The Centers for Medicare and Medicaid Services (CMS) has issued additional guidance regarding the new subsets of modifier 59 (i.e. XE, XP, XS, and XU) that became effective January 1, 2015 and the continued use of modifier 59 after January 1, 2015. In the updated guidance, CMS states providers may continue to use modifier 59 after January 1, 2015 in any instance in which it was correctly used prior to January 1, 2015. Additional guidance and education as to the appropriate use of the new modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and controlled fashion. That guidance will include additional descriptive information about the new modifiers. CMS will identify situations in which a specific modifier will be required and will publish specific guidance before implementing edits or audits. To access the CMS document, Gold Members log in or become a Gold member and click
I often have therapists tell me they are treating a current patient for a specific diagnosis/condition and that the patient will be returning to see their physician for a follow-up visit. The therapist tells me they wrote a Progress Report and sent it to the physician to provide the physician with the most current status of their patient. In order to write the Progress Report, the therapist not only gathered subjective comments from the patient and/or their family, but also gathered objective data, tests, and measures that included range of motion measurements and manual muscle testing. Since the therapist took these measurements and performed the manual muscle testing, they then ask me, can I bill CPT code 95831 – Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk and CPT code 95851 – Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine) and my answer without asking them another question is no and I’m usually right with this answer 99% of the time.
Why am I right? Because in order to bill CPT codes 95831 and 95851, the therapist must perform manual muscle testing and take range of motion measurements of
The Centers for Medicare and Medicaid Services (CMS) has released the results of the ICD-10 end-to-end testing week that was conducted from January 26, 2015 through February 3, 2015. CMS received 14,929 test claims and 12,149 were accepted for an 81% acceptance rate.
Reasons for rejected claims
* 3% – Invalid submission of ICD-9 diagnosis or procedure code
* 3% – Invalid submission of ICD-10 diagnosis or procedure code
* 13% – Non-ICD-10 related errors, including issues setting up the test claims (e.g., incorrect NPI, Health Insurance Claim Number, Submitter ID, dates of service outside the range valid for testing, invalid HCPCS codes, invalid place of service).
To access the report, click HERE.
In addition, CMS has released a short video titled “Introduction to ICD-10 Coding” that provides an overview of ICD-10’s features and explains the benefits of the new code set to patients and to the health care community. To view the video, click HERE.
On February 11, 2015, the American Hospital Association (AHA) urged the Health Subcommittee of the Committee on Energy and Commerce of the U.S. House of Representatives to oppose any further delays to the implementation of ICD-10 scheduled for October 1, 2015. The AHA noted that 93% of hospitals surveyed this year were moderately to very confident they could meet the October 1, 2015 implementation deadline. Previous delays in the implementation of ICD-10 has cost health plans Medicare, Medicaid, hospitals and large providers anywhere from $1.2 billion and $6.9 billion. To read the AHA statement, click HERE.
Priority Health in the state of Michigan has announced they will provide coverage for patients to access physical therapy services without requiring a referral as allowed by the law for commercial products. This is due to a state law that took effect January 1, 2015 allowing anyone to seek physical therapy services without a physician referral for up to 21 days or 10 visits, whichever comes first. Medicaid patients still require a referral for physical therapy services as mandated by the state. To access this decision, click
The Centers for Medicare and Medicaid Services has issued a change request to address the new prepayment review timeframe for Additional Documentation Requests (ADRs) submission. The change request instructs Medicare Administrative Contractors, Recovery Auditors, and Comprehensive Error Rate Testing contractors to allow