In This Issue:
CMS:

• New Diagnosis Codes
• Deadline For Data Updates to NPPES
• Delay of Dissemination of NPPES Data

NHIC:

• Flow Cytometry and Immunocytochemistry for Cancer Diagnoses and Prognoses
• Quarterly Certs Review

Medi-Cal:

• 2007 CPT-4/HCPCS Updates
• Medi-Cal Transitions to CMS-1500 Form and NPI
• Nonspecific ICD-9-CM Codes Not Billable with a Lab Procedure Code

  CMS

Transmittal 207: CR5584 (PDF).
Effective Date: October 1, 2007

Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

The following are new codes:

  CMS

CMS will be disseminating provider information contained in the National Plan and Provider Enumeration System (NPPES) on August 1, 2007. Providers, assigned National Provider Identifiers (NPIs), are asked to view their NPPES data and to update, change, or delete (where permitted) the data that will be disclosed under the FOIA.

CMS makes available a document to assist providers in making updates, changes, and deletions to the FOIA-disclosable NPPES provider data. This document, “National Plan and Provider Enumeration System (NPPES) Data Elements – Data Dissemination – Information for Providers” is available on the on the NPI website at:   http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPPES_FOIA_Data%20Elements_062007.pdf.

In order for providers’ updates, changes, and deletions to be reflected in the initial downloadable file, providers must ensure that their updates, changes, and deletions are submitted to NPPES no later than July 16, 2007. To ensure the inclusion of updates, changes, and deletions in the initial downloadable file, July 16 is the last date on which they may be submitted via the web-based process, and is the last date by which the NPI Enumerator can receive them on the paper NPI Application/Update form (CMS-10114).

  CMS

Approximately 98% of the 2.3 million covered health care providers now have NPIs. Health plans, health care clearinghouses and health care providers are now transitioning to the implementation phase for NPI compliance.

The NPPES Data Dissemination Notice (CMS-6060-N) was published on May 30, 2007. NPPES health care provider data that are required to be disclosed under the Freedom of Information Act (FOIA) will be made publicly available. The FOIA-disclosable data will be made available in an initial file downloadable from the Internet, with monthly update files also downloadable from the Internet, and in a query-only database (the NPI Registry) whereby users can query by NPI or provider name. The Notice stated that these data will be available 30 days after the publication date, and CMS had previously stated that they would be available on June 28, 2007.

CMS believes that health care providers need additional time, beyond what was afforded in the Data Dissemination Notice, in which to view their FOIA-disclosable NPPES data and make any updates or deletions (where permitted) that they feel are necessary. Therefore, CMS has decided to delay the dissemination of FOIA-disclosable NPPES health care provider data until August 1, 2007, 60 days after the publication date of the Notice.

  NHIC - Medicare

Flow Cytometry and Immunocytochemistry for Cancer Diagnoses and Prognoses 

Added ICD-9-CM codes 283.0, 283.9, 284.01, 284.09, 284.1-285.0, 285.8, and 285.9 per provider request. Added information regarding Anemia, Repeat Testing and Correct Coding Initiative.

Transmittal 207: NHIC, Corp. - Northern California - 31140.

Transmittal 207: NHIC, Corp. - Southern California - 31146.

  NHIC - Medicare

NHIC and CMS continue to focus identification of provider compliance errors on duplicate claim denials. NHIC denied 4.00% of submitted claims as duplicates during the month of May 2007. Analysis indicates the following specialties as high volume duplicate submitters:

Specialty % of claim denials:

1. Family Practice 7.08%
2. Dermatology 5.14%
3. Physical Therapist In Private Practice 5.00%
4. Internal Medicine 4.84%
5. Podiatry and/or Surgical Chiropody 3.94%
6. Cardiology 3.91%
7. Multiple Specialty Group 3.73%
8. Ophthalmology 3.43%
9. Diagnostic Radiology 3.24%
10. Clinical Laboratory 2.21%

NHIC denied a total of $90,610,665 dollars due to duplicate claims during the month of May 2007. NHIC reminds providers that duplicate billing is not cost effective for the Medicare program.

Duplicate submissions are also the number one reason for poor provider compliance in the CERT review. Remember, duplicate billing is considered abusive and can result in additional auditing of your billing practice. Post your payments and denials to your records promptly. Review the reasons for denials and take the appropriate action. Check the IVR for payment information. Don’t automatically rebill services.

  Medi-Cal

Medi-Cal General Medicine: Bulletin 396 (PDF).
Pathology Billing Restrictions

  Medi-Cal

Medi-Cal General Medicine: Bulletin 394 (PDF).
May 2007

  Medi-Cal

Medi-Cal General Medicine: Bulletin 396 (PDF).

Effective for dates of service on or after July 1, 2007, the following nonspecific ICD-9-CM diagnosis codes are not billable with a laboratory procedure code: V70, V70.0, V70.5 – V70.9, V72, V72.1 and V72.9. This does not change the policy that any laboratory procedure must be billed with a diagnosis code, nor does it change the policy requiring specific diagnosis codes for certain laboratory procedures. Providers billing a laboratory procedure code with any of the above diagnosis codes will have their claims denied for nonspecific diagnosis.