Lack of accreditation causes denials

February 10, 2012

Questions include MRI accreditation, multi-procedures, and signature requirements. Find out the answers to your pressing coding questions.

Q: Our office did not meet the December 31 deadline to submit our magnetic resonance imaging accreditation. Will this affect our reimbursement?

If you receive denials for non-ADI accreditation, you will see remark code N290 on the remittance advice for claims submitted for, or including, the technical component of an ADI procedure. The Medicare Improvements for Patients and Providers Act expressly excludes x-ray, ultrasound, and fluoroscopy procedures.

MULTI-PROCEDURE PAYMENT REDUCTION EXPANDED

Q: Does Medicare apply a 50% payment reduction to the technical and professional components of x-ray services performed on the same date?

A: Part of the Patient Protection and Affordable Care Act identifies potentially misvalued codes by examining multiple codes that are billed frequently in conjunction with furnishing a single service. January 3, 2012, Medicare expanded the multiple procedure payment reduction (MPPR) to include the professional component in addition to the technical component reduction implemented on January 1, 2011. The MPPR applies when multiple diagnostic imaging procedures are performed on the same patient on the same date and in the same session by the same provider.

In these instances, the professional component with the highest-valued fee schedule amount will be paid at 100%. All subsequent and lower-valued professional components on the Medicare physician fee schedule will be paid at 75% of the physician fee schedule amount, a 25% reduction. This is better than the 50% MPPR for the technical component of subsequent services furnished by the same physician to the same patient in the same session on the same day.

This new reduction will apply to services submitted as global procedures or broken down into each component (professional and technical) and billed separately. Claims affected by this payment reduction will have claim adjustment reason code CO-59 appended to any line items with payment amounts that were reduced. All items that were reduced also will have the modifier 51 appended.