March 2001 • Volume 7 • Number 3
On two counts
You should get paid after all
In two situations in which Medicare has not paid for separate services, the tables have turned. The Health Care Financing Administration recently corrected two payment glitches.
Effective Jan. 26, HCFA suspended, retroactive to last Oct. 30, Correct Coding Initiative edits that bundled evaluation and management services into certain procedures when both types of services were provided on the same date. The procedures are those to which HCFA's usual global surgical package concept does not apply.
You can now bill for E/M services with such procedural services, if the work entailed in the E/M service is significant and separately identifiable from the procedural service.
Claims denied as a result of one of these Correct Coding Initiative edits should be resubmitted with a "-25 modifier" attached to the E/M code -- alerting the claims processor that you're billing for a significant E/M service separate from the procedural service.
In addition, effective Jan. 1, HCFA told Medicare carriers to no longer bundle E/M services into vaccine administration services when both are provided the same day.
If you billed for an office visit and included the code for administering a vaccine, you probably were denied payment for the visit. That occurred with influenza virus vaccine, pneumococcal vaccine and hepatitis B vaccine. If you resubmit the claims, you should be paid for both the visit and the vaccine administration.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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