July 2007

Modifiers GY and KX Take On New Meanings July 1
New Deadline for CMS-1500
E/M Tip of the Month
Take Your Exam Online
Upcoming Events

Hello from the Board of Medical Specialty Coding! We hope you enjoy your monthly ezine and find the information useful. If you have any comments or recommendations for future issues, please contact me through the following channels:

Victoria Forlini, Executive Director
vforlini@medicalspecialtycoding.com
301/287-2250 (phone)
301/287-2941 (fax)

Modifier GY and KX Take On New Meanings July 1

The July update to the HCPCS codes includes two modifier revisions of particular importance. Make sure you note the revision to “exclusion” modifier GY that will allow it to be used by non-Medicare payers. Also pay heed to a revision to “documentation on file” modifier KX. Modifier revisions effective July 1 include:

• GY – item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, is not a contract benefit
• KX – requirements specified in the medical policy have been met

The HCPCS update also includes some new modifiers to use for DMEPOS items in conjunction with suppliers’ competitive bidding programs. Many offices, including many primary care practices, will see limited application for them. Nevertheless, here they are, effective July 1:

• KG – DMEPOS item subject to DMEPOS competitive bidding program number 1
• KK – DMEPOS item subject to DMEPOS competitive bidding program number 2
• KL – DMEPOS item delivered via mail
• KT – beneficiary resides in a competitive bidding area and travels to a noncompetitive bidding area and receives item from a non-contract supplier
• KU – DMEPOS item subject to DMEPOS competitive bidding program number 3

For more on the new HCPCS codes visit: www.cms.hhs.gov/HCPCSReleaseCodeSets
/02_HCPCS_Quarterly_Update.asp#TopOfPage

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New Deadline for New CMS-1500

Medicare now says you must begin using the newly revised version of the CMS 1500 form (version 08-05) starting July 2. The original April 1 deadline previously was extended due to formatting errors.

“…CMS intended to gather and review statistics from our contractors in an effort to set a new deadline,” says CMS Pub. 100-04 Transmittal 1247 (www.cms.hhs.gov/transmittals/
downloads/R1247CP.pdf). “…providers will now be required to begin submitting the Form CMS-1500 (08-05) only beginning July 2, 2007. It is important to note that this transmittal requires the submission of the revised Form CMS-1500 paper claim form only, and has no bearing on the implementation of the National Provider Identifier (NPI) nor mandates the submission of the NPI by July 2, 2007,” the transmittal adds.

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E/M Tip of the Month
Test your E/M coding skills by identifying the answer to this question:

Is it considered a consultation when a patient comes into the office asking for a second opinion?

Find out the answer at the bottom of this email newsletter. Also check this space monthly for the E/M Tip of the month.

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Take Your ACS or SCP Exam Online

To make test-taking easier for you, you can now take the ACS and SCP certifications and ACS recertification exams online. It's simple! Register as you normally would -- via our website or on paper, and select the Online option. We will send you an email confirming your registration and giving you further instructions. Don't worry! You still can take the exam at a conference, but we're listening to you as you search for easier ways to become certified.

Visit us at www.medicalspecialtycoding.com for more information.

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Upcoming Events

Here's the 411 on some upcoming events where you'll get top-notch educational opportunities to earn CEUs and even a place to sit for your specialty certification or recertification exam!

Event: Urology Stent and Diagnosis Coding
Date: August 1, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1285/home.html

Event: Office Hours with Barb Pierce
Date: August 8, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1324/home.html


Event: Diabetes Coding Challenges in Your Doctor’s Office
Date: August 9, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1310/home.html

Event: Office Hours with Margie Vaught
Date: August 15, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1327/home.html

Event: Intestinal Surgery: Learn the Coding Mysteries of 24 to 30 Feet of Twists and Turns
Date: September 5, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1248/home.html

Event: Conquer Coding and Billing for Physician Services Outside of the Office
Date: September 17-18, 2007
To register or to learn more information:
http://www.specialtyconferences.com/outside/index.html


Event: Conquer Coding and Billing for Physician Services Outside of the Office
Date: September 17-18, 2007
To register or to learn more information:
http://www.specialtyconferences.com/outside/index.html

Event: Billing and Coding Pain Management
Date: October 10-12, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/pain2007/index.html

Event: Improve Billing, Coding and Profitability for Freestanding ASCs
Date: October 15-16, 2007
To register or to learn more information:
http://www.specialtyconferences.com/asc/index.html

Event: Medical Practice Management Summit 2007
Date: November 12-14, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/summit2007/

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Answer to the E/M Tip of the Month is...

No. You must report this type of encounter with an office visit code (99201-99215; 99211 cannot be used for a consultation). The CPT manual says consultations must be "requested by a physician or other appropriate source (e.g., physician assistant, nurse practitioner, doctor of chiropractics, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, lawyer or insurance company)."

Source: http://www.cms.hhs.gov/MLNMattersArticles/
downloads/MM4215.pdf