radiology coding,medical coding resource
You never know what every new quarter will unfold as far as Medicare updates are concerned. This month you need to ensure your practice is up to speed on physician fee schedule news.
New: The bilateral surgery indicator for 77071 (Manual application of stress carried out by doctor for joint radiography, including contralateral joint if indicated) has changed from three (The usual payment adjustment for bilateral procedures does not apply) to 2 (150 percent payment adjustment does not apply).
While the effective date is January 1, the implementation date is April 4, 2011. This means that the changes are retroactive to January 1 this year. But then your carrier's deadline for implementing the changes is April 4.
Previous way: '3'offered payment for two sides
77071 used to have a bilateral indicator of 3. As per the Medicare Physician Fee schedule, a bilateral surgery indicator of three basically means that when you code the procedure as bilateral, the carrier will pay you separately for each side.
Indicator three rule: When you code both sides on the same date, Medicare will base the payment for each side on whichever is lower -- the actual charge for each side or 100 percent of the fee schedule sum for each side. The rule holds true regardless of how you report the bilateral service. (say for instance using modifier 50 (Bilateral procedure), modifiers RT and LT or two units.
What's more, Medicare's policy for the three indicator is: "If the procedure is reported as a bilateral procedure and with other procedure codes on the same day, figure out the fee schedule amount for a bilateral procedure prior to applying any multiple rules.
Just-in way: '2'tells you 1 code includes Bilateral Service
Since code 77071 now has a 2 bilateral indicator, you will need to be sure your reimbursement expectations are in line with the official fee schedule.
Indicator 2 rule: When the agency labels a code with a 2 bilateral indicator, relative value units are already based on the procedure being carried out as a bilateral procedure, as per fee schedule documentation.
Consequently, if you report the procedure a couple of times on the same date, Medicare will base payment on the lower of:
New: The bilateral surgery indicator for 77071 (Manual application of stress carried out by doctor for joint radiography, including contralateral joint if indicated) has changed from three (The usual payment adjustment for bilateral procedures does not apply) to 2 (150 percent payment adjustment does not apply).
While the effective date is January 1, the implementation date is April 4, 2011. This means that the changes are retroactive to January 1 this year. But then your carrier's deadline for implementing the changes is April 4.
Previous way: '3'offered payment for two sides
77071 used to have a bilateral indicator of 3. As per the Medicare Physician Fee schedule, a bilateral surgery indicator of three basically means that when you code the procedure as bilateral, the carrier will pay you separately for each side.
Indicator three rule: When you code both sides on the same date, Medicare will base the payment for each side on whichever is lower -- the actual charge for each side or 100 percent of the fee schedule sum for each side. The rule holds true regardless of how you report the bilateral service. (say for instance using modifier 50 (Bilateral procedure), modifiers RT and LT or two units.
What's more, Medicare's policy for the three indicator is: "If the procedure is reported as a bilateral procedure and with other procedure codes on the same day, figure out the fee schedule amount for a bilateral procedure prior to applying any multiple rules.
Just-in way: '2'tells you 1 code includes Bilateral Service
Since code 77071 now has a 2 bilateral indicator, you will need to be sure your reimbursement expectations are in line with the official fee schedule.
Indicator 2 rule: When the agency labels a code with a 2 bilateral indicator, relative value units are already based on the procedure being carried out as a bilateral procedure, as per fee schedule documentation.
Consequently, if you report the procedure a couple of times on the same date, Medicare will base payment on the lower of:
Or 100 percent of the fee schedule amount for a single code.
Impact of the change: This could be a big drop for practices that were collecting twice the reimbursement and now will get no payment adjustment. But then since the descriptor refers to inclusion of the contralateral joint, it would be difficult to dispute the fact that the code is inherently bilateral.
Good tidings: Although the change is retroactive to January 1, Medicare is not requiring contractors to search their files to adjust claims they have paid already. But then contractors will adjust claims if you bring them to their notice.
Impact of the change: This could be a big drop for practices that were collecting twice the reimbursement and now will get no payment adjustment. But then since the descriptor refers to inclusion of the contralateral joint, it would be difficult to dispute the fact that the code is inherently bilateral.
Good tidings: Although the change is retroactive to January 1, Medicare is not requiring contractors to search their files to adjust claims they have paid already. But then contractors will adjust claims if you bring them to their notice.
