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Month 2009 Issue

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Month 2009 Issue NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here. April 2010 Issue In This Advisory Part A Articles Part A LCD Updates Part B Articles Part B LCD Updates Part A & B Articles Forms & Documents Acronyms Monthly Feature Questions and Answers on Reporting Physician Consultation Services This article is for physicians and non-physician practitioners (NPPs) who perform initial evaluation and management (E/M) services previously reported by Current Procedural Terminology (CPT) consultation codes for Medicare beneficiaries and submit claims to Medicare Carriers and/or Medicare Administrative Contractors (MACs) for those services. It is also intended for Method II critical access hospitals, which bill for the services of those physicians and NPPs. Continued on Page 36 www.palmettogba.com/J1a www.palmettogba.com/J1b www.cms.hhs.gov Table of Contents J1 Part A ......................................................................................................................................1 Accumulation of Claims with Condition Code 04 on the Provider Statistical and Reimbursement Report (PS and R)............... 1 April 2010 Update of the Hospital Outpatient Prospective Payment System (OPPS)................................................................ 2 Additional ICD-9 Codes Analysis and Processing Direction (Institutional Claims Only)........................................................... 10 April 2010 Integrated Outpatient Code Editor (I/OCE) Specifications Version 11.0 ................................................................. 12 Medicare Mammography Services Claims Process Issue ....................................................................................................... 13 Medicare Non-Covered Claims with Professional Component Claims Process Issue ............................................................. 13 Medicare Inpatient Skilled Nursing Facilities No Payment Claim’s Processing Issue .............................................................. 13 Completion of Service-Specific Review for Inpatient Hospital DRG Code 544 ........................................................................ 14 Reporting Inpatient Hospital Evaluation and Management (E/M) Services that Are Described by Current Procedural Terminology (CPT) Consultation Codes .................................................................................................................................. 14 Reporting Hospice Services Provided by Physicians Under Part A that Could be Described by Current Procedural Terminology (CPT) Consultation Codes .................................................................................................................................. 15 Supervision Requirements for Therapeutic Services in Critical Access Hospitals (CAHs) – Calendar Year 2010................... 16 Critical Access Hospitals (CAH) Method II Providers Notification ............................................................................................ 16 Part A LCD Updates ................................................................................................................................................................ 18 J1 Part B ....................................................................................................................................19 One-Time Mailing of Supplier Responsibilities Letter – Individual Practitioners Only .............................................................. 19 Revised Clinical Laboratory Fee Schedule and ZIP Code File to Include New Kansas Payment Locality Structure ............... 21 Services Denied for Provider Not Eligible/Deactivated: Liability for Charges........................................................................... 22 FDA Approves Xiaflex™ (collagenase clostridium histolyticum) .............................................................................................. 23 Oral Surgery and Maxillofacial Surgery Specialty Codes......................................................................................................... 24 Portable X-Ray Services.......................................................................................................................................................... 24 eCardio Cardiac Monitoring Services Billing/Coding Guidelines.............................................................................................. 25 Completion of Service-Specific Complex Edit Review for Chiropractic Services in Hawaii and Nevada: Procedure Codes 98940, 98941 and 98942 ......................................................................................................................................................... 25 Completion of Service-Specific Complex Edit Review for Chiropractic Services in Northern and Southern California: Procedure Codes 98940, 98941 and 98942 ............................................................................................................................ 26 Part B LCD Updates ................................................................................................................................................................ 29 J1 Part A & Part B.....................................................................................................................31 Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Non-Coverage (ABNs).............................. 31 July 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files ......................................................................................................................................................................................... 33 Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens................................................................... 34 Questions and Answers on Reporting Physician Consultation Services.................................................................................. 36 Electronic Funds Transfer (EFT) Authorization Agreement Processing................................................................................... 46 Correction Notice: Feature Article on March 2010 Advisory Cover Page Contains Incorrect Page Number............................ 47 PCC Training and Holiday Closure Schedule for FY 2010...................................................................................................... 47 Forms & Documents.................................................................................................................49 Important Addresses and Telephone Numbers........................................................................................................................ 50 Northern California EDI FAX Cover Sheet ............................................................................................................................... 53 Southern California EDI FAX Cover Sheet .............................................................................................................................. 54 J1 Pacific HI/NV EDI FAX Cover Sheet ................................................................................................................................... 55 Medicare J1 A/B MAC Part A Redetermination Form .............................................................................................................. 56 Medicare Part B Redetermination/Request Form .................................................................................................................... 57 J1 Overpayment Refund Form................................................................................................................................................. 58 Medicare Reconsideration Request Form - QIC North ............................................................................................................ 59 Provider Outreach and Education Request Form .................................................................................................................... 60 Medicare Secondary Payer Overpayment Refund Form ......................................................................................................... 61 Palmetto GBA Listserv Registration Form ............................................................................................................................... 62 J1 Medicare Publications Subscription Form ........................................................................................................................... 63 Acronyms................................................................................................................................................................................. 64 J1 Part A J1 Part A Accumulation of Claims with Condition Code 04 on the Provider Statistical and Reimbursement Report (PS and R) MLN Matters® Number: MM6784 Related Change Request (CR) #: 6784 Related CR Release Date: February 26, 2010 Effective Date: July 1, 2010 Related CR Transmittal
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