NYSRS Medical Insurance and Compensation Committee Report

 August 5, 2005

Arthur J. Segal, M.D., F.A.C.R., Chairman

MEDICARE UPDATE

 I.   National Provider Identifier (NPI)

The National Provider Identifier will be implemented no later than May 23, 2007.  As the UPIN is phased-out, the NPI will be phased-in, likely beginning November/December 2006.  NPI was mandated by HIPAA to “simplify” all billing.

Part B News, Vol 19, No. 22, May 30, 2005

II.  Opportunity To Bill for Clinically Appropriate Lateral Decubitus View (71035) in Addition to a Single-View Chest (71010 or 71020)

Although most chest x-rays are bundled, special views (e.g. lateral decubitus, apical lordotic, obliques with barium) can be billed separately, when “both are performed, documented and meet medical necessity guidelines.”

Radiology Coder’s Pink Sheet, Vol.4, No 6, June 2005, p3-4

III.   CT Evaluation of the Coronary Vasculature

“The ACR now recommends that the unlisted CPT code 76497 (Unlisted computed tomography procedure (eg, diagnostic, interventional)) be used to describe the CT evaluation of the coronary vasculature, as well as the other special cardiac CT and CTA examinations under development.”  ACR Members may see the complete reference on line at: http://www.acr.org/s_acr/doc.asp?TrackID=UT5WCUAXXZMZXHUPE7NYEF7P79Z9HQPX&SID=1&DID=20529&CID=3401&VID=2&RTID=0&CIDQS=&Taxonomy=False&specialSearch=False

The ACR Coding Source Jan/Feb 2005

IV.      Use of Modifiers -52 and -53

 Modifier -52 (reduced service) is used when there is á priori knowledge that the service will not be complete as defined by the full code description.  Modifier -53 (discontinued service) is used when the procedure or service is discontinued due to unforeseen or unexpected circumstances. Radiology Coder’s Pink Sheet, Vol.4, No 7, July 2005, p7-8

Home Page Information:

http://www.ghimedicare.com/

http://www.umd.nycpic.com/

          http://www.gao.gov

Coding 

Upstate Medicare - http://www.umd.nycpic.com/billtips.html#ICD-9-CM  and then select, ICD-9-CM Coding for

             Diagnostic Tests 

 Respectfully submitted,

Arthur J. Segal, M.D., F.A.C.R.

Chairman, Medical Insurance and Compensation Committee

NYSRS CAC Representative