Endonomics™ is an e-newsletter from the Socioeconomics & Member Advocacy Office of the American Association of Clinical Endocrinologists (AACE).
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Do you know the purpose of the CERT contractor? The CERT contractor checks to see that providers are billing correctly and contractors are paying correctly. They select and review claims, assign improper payment categories, calculate improper payment rates and provide education to change behaviors.
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What is HPID? It's a Health Plan Identifier and is a standard, unique health plan identifier required by HIPAA. All controlling health plans, except small plans, were required to obtain HPIDs by Nov. 5, 2014.
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Endonomics™ is distributed free to both AACE members and non-members. The goal is to provide the latest industry news to those who work in the business side of an endocrinology practice.
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To be added to the distribution list, email your name, title, name of practice/business, phone and fax, and preferred email to: Endonomics@aace.com.
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Dear Practice Support Subscriber,
Welcome to another edition of
Endonomics™ ,
an
e-newsletter for physicians, practice management specialists, office administrators, coders, billers, collectors and other endocrinology business office staff.
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ALERT
Effective January 1, 2016 CPT
® codes 76536 and 76942 cannot be billed together unless performed at separate anatomic sites.
CMS will add a new procedure to procedure (PTP) edit to the National Correct Coding Initiative (NCCI) that will affect Medicare reimbursement if a physician performs guidance for needle placement (CPT® code 76942) and a diagnostic head and neck ultrasound (CPT® code 76536) at the same patient encounter. The new edit was put into place because CMS indicated that evaluation of a patient's anatomic region and guidance for a needle placement procedure in that anatomic region, by the same radiologic modality at the same patient encounter, are not separately reportable services. AACE recently sent comments to NCCI
strongly opposing this PTP edit explaining the undue hardships this will pose to both patients and the endocrinologists that treat them, and is working with other organizations and societies to advocate for the reversal of this edit decision.
Please alert your coding, billing and collection staffs.
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Join AACE's free Practice Support Network and receive bimonthly editions of
Endonomics
™ -- A Practice Management newsletter for the business side of your office. Send your name, address, phone, fax and email address to:
endocoding@aace.com
and become part of the network today.
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for more information on
Endonomics
™ and see the latest editions.
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All medical coding must be supported with documentation and medical necessity. **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation recommendations. As CPT®, ICD-10-CM and HCPCS codes change annually, you should reference the current CPT®, ICD-10-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information. This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only and should not be deemed as legal advice, which should be obtained from competent local counsel. Current Procedural Terminology (CPT©) is copyright and trademark of the 2015 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT©. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
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