Tip: Take advantage of online resources to avoid coding errors
Two recent reports published by the Office of Inspector General (OIG) cited significant issues leading to coding errors on Medicare hospital claims, according to CMS.
The OIG found that hospitals nationwide generally did not comply with Medicare requirements for billing outpatient right heart catheterizations with heart biopsies, using modifier -59 incorrectly, which leads to significant overpayments on claims for these services.
“Modifier -59 will clear your code edit, but that doesn’t mean you should use it all the time,” Kathryn DeVault, MSL, RHIA, CCS, CCS-P, FAHIMA, said during her ACDIS Symposium: Outpatient CDI presentation. “If you do, you’re inviting investigation.”
The OIG found in a separate report that Medicare improperly paid hospitals for beneficiaries who had not received 96 or more consecutive hours of mechanical ventilation due to use of incorrect procedure codes.
So, how do facilities guard against these errors? CMS offers a list of online resources to ensure correct billing and avoid overpayment recoveries:
- OIG Reports Highlight Hospital Billing Issues MLN Matters® Special Edition Article
- Proper Use of Modifier 59 MLN Matters Special Edition Article
- Specific Modifiers for Distinct Procedural Services MLN Matters Article
- Medicare Claims Processing Manual, Chapter 3, Inpatient Hospital Billing: Section 10, General Inpatient Requirements
- Medicare Quarterly Provider Compliance Newsletter, Volume 2, Issue 1
- Medicare Quarterly Provider Compliance Newsletter, Volume 7, Issue 4