (1-800-318-2596).

If your state has its own health insurance exchange, contact your state. To find the website for your state exchange, select the name of your state in the box at the left hand side of the health care website at: https://www.healthcare.gov/marketplace/individual/#state=alaska

How else can you help your patient?

Remind your patients to keep all of their paperwork and receipts from all of their doctor’s appointments and from the pharmacy as well. They may need them for their insurer. Remind them they should carry their card at all times. If they don’t have a card, they can contact their plan to get a card.

If the patient is uninsured, they have until March 31st to sign up for non-employer based coverage. They can go to HealthCare.gov to sign up for a plan and apply for financial assistance. The vast majority of uninsured will qualify for financial assistance to reduce their costs. You can also download copies of various fact sheets or educational material for your patients at: http://marketplace.cms.gov/getofficialresources/publications-and-articles/publications-and-articles.html

AETNA SETTLEMENT

We have received notification of a proposed settlement in a class action lawsuit: In re Aetna UCR Litigation. This lawsuit pertains to providers considered Out-of-Network who provided covered services to Aetna Plan Members and whose resulting claims for reimbursement included partially allowed claims.  Providers may be eligible to receive payment for improper reimbursement.  This settlement may apply to you if you were an Out-of-Network provider from June 3, 2003 through August 20, 2013.  Providers must complete and submit a claim form no later than March 28, 2014.  Providers may opt to make a claim from the General Settlement Fund or from the Provider Settlement Fund.  General Settlement Fund claims are anticipated to result in a payment of less than $40 per year for each year Out-of-Network covered services were provided.  Provider Settlement Fund claims are expected to make payment of up to 5% of the allowed amount for qualifying claims.  Please contact Sarah Howarth for additional information.

For Practicefirst to file a claim on your behalf, you must certify that you have provided Out-Of-Network services to Aetna Plan Member(s). Practicefirst will charge a flat fee of $25.00 for solo physicians and $50.00 for group practices. Please contact Sarah Howarth at Practicefirst by March 1, 2014 to file a claim form on your behalf. As always, you are free to file the claim on your own.  Additionally, if you have received a notice from Aetna, you may forward that to Sarah indicating you would or would not like to be included in this Class Action Lawsuit.

For Billing questions, please contact Sarah Howarth at 716-348-3923 or sarahh@pracfirst.com