77071: A Small Status-Indicator Change Could Cost You $46 Per Claim

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:

The actual fee for both sides

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.

Podiatry Billing: Give these modifier 24 myths a miss

Podiatry billing guidelines: You need to train eyes on podiatrist's documentation and not the appointment book.


In order to seal your payments for services your podiatrist carries out after a major procedure while you are still billing in the global period of the procedure, you need to be well-versed with the ins and outs of modifier 24.


Here are some myths relating to this modifier that you can stay away from:


Modifier 24 is applicable to any service done in the post-op period – this is a no.


You should add modifier 24 to an appropriate E/M code when an evaluation & management service takes place during a postoperative global period for reasons not related to the original procedure. This modifier tells the payer that the surgeon is treating the patient for a new problem. As such, the plan shouldn't include the evaluation & management service in the previous procedure's global surgical package.


This modifier is only for use on E/M codes and only for use during the post-operative period (10 or 90 days).


As a rule, you cannot bill separately for evaluation & management related services pertaining to the original surgery during the global period. This surgical package includes routine postoperative care during the global period.


Scheduled office visit means no modifier 24


Don't assume you are unable to bill separate services using modifier 24 just because of the fact that a patient was scheduled to visit related to the surgery.


Here's an example to substantiate this: A patient has a lumpectomy. When the patient comes back in to the office for sutures pathology has found out that the lump turned out to be cancer. As such, the doctor does an extensive E/M service/office visit with the patient to discuss.


Here, you should be able to use modifier 24 to describe an evaluation & management service not related to the surgery. CPT would always allow this, however even Medicare says that care directed at the underlying disease process is billable separately in the global period.

Cardiology Guidelines, CPT codes cardiology and more in one Convenient Resource

Specialty-specific Guide to Assist Correct Coding, Reimbursement & Compliance in 2013

This year ushered in a vast sea of code changes that has affected every practice in some way or the other. In fact, even you must be struggling to find out the top cardiology CPT codes, most sought after ICD-10 documentation strategies for top ICD-10 codes, and key tactics to help you reduce denials and increase reimbursement in 2013? If ever-changing payer policies, new protocols, stringent state & federal regulations, continual threats of payment cut plaguing your claims submission and billing work, then you need to sit-back and think of a better way to help yourself. 

Amongst all the challenges that you face every day, there may be multiple reasons behind improper coding, billing and documentation of cardiology services. For instance, many coders get confused about which add-on codes to pair with primary codes when CPT® introduced new codes for pacemaker revisions. At times, coding peripheral vascular services in addition to cardiac catheterizations can leave you puzzled?

This is the time to ensure you aren’t writing off potential income and not setting your cardiology practice up for serious scrutiny and unpleasant payback requests. With so many uncertainties hovering around you, you need to gear-up now to ensure that you aren’t making any of the common mistakes that befall coders, and you can maximize your income to hopefully offset the upcoming cuts. 

But you can easily set yourself up for a profitable start to 2013. The Coding Institute offers various helpful coding resources and tools that will assist you in correct coding to keep your practice compliant and profitable. Take a giant leap forward in coding correctly and boosting reimbursement with SuperCoderIllustrated for Cardiology 2013. Arm yourself with all the essential coding information you need to tackle any coding challenge in 2013 and stay on course to a profitable and compliant year ahead! 

This handy book contains features like code descriptor and Medicare details, up-to-date codes and CCI edits, step-by-step anatomical illustrations, CPT® code’s Medically Unlikely Edits (MUEs), ICD- 9 & ICD-10 CrossRef to take care of all your coding needs. You’ll get everything you need to know for each cardiology CPT® code, on one page! You can easily carry this book around and look-up code info whenever you want. Get ICD-10 updates, CPT codes updates and other valuable information to overcome any coding or billing challenge and ensure a smooth sailing for your practice.