Medical Billing Blog

By Sherry Sparham, CPC-D--Sometimes, there are wrinkles in the way payers process claims for medical billing of new procedures. For instance, in the May, 2011, BCBS Record, there is notice of a New Procedure to Bill For Cryotherapy performed in the office. The new procedure code is 17340.  Some of you may remember this procedure was used a while back to bill Medicare for cryotherapy of acne. At present, Medicare no longer covers this procedure, but BCBSMI does cover this code effective 08/01/2011. BCBSMI is still paying for procedure 10040, as well, but there are changes to descriptions for each procedure.

Health and Human Services Secretary Kathleen G. Sebelius today announced plans to postpone implementation of International Classification of Diseases, 10th Edition Diagnosis and Procedure Codes (ICD-10) by certain health care entities.

Currently, under ICD-9, a 453.42 code is for acute venous embolism and thrombosis of deep vessels of distal lower extremity.  Included under this code is a diagnosis involving a thrombosis or embolism to the calf, lower leg NOS, or the peroneal or tibial veins. All possible combinations are included under this one code.

In any medical practice or clinic, the objective is to provide the best care possible and be reimbursed at the highest possible rate.  The former is in the hands of the provider—usually the clinic or practice owner—who has a vested interest in making sure that “best care possible” proposition is carried out.  He has direct control and authority over the level of care patients receive, and can easily make adjustments when circumstances warrant.  He is comfortable with his level of knowledge and education, knows his limitations, and brings in consultants when necessary to compensate for any lapse in quality he may feel would detract from the care scenario his patients receive.  We all know this is a full time job—and then some.  So what about the latter—being reimbursed at the highest possible rate?  Usually the physician has some knowledge of coding requirements that comes through osmosis from filling out encounter slips for the patients he sees, but there is hardly enough time in the day for a physician to double check every code on every chart processed by his billers and coders.  He is justified in expecting that the biller or coder will exhibit the highest commitment to excellence in knowledge, professional standards, compliance and ethics, even though the biller or coder does not have the ownership interest in the practice that the provider has. 

The Centers for Medicare and Medicaid Services (CMS) released a new ICD-9-CM code set that deals specifically with malignant neoplasms for medical billing. These updated dermatology codes become effective October 1, 2011.

CMS has announced that some Medicare Providers will be required to revalidate their enrollment status in order to comply with Section 6401(a) of the Affordable Care Act.  Any provider who enrolled prior to March 25, 2011 may be affected by the requirement.  Beginning now and going through March 23, 2013, Medicare Administrative Contractors (MAC’s) will be contacting providers who need to revalidate their enrollment.  Only Providers who are contacted by a MAC need to revalidate their enrollment, and they must wait until after they are contacted.