Everything's up-to-date in Kansas City

Last week, I received a call from a doctor's office inquiring why her claim for a B-12 injection might have been denied by a particular payer.  She indicated that they used Current Procedural Terminology (CPT) code 90772 to report the service. 

A quick check of my 2009 CPT book identified the problem.  Code 90772 has been deleted for 2009; the correct new code is 96372. 

It never ceases to amaze and amuse me when a physician's practice is not using the current versions of a CPT, Healthcare Common Procedure Coding System (HCPCS), or International Classification of Diseases, 9th Revision - Clinical Modification (ICD-9-CM) manual.  It does not take too many claims denied because of out-of-date codes to equal or exceed what it would have cost the practice to buy current copies of the necessary coding manuals.  Indeed, the ICD-9-CM manual is available on CD-ROM from the U.S. Government Printing Office for only $19.00, and HCPCS can be accessed freely on the Centers for Medicare and Medicaid Services web site (although I still prefer to use the manual version). 

So, take a moment right now, while you're thinking about it, and pull your CPT, HCPCS, and ICD-9-CM books off the shelf.  If they are not the most current versions (i.e., 2009, as I write this), then it's time to order new ones.  This ounce of prevention for denied and returned claims should more than equal the pound of cure found in resubmitting or appealing such claims. 

Posted at 12:09PM May 28, 2009 by Kent Moore  |  Comments[1]

The future of diagnosis coding

The Centers for Medicare & Medicaid Services (CMS) announced the future of diagnosis coding for physicians last week.  Specifically, on Jan. 16, CMS published a final rule specifying that by Oct. 1, 2013, the International Classification of Diseases, 10^th Edition, Clinical Modification (ICD-10) must be used to report health care diagnoses.

The good news is that you have almost five years to get ready, which is two years longer than CMS originally proposed.  The bad news is that you will still have to make systems changes and train yourself and your staff to use the new codes.

In the meantime, you and your practice will also have to comply with an updated X12 standard, Version 5010, for certain electronic health care transactions, including claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions.  Version 5010 accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard.  The compliance deadline is Jan. 1, 2012 – thankfully, 21 months later than CMS originally proposed.  For more information on both the Version 5010 and ICD-10 rules, you can access a fact sheet on the CMS web site.

They say that “forewarned is forearmed.”  Please consider yourself “forewarned” and anticipate that Family Practice Management, the American Academy of Family Physicians, and others will help you “forearm” as the compliance dates mentioned above get closer.

Posted at 05:15PM Jan 21, 2009 by Kent Moore  |  Comments[0]