NYSRS Health Insurance and Compensation report for January 11, 2002

Arthur J. Segal, M.D., F.A.C.R., Chairman

There are three significant issues that are worthy of highlighting:

• Changes in the correct way to code for Medicare (CMS) services
• Changes in rules for PET
• Changes in rules for screening vs. diagnostic mammography

Unfortunately, each of these issues is rather complex and does not lend itself to a simple outline.  Therefore, I have taken the liberty of providing a "direct" web address (see below) that will allow the opportunity to better evaluate the detail for each of these changes.  I have these specific addresses for two (Western N.Y. & Empire) of the three Carriers; however, I don't think that it would be difficult to go to the GHI web site to check these out. 

                For your convenience, here is the home page of each carrier + the GAO:

http://www.empiremedicare.com/

http://www.ghimedicare.com/

http://www.umd.nycpic.com/

http://www.gao.gov

Coding  - 

Upstate Medicare - http://www.umd.nycpic.com/billtips.html#ICD-9-CM  and then select, ICD-9-CM Coding for Diagnostic Tests

 Empire - http://www.empiremedicare.com/benenews/brf01-11/fro.htm

Mammography  - 

New modifer GG indicates performance and payment of a screening and diagnostic mammography on the same patient on the same day. For dates of service on or after January 1, 2002, attach the GG modifier to the claim for the diagnostic mammography code to show that a screening test and a diagnostic test were performed on the same patient on the same day; Medicare will pay both the screening and diagnostic mammography tests. This modifier is for tracking and data collection purposes only.

Upstate Medicare - http://www.umd.nycpic.com:80/cgibin/bookmgr/bookmgr.cmd/BOOKS/PB200112/24.0

Empire- http://www.empiremedicare.com/benenews/brf01-11/pol.htm  -- then scroll 80% down the panel to find this information. 
 

                        Empire - http://www.empiremedicare.com/news/11-28pet.pdf