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CodeMap® 01/15/2002 - CodeMap® Quarterly Reports, Volume I, No. 1 CodeMap®-01/15/2002 - CodeMap® Quarterly Reports, Volume I, No. 1 Archive

CodeMap Reports
___________________________________________________
Coding, Reimbursement and Compliance Information
Volume I, No. 1, January 15, 2002
Published by CodeMap, Barrington, IL  847-381-5465
___________________________________________________

IN THIS ISSUE:

  • Reimbursement Forum: How Medicare Sets Fees for New Laboratory CPT Codes
  • Compliance Issues: Making Your Compliance Program Cost Effective
  • Coding Basics: Coding and Medicare Reimbursement for Flow Cytometry
  • Q&A: Coding, Coverage and Reimbursement Issues
  • Codemap Compliance Tools
  • About CodeMap 

___________________________________________________
Welcome from the Editor.

Here is the first issue of CodeMap Reports, your source for information and commentary on how to get paid correctly and remain in compliance with Medicare rules and regulations.  Our focus is primarily on issues involving Medicare Part B payment for laboratory, pathology and radiology services plus the Hospital Outpatient Prospective Payment System (OPPS).  

Rather than merely reporting on every new rule and policy change concerning Medicare coding and reimbursement, we will try to explain both new rules and existing issues in terms of what they mean to you, the healthcare provider. Our goal will be to make sure you know how to comply with all rules and regulations, minimize the risks of non-compliance, and still receive accurate and complete reimbursement for the services you provide to Medicare and Medicaid patients.

Sincerely,

Charles B. Root, Ph.D., Editor
___________________________________________________
How Medicare Sets Fees for New Laboratory CPT Codes

The amount paid for new laboratory CPT codes is often crucial to future utilization of a test or procedure. When payment levels are set too low, adoption of new tests is very slow. The current system for adding new tests to the Laboratory Fee Schedule is complicated when left to function at its own pace and often leads to payments which are less than the cost of the test. New efforts by Medicare to make the fee setting process more transparent are a much-needed improvement. Providers need to understand how the system works and actively participate in the process, where appropriate, to ensure reasonable results.

Two methods are used by CMS to assign payment for new codes, mapping and gap filling. Mapping is used when the new code is similar to an existing code. The new code is then assigned the same reimbursement as the existing code to which it is mapped. In some cases the mapping may be to some combination of existing codes rather than a single code.

Mapping results in an immediate fixed reimbursement for the new code effective January 1 of the year the new CPT code is published. A National Limitation Amount (NLA), equal to that of the code to which the new code is mapped, is also assigned effective January 1.

Gap filling is used when mapping is not appropriate. Using this method, each Medicare carrier is instructed to determine a reasonable payment for the new code by considering submitted charges and other available information. The payment amount must be reported to CMS before April 1 of the year the new code is published. By the end of the same year, CMS assigns a NLA to the gap filled code by calculating the median of all amounts reported by the carriers. This new NLA becomes effective January 1 of the following year.

During the first three months of the year, gap filled payments are individually determined by carriers for each claim until a payment amount is assigned and reported to CMS. After April 1 the only way to determine the fee schedule amount for a Gap Filled test is to submit a claim and see what is paid or to request the payment amount from the carrier using a Freedom of Information request.

The Gap Filling process is highly variable in its results. Carriers sometimes report vastly different reimbursement amounts with no apparent basis. In some cases carriers will simply use their own form of mapping and report a reimbursement amount based on a test they believe is similar.

CMS prefers to map as many codes as possible because the method is simple and provides an immediate uniform payment amount throughout the country. Another more subtle reason for CMS to prefer mapping is that by basing the new payment on an existing charge, the 26% reduction in NLA is carried forward for the new code. On the other hand, gap filling results in a NLA that, by law, remains at 100% of the median of all reported reimbursement amounts. Thus, gap filling offers the potential of higher reimbursement, especially for codes that might otherwise be mapped to a low paying test.

In some cases, there is simply no reasonable mapping possible and gap filling becomes the only alternative. However, in most cases either process may be appropriate and manufacturers and providers have the opportunity to influence CMS's decision. Starting last year, CMS established a new, more open process for determining reimbursement levels for new CPT codes. The reimbursement for all new laboratory CPT codes included in the 2003 CPT will be discussed at an open meeting on August 5, 2002. This meeting will serve as an information gathering session for CMS during which interested parties can present their arguments as to how payment levels for the new codes should be determined (by mapping or gap filling techniques). Decisions regarding reimbursement levels are not made at this meeting, however, last year most of the recommendations presented for mapping versus gap filling were adopted.

MCF Compliance will be monitoring the assignment of new 2003 CPT codes by the American Medical Association during the coming year and attend the August 5th meeting to make sure CodeMap Reports readers get the most accurate information and predictions of what will happen next year.

____________________________________________________________
Making Your Compliance Program Cost Effective

Compliance programs can be designed to monitor and ensure appropriate Medicare revenues while reducing the risk of false claims and Medicare fraud.  Lets get right to the basics.  Your biggest problems in dealing with Medicare are: (1) getting paid right the first time a claim is submitted; and (2) avoiding false claims and potential Medicare fraud. At the same time you must justify the cost of an effective compliance program.

A properly designed compliance program can improve Medicare collections while reducing the risk of audits and investigations.  Collections can be accelerated and administrative overheads reduced.  You can protect your organization from whistle-blowers by creating an effective training program that makes it clear to all employees what their first responsibility is to report suspected problems to YOU rather than the Office of Inspector General. 

No one wants to spend money to prevent something that mght happen. An effective compliance program can produce measurable economic benefits in excess of its cost.  In other words, a compliance program can be a profit center, not an expense item in your budget. 

The following six rules should be followed to ensure compliance AND appropriate Medicare reimbursement.

1.   Know how much Medicare pays for each and every covered service.  Use current fee schedules and coverage policy to determine exactly what you should receive for each test or procedure for which you bill.

2.   Verify that every procedure and code is accurate, up to date, and properly priced.  Perform a comprehensive charge-master review to ensure that all services are properly described and assigned the correct CPT code(s).

3.   Audit and optimize your charge capture process and use compliance policy to ensure every procedure is documented and billed properly.  Use an initial audit to discover what needs to be fixed. Then keep in touch with everyone who performs billable procedures to make sure they know how to record and document everything they do.
 
4.   Identify limited coverage and frequently denied procedures and use Advance Beneficiary Notices (ABNs) to ensure patient payment when appropriate. A review of selected Explanation of Benefit forms (EOBs) will show you which procedures need attention.  Consistent ABN policy can ensure that patients are billed for denied claims.

5.   Educate all employees on basic compliance policy and their responsibilities. Provide specialized training for those in critical positions.  Internet based compliance training can be used to quickly train and certify both physicians and other employees regarding their responsibilities.

6.   Monitor all payments, reimbursement levels, and denials to detect problems that reduce or delay payment.  Develop and implement a revenue monitoring system for Medicare reimbursement that provides an early warning of compliance problems.

Diligent application of the above rules will provide maximum protection from inadvertent violation of federal rules and regulations, and at the same time, ensure that you receive full and correct reimbursement for all services provided to Medicare patients.  In most cases the improved cash flow more than pays for the cost of the program including compliance training and administration costs.

CodeMap can provide the audit tools and/or services needed to create or maintain an effective compliance program. We can also provide cost-effective compliance training. Give us a call at 847-381-5465 with your questions or needs.

____________________________________________________________
Coding Basics: Coding and Medicare Reimbursement for Flow Cytometry Services

Flow Cytometry is recognized as a key diagnostic tool for managing a wide variety of cancers and other conditions and can be an important revenue source if correct coding procedures are used.  Both physician and technical components must be coded correctly to receive appropriate reimbursement from Medicare and other payers.

The following CPT codes are used to identify flow cytometry services for Medicare payment:

  • 88180  Flow cytometry; each cell surface marker
  • 88181  Flow cytometry; cell cycle or DNA analysis
  • 86359  T cells; total count
  • 86360  T cells; absolute CD4 and CD8 count, including ratio
  • 86361  T cells; absolute CD4 count
  • 85045  Blood count, reticulocyte count, flow cytometry

Note that CPT code 88180 is defined as EACH cell surface marker. If a 8-marker panel is performed, the code would be submitted 8 times in order to obtain correct payment.  Likewise, CPT code 88181 is submitted for EACH cell cycle or DNA analysis performed.

When a pathologist and a laboratory submit separate bills for the professional and technical components of the above services, modifiers 26 (professional) and TC (technical) are used with the above codes. If the same entity performs both the technical and professional services, the unmodified (global) code is used.

CPT codes 88180 (Flow cytometry; each cell surface marker) and 88181 (Flow cytometry; cell cycle or DNA analysis) are part of the Physician Fee Schedule. As such they are subject to a 20% copayment by the beneficiary and may be split into separately billed professional and technical components if performed by a laboratory and pathologist. Payment is based on the relative value of each procedure multiplied by $36.20 and adjusted by local expense and malpractice factors. The unadjusted 2002 reimbursement amounts for these codes are:

  • 88180: $35.84
  • 88181: $95.57

86359, 86360, and 86361 describing T cell counts and 85045, reticulocyte count, are part of the Laboratory Fee Schedule and are not subject to the 20% copay.  The amount paid is the same as that on the fee schedule and no additional amount may be billed to the beneficiary. 2002 National Limitation Amounts for these codes are:

  • 86359: $52.13
  • 86360: $64.93
  • 86361: $37.00

Coding Examples

Example I: A reference laboratory performs an AIDS panel utilizing a physician drawn blood sample which includes a total T cell count plus absolute CD4 and CD8 counts.

Coding for these tests would be as follows:

86359:  T cells; total count
86360:  T cells; absolute CD4 and CD8 count, including ratio 
                      
Example II: A hospital laboratory performs a flow cytometry leukemia/lymphoma panel for an outpatient that includes 10 cell surface markers.  An independent pathologist, not employed by the hospital, interprets the results, issues a written report, and bills Medicare using his provider number.

The hospital submits the following codes:

88180-TC X 10: Flow cytometry, each cell surface marker  
           
The pathologist submits the following codes:
  
88180-26 X 10: Flow cytometry, each cell surface marker

____________________________________________________________
Q&A: CODING, COVERAGE AND REIMBURSEMENT ISSUES

QUESTION: Please consider the following scenario:  After November 25th when the new National Coverage Deteminations (NCDs) for lab tests becomes effective, we receive an order from a physician for a glucose test with a diagnosis that is not covered by the NCD for glucose.  We bill the service to Medicare, receive a denial, and bill the patient since we have a valid ABN on file.  The patient contacts his/her physician and asks for a review of the chart to determine if the physician provided the most appropriate diagnosis for the test ordered.  The physician provides our laboratory with written documentation requesting a rebill using an alternate diagnosis.

Is it acceptable to rebill this claim to Medicare with the revised information, or is this the point where our right to appeal is denied?

ANSWER: You can rebill with the new information provided by the physician.  You are not allowed to appeal a National Coverage Determination, but this is merely a corrected claim. An appeal would involve contesting the validity of the ICD-9 codes listed as covered in the NCD.  Such an action is only allowed when Local Medical Review Policy is involved.

QUESTION: When Medicare maps a new CPT code to an existing code which code do I use to submit Medicare claims?

ANSWER: Use the new code, not the code to which it is mapped, to submit Medicare claims.

____________________________________________________________
ABOUT CODEMAP

CodeMap offers unique publications and services to help you with all your compliace information and education needs.  For information on CodeMap Medicare Reimbursement Manuals for Laboratory, Pathology, Radiology, Nuclear Medicine and Outpatient services, please go to http://www.codemap.com/publications

For economical internet based training, go to http://www.codemap.com/training

CodeMap can provide annual compliance audits, charge-master reviews and advice on all your regulatory problems.  Just give us a call at 847-381-5465.

Please feel free to let us know what you think of this newsletter by sending us an e-mail at info@codemap.com.  Suggestions for future articles, questions, and comments are appreciated. 


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07/15/2016: 2016 Annual Laboratory Public Meeting
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04/27/2016: Federal Anti-Kickback Statute
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03/17/2016: Coding and Reimbursement for Genomic Sequencing Procedures, Part 1
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10/09/2015: Update on Lab Tests for Colorectal Cancer Screening
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08/07/2015: DNA Based Infectious Disease Assays
07/24/2015: CMS Annual Laboratory Public Meeting
07/15/2015: FAQs Concerning ICD-10, 2016 Reimbursement, and CodeMap®
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06/17/2015: Specimen Collection Supplies Revisited
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04/30/2015: Recent Enforcement Actions
04/23/2015: -59 Modifier Use and Changes
03/12/2015: Coding Waived Tests
02/5/2015: Providing Computer Equipment
01/15/2015: New Frequency Limits for Lab Tests
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10/30/2014: Advisory Panel
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07/17/2014: PAMA Part 2: Creating and implementing the New Market Based Fee Schedule
07/10/2014: The Protecting Access to Medicare Act of 2014 (PAMA): An Overview
05/30/2014: Diagnosis Coding Issues
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05/22/2014: Discounts to Financially Needy Patients
05/21/2014: Screening Employees and Customers
04/30/2014: Discounts to Financially Needy Patients
04/02/2014: New 2015 CPT Codes, Part 2: Quantitative Drug Determinations
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02/13/2014: HIPAA Notice of Privacy Practices
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11/20/2013: Fraud and Abuse Enforcement
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10/24/2013: Urinary Systems Procedures, Part 2
10/11/2013: New Molecular Pathology Fees
09/25/2013: Urinary Systems Procedures
09/18/2013: Coding and Reimbursement Updates
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08/21/2013: Medicare Coverage Edits Part 2
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05/16/2013: OIG Special Advisory Bulletin Concerning Exclusions
05/03/2013: EMR and EHR Safe Harbor Proposals
05/08/2013: Breast Biopsy Coding Tips
04/03/2013: Medicare Coverage of Preventive Care, Part 2
03/27/2013: Medicare Coverage of Preventive Care
03/15/2013: Sequestration Payment Reductions for Labs and Pathologists
03/14/2013: Anti-Kickback Law and Physicians
02/21/2013: Anti-Kickback Enforcement and Physicians
02/21/2013: Coding for Discontinued Outpatient Procedures
02/14/2013: Update on Prostate Biopsy Codes and Payment
01/31/2013: Medicare Gap-Fill Payments for Molecular Pathology Codes
01/31/2013: 2013 NCCI Policy Changes
01/16/2013: HIPAA Mistakes
01/16/2013: HIPAA Mistakes
01/04/2013: Reimbursement and Compliance Developments
12/20/2012: 2013 Head and Neck Angiography Coding
12/18/2012: Update to 2013 Lab Fee Schedule
12/13/2012: Apparent Errors in 2013 Lab Fee Schedule
12/07/2012: FAQs - CT/CTA/3D Rendering
11/30/2012: Coding HLA Typing Tests
11/09/2012: 2013 Physician Fee Schedule Final Rule
10/18/2012: 2013 Radiology Coding Update, Part 2
10/16/2012: Stark Prohibitions and Non-Monetary Compensation
10/11/2012: Coding and Reimbursement for Calculated Lab Results
10/04/2012: 2013 Radiology Coding Update, Part 1
09/19/2012: CMS to Gap-Fill Molecular Pathology Codes
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08/29/12: To Code or Not to Code
08/21/2012: 2013 Medicare Laboratory Fee Schedule
08/15/2012: Compliance Issues Related to Test Ordering Systems
08/08/2012: Preparing for ICD-10
08/08/2012: Preparing for ICD-10
08/02/2012: Future Directions: Medicare Compliance Enforcement
08/2/2012: Future Directions: Medicare Compliance Enforcement
7/26/2012: Waiving Copays
07/25/2012: Waiving Patient Copays
07/20/12: Correct Use of Modifier -59 for Radiology Procedures, Part 2
07/12/12: Correct Use of Modifier -59 for Radiology Procedures, Part 1
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05/04/2012: Frequency Limits (MUEs) for Pathology Services
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04/25/12: Diagnosis Coding for Diagnostic Radiology, Part 1
04/05/2012: Coding for Drug Determinations, Part 2
03/30/2012: Coding for Drug Determinations, Part 1
03/21/12: Fluoroscopy Coding Revisited, Part 2
03/16/2012: Multianalyte Assays with Algorithmic Analysis (MAAAs)
03/14/12: Fluoroscopy Coding Revisited, Part 1
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01/13/2012: 2012 Coding Update
2012 Publications Notification
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12/19/2011: Questions for 2012
12/09/2011: Annual Compliance Audit
12/07/2011: Revascularization Coding FAQs
12/02/2011: Compliance Policies
11/18/2011: The Chief Compliance Officer
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10/28/2011: Dialysis Access Maintenance Coding 2
10/28/2011: The Use of Custom Panels
10/12/2011: Dialysis Access Maintenance Coding 1
10/7/2011: Palmetto LCD for Molecular Diagnostic Tests
9/26/2011: Proposed Payment for New CPT Codes
9/09/2011: New CPT Codes for 2012
9/9/2011: Evaluation and Management Services Part 2
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8/12/2011: Annual Physician Notices
07/29/11: Recent OIG and DOJ Activity
8/5/2011: Update to 2012 Laboratory Fee Schedule
7/29/2011: Genetic Testing 2012
6/17/2011: CMS Meeting to Discuss Payment for 2012 New Lab Tests
5/13/2011: Recovery Audit Contractor Program Results
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04/08/2011: EMR/EHR Safe Harbors
04/01/2011: Genetic Testing Demonstration
2/25/2011: Medicare Drug Screening Update
2/11/2011: Recent OIG and DOJ Activity
2/4/2011: Medicare Annual Wellness Visit (AWV)
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01/14/2011: Stark Self-Referral Prohibitions 2
01/07/2011: Stark Self-Referral Prohibitions 1
2011 Publications Notice
12/17/2010: New, Revised and Deleted Radiology Codes
12/17/2010: Year-End Changes
12/10/2010: 2011 Medicare Lab Fee Schedule
11/19/2010: Coding and Reimbursement of Automated Tests
11/12/2010: 2011 OIG Work Plan
10/29/2010: Proposed Medicare Payments for new 2011 Lab Codes
10/12/2010: Medicare Provider Anti-Fraud Rule: Screening Tools
10/04/2010: Medicare Provider Anti-Fraud Rule: Risk Classification
09/17/2010: 2011 CPT Code Changes
09/03/2010: Conversion to ICD-10 Stays On Schedule
08/23/2010: Chromatography CPT Codes
08/23/2010 The Medicare Physician Fee Schedule
08/06/2010: Reimbursement Review
07/23/2010: Coding Review
07/16/2010: Supervision Requirements
07/08/2010: Employee Screening
07/01/2010: Signature Requirements for Test Requisitions and Orders
06/25/2010: Employee Screening
06/18/2010: Coding Quantitative Drug Tests
06/05/2010: 2011 Laboratory CPT and HCPCS Codes
05/21/2010: Timely Submission of Medicare Claims
5/14/2010: RAC Audits Part 3
05/07/2010: New HIV Screening Codes
04/23/2010: E/M Coding and Breast Procedures
04/23/2010: Outpatients and Nonpatients
04/16/2010: RAC Audits Part 2
04/09/2010: Update: Healthcare Reform and Laboratories
04/01/2010: Multiple Procedure Payment Reductions II: Outpatient Services
3/19/2010: Multiple Procedure Payment Reduction
3/19/2010: MUE Update
3/05/2010: Coding & Reimbursement Update
3/5/2010: RAC Audits Part 1
2/19/2010: Beneficiary Inducement Prohibition
2/05/2010: Urinalysis Codes
01/29/2010: Dialysis Access Maintenance Coding
1/22/2010: Drug Screening Codes
01/08/2010: Medicare Fee Schedule Updates
CodeMap Compliance Briefing: 1/7/2010
2010 Publication Notice
2010 CodeMap® Publications Shipping Update
12/11/2009: Year End Coding Changes
12/04/2009: Travel Allowance Reimbursement
11/20/2009: Diagnosis Coding Rules for Pathologists
11/13/2009: Diagnostic Coding Rules for Laboratories
11/06/2009: Coding for Mammography Services
10/30/2009: Preliminary Payment for New Lab CPT Codes
10/23/2009: Civil Monetary Penalties
10/15/2009: HIPAA Amendments
10/02/2009: Proposed Medicare Coverage for HIV Screening
09/25/2009: Radiology Services in the Emergency Room
Upcoming Coding and Reimbursement Changes
09/18/2009: Essential Health Information System Updates
CodeMap Radiology Briefing: 09/11/2009: Compliance Vocabulary
08/28/2009 Reimbursement for Lab CPT Codes
08/21/2009: Utilization of Radiology Services
08/14/2009 Creating New CPT Codes
8/7/2009 New 2010 Laboratory CPT Codes
08/07/2009: Supervision Requirements
07/31/2009 Physician Signature Requirements
07/31/2009: Medicare Administration/Organization
07/24/2009: Health Care Reform and the Future
07/24/2009: Ultrasound Coding, Part 2
07/17/2009: New Information and Hospital Lab Direct Billing Rules
07/10/2009: Ultrasound Coding, Part 1
06/26/2009: The Future of Medical Necessity
06/19/2009: Employee Screening
06/17/2009: Documentation Requirements: Part 2
06/05/2009: NPI Issues
05/29/2009: Documentation Requirements
05/22/2009: Who Can Order Tests for Medicare Patients?
05/15/2009: The Civil False Claims Act
5/1/09: Coding Molecular Microarray Procedures
4/24/2009: Diagnostic Test Orders
4/17/09: Comparative Effectiveness Studies
4/03/2009: Fluoroscopy Coding Part 2
4/03/09: Medicare Recovery Audit (RAC) Contractor Program
03/27/09: Fluoroscopy Coding Part 1
03/20/2009: Compliance Risk Areas
03/13/09: The Terminology of Reimbursement
3/06/09: Quantitative Drug Assay Codes
02/27/2009: New ABN Form
Q2 NCD Updates
02/20/2009: Discounts for Financially Needy Patients
02/13/2009: The Terminology of Coding
2/06/09: In Vivo Lab Procedures
1/30/09: ICD-10 Implementation, Final Rule
1/23/09: 2009 Laboratory Fee Schedule
CodeMap Radiology Briefing: 01/14/2009
CodeMap Compliance Briefing: 01/14/2009
CodeMap Compliance Briefing: 12/19/08: Prostate Saturation Biopsies
12/19/2008: Year End Radiology Wrap-Up
NCD Q1 2009 Breaking News
12/05/2008: Anti-Markup Provisions
12/2/2008: Interventional Radiology Coding Conclusion 2
11/25/2008: Interventional Radiology Coding Conclusion
11/21/2008: Civil Monetary Penalties
11/12/08: Clinical Laboratory Interpretation Services
11/07/2008: Interventional Radiology Coding 3
10/29/08: MUE Update
10/24/2008: Interventional Radiology Coding 2
10/15/08: The NCD Update Process
10/10/2008: Interventional Radiology Coding 1
10/08/2008: 2009 Payment Recommendations
10/01/08: Two Issues Resolved
9/19/08: Coding and Reimbursement for HIV Tests
9/12/08: The Terminology of Reimbursement
9/5/08: The Terminology of Coding
8/22/08: Recent Subscriber Questions
08/08/2008: New PSA Screening Criteria
7/25/2008: 2008 Travel Allowances
7/17/2008: Medicare Improvements Act
6/27/2008: New Laboratory CPT Codes
6/20/2008: Medicare Payment Systems for Lab Tests III
July 2008 NCD Update
6/6/2008: Medicare Payment Systems for Lab Tests II
05/30/2008 Physician Signature Policy for Lab Claims
05/23/2008: Medicare Payment Systems for Lab Tests
05/09/2008: HCPCS Coding System
05/02/2008: Fecal Occult Blood Tests
04/25/2008 Routine Monitoring vs. Diagnostic Glucose Testing
04/11/2008: Subscriber Questions
04/04/2008: Relying on Guidance
03/28/2008: Comparative Effectiveness
03/14/2008: New ABN Form
02/22/08: Standing Orders
02/15/2008: New Metabolic Panels
2/8/2008: Diagnosis Coding Rules for Labs
02/01/2008: Using Unlisted CPT Codes
01/18/2008: Home PT/INR Testing and Monitoring
01/11/2008: Significant Changes to 2008 Physician Fee Schedule
CodeMap Compliance Briefing: 01/03/2008: Annual Compliance Audits
CodeMap Compliance Briefing: 12/14/07: 2008 PFS: New Direct Billing Provisions
12/07/07: Reconsideration of Medicare Payment for New Lab Codes
11/30/07 - Changes in Pathology Reimbursement for 2008
11/16/2007 Medical Necessity Data Files
11/9/2007: Direct Billing Rules for Hospital Laboratories
11/2/07: Payment Jurisdiction for Referred Lab Tests
10/19/07: OIG Work Plan 2008
10/12/07: Medicare Coverage of Hospital-Acquired Conditions
9/28/2007: Medicare Reimbursement for 2008 Lab Codes
9/21/07: Coding and Reimbursement for MRSA Tests
9/14/07: Coding Pap Smears
9/7/07: Date of Service Rules
8/24/07: TeleConference Tools
CodeMap Compliance Briefing: 8/17/07: Medicare Claims Processing Rules
8/10/07: Procedure Code Modifiers
7/27/07 Billing Medicare for Peripheral Blood Smear Interpretations
7/20/07: 2008 ICD-9 Code Changes
7/13/07: New 2008 Laboratory CPT Codes
6/22/07: Excessive Charges to Medicare
6/15/07: Compliance Training
6/08/07: Glucose Testing for Hospital Patients
6/01/07: Reimbursement for Unlited Procedures
5/11/07: Molecular Diagnostic Codes and Reimbursement II
5/4/07: Molecular Diagnostic Codes and Reimbursement
04/20/2007: Medicare Coverage Vocabulary
04/13/2007: Coding Vocabulary
03/30/2007: Reimbursement Vocabulary
03/23/07: Compliance Vocabulary
3/16/07: Medically Unlikely Edits (MUE) Implementation
3/2/07: The Physician Quality Reporting Initiative (PQRI)
CodeMap Compliance Briefing: 2/23/07: New Anticoagulant Management Codes
2/09/07: Glycosylated Hemoglobin (A1c) Test Codes
02/02/2007 National Provider Identifiers
CodeMap Compliance Briefing: 1/26/07: The Deficit Reduction Act
CodeMap Compliance Briefing: 1/19/07: The Civil False Claims Act
12/19/06 Medically Unlikely Edits (MUEs)
12/11/06 - 2007 Medicare Laboratory Fee Schedule
CodeMap Compliance Briefing: 12/1/06: Category III Codes
11/17/2006 2007 Radiology CPT Codes
11/10/06 New and Revised CPT Codes for Laboratory and Pathology Procedures
11/03/06 Logical Observation Identifier Names and Codes
10/20/06 Dealing with Medicare Overpayments 
10/13/06 Stark II Issues, Part 2
10/6/06: Stark II Issues, Part 1
09/29/2006 Medical Necessity Updates
09/15/06: Medicare Coverage of PSA Testing
9/8/06 Public Consultation on Medicare Payment for Lab Tests
08/25/06: Point of Care Hemoglobin A1c Testing
08/21/06 Subscriber Questions
08/11/06 CMS Awards First A/B MAC Contract
7/21/06 Medicare Coding Vocabulary
7/14/06 Setting Reimbursement Amounts for New 2007 Codes
07/07/06: New 2007 Laboratory CPT Codes
06/09/2006 Competitive Bidding III
06/02/2006 Competitive Bidding II
05/26/2006 Competitive Bidding I
05/12/2006 Briefing: ABN Update
CodeMap Compliance Briefing: 5/5/06: Subscriber Questions
04/28/2006: Billing for Purchased Interpretations
CodeMap Compliance Briefing 4/21/06
03/31/2006: Physician Voluntary Reporting System
03/24/06 Medicare Organization/ Administration
03/17/2006: Compliance Disclosure Programs
03/10/06: Automated Test Coding and Reimbursement
02/24/2006 Pay for Performance
02/17/2006: Inherent Reasonableness
2/10/06: Microarray Codes
02/03/2006 Refresher Course: Compliance Programs
01/20/2006 Refesher Course: Medicare Reimbursement
01/13/06: Laboratory Phlebotomists in Physician Offices
CodeMap Compliance Briefing: 1/06/06 2006 Federal Budget
CodeMap Compliance Briefing: 12/16/05: Lipid Codes
CodeMap Compliance Briefing: 12/9/05: Important Year End Dates
12/02/05 Fecal Occult Blood Tests
11/18/05 Employee Compliance Training
11/04/2005 New CPT Codes for Radiology
Compliance Policy Manual
10/21/2005: New CPT Codes for Lab and Pathology
CodeMap Compliance Briefing: 10/14/05: Providing Regulatory Information to Customers
CodeMap Compliance Briefing: 10/07/05: Employee Screening
CodeMap Compliance Briefing: 9/29/05: Waived Testing
CodeMap Compliance Briefing: 09/23/05: Drafting Compliance Policies
09/16/2005 2006 Lab Codes and Proposed Payments
09/09/2005: LIS and Medical Necessity
08/19/2005: Lab Tests on the 2006 Physician Fee Schedule
08/05/2005 Coding Bone Marrow and Bone Biopsies
CodeMap Compliance Briefing 07/22/05: Coding Antibody and Antigen Assays II
07/08/2005 Coding Antibody and Antigen Assays: I
06/24/2005 Resubmitting Denied Medicare Claims
06/17/2005 Diagnosis Coding Rules-Part 2
05/20/05 Diagnosis Coding Rules Part 1
05/13/2005 Reflex Manual WBC Differentials
05/06/2005 Incident To Services
04/29/2005 CMS Manuals
04/22/2005 Reflex Testing
04/15/2005 Custom Panels
04/08/2005 Medicare Administrative Contractors (MACs)
04/01/2005 Place of Service (POS) Codes
03/18/2005 Subscriber Questions
03/11/2005 Medically Unbelieveable Edits
03/04/2005: Final Hospital Compliance Guidance 4
02/25/2005: Final Hospital Compliance Guidance 3
02/18/2005 Final Hospital Compliance Guidance 2
02/11/2005 Final Hospital Compliance Guidance
02/04/2005 Final Diabetes Screening Rules
01/28/2005 Medicare Appeals II
01/21/2005: Medicare Appeals I
01/14/2005 Providing Services to SNFs
01/07/2005 Medicare Errors
12/17/2004 Year End Subscriber Questions
12/10/2004 Coding Flow Cytometry Services
12/08/2004 Alert: 2005 CodeMap Manual Production Schedule
12/03/2004 Diabetes Screening Tests
11/22/2004 Announcing CodeMap Data Files
11/19/2004 Flow Cytometry Coding and Reimbursement
11/12/2004 New Venipuncture Rules
11/05/2004 Medicare Cardiovascular Screening Benefits
10/29/2004 Subscriber Questions
10/22/2004 Genetic Testing Modifiers
10/15/2004 Coding Glucose Tests
10/08/2004 Shared Laboratories
10/01/2004 Stark II and POLs
09/24/2004 New CPT Codes for Pathology Services
09/17/2004 New CPT Codes for Lab Services
08/27/2004 SNF Consolidated Billing Exceptions
08/20/2004 The OIG Exclusion Program
08/13/2004 Medicare Initial Preventive Physical Exam
08/06/2004 New Medicare Coverage for Screening Tests
07/30/2004 Discounts to Financially Needy Patients
07/23/2004 Date of Service for Lab Tests
07/16/2004 New CPT Codes for 2005
06/25/2004 Updates to NCDs and LMRPs
06/18/2004 New Compliance Program Guidance for Hospitals II
06/11/2004 New Compliance Program Guidance for Hospitals II
06/04/2004 Annual Physician Notices
05/21/2004 Screening Pap Smear Coverge
05/14/2004 Transfusion Medicine Codes II
05/07/2004 Transfusion Medicine Codes I
04/23/2004 Anti-Mark-Up Controversy
04/16/2004 Subscriber Questions
04/09/2004 Genetic Testing Codes II
04/02/2004 Genetic Testing Codes I
03/26/2004 Laboratory Marketing Practices III
03/19/2004 Laboratory Marketing Practices II
03/12/2004 Laboratory Marketing Practices I
03/05/2004 Medicare Payment for CLIA Waived Tests
02/27/2004 Medicare Payment for ReferredTests
02/20/2004 Grace Period for CPT Codes Eliminated
02/14/2004 CCI Edits Associated with New Lab and Pathology Codes
02/06/2004 CCI Edits Associated with New Radiology Codes
01/30/2004 Venipunctures
01/23/2004 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
01/16/2004 Travel Allowances
12/19/2003 Medicare Modernization Act
12/12/2003 Medicare Reform Bill Part 2
12/05/2003 Medicare Reform Bill Part 1
11/21/2003 New HCPCS Codes for CBCs without Platelets
11/07/2003 GA, GY and GZ Modifiers
10/31/2003 Specimen Collection
10/24/2003 Coding Qualitative Drugs-of-Abuse Tests
10/17/2003 The OIG's Work Plan, Medicare CDs, Recent Enforcement Actions.
10/10/2003 ESRD Composite Rate Lab Tests
10/03/2003 End Stage Renal Disease (ESRD) Reimbursement for Automated Tests
09/26/2003 Proposed Rules from the OIG
09/12/2003 Category III (Tracking) CPT Codes
09/05/2003 New Proposed Rules for Flow Cytometry
08/15/2003 Thyroid Testing
08/01/2003 CMS Lab Reimbursement Meeting
07/25/2003 NCD Misconceptions
07/18/2003 The -GZ Modifier
07/11/2003 Screening Mammogram Codes
06/27/2003 Correct Coding Edits II
06/20/2003 Correct Coding Edits I
06/13/2003 Diagnosis Coding Rules II
06/06/2003 Diagnosis Coding Rules I
05/23/2003 Revised Medicare Appeals Provisions II
05/16/2003 Revised Medicare Appeals Provisions I
05/09/2003 Business Associates Agreements
05/02/2003 Pathologist Interpretation of Clinical Lab Tests
04/25/2003 TC Billing of Pathology Services
04/18/2003 Medicare Reimbursement for Pathology Services
04/11/2003 How to Respond to a Search Warrant
03/28/2003 How to Respond to Subpoenas
03/21/2003 How to Respond to Investigators
03/14/2003 Mandatory Claim Submission
03/07/2003: Who Can Order Diagnostic Tests?
02/28/2003 Changes in 2003 Physician Fee Schedule
02/21/2003 Medical Necessity Requirements for Chemistry Panels, Part II
02/14/2003 Medical Necessity Requirements for Chemistry Panels I
02/07/2003: ABNs and Client Cooperation
01/31/2003: Patient Ordered and/or Performed Testing
01/24/2003: The Beneficiary Anti-Kickback Statute
01/17/2003: Significant Changes in 2003 Medicare Reimbursement
01/10/2003: 2003 Medicare Lab and Physician Fee Schedules
12/13/2002: More National Coverage Policies
12/06/2002: How Medicare Sets Fees for New CPT Codes
11/22/2002: Critical Year End Dates
11/15/2002: 2003 Medicare Laboratory Fee Schedule
11/08/2002: Stark Self-Referral Prohibitions
11/01/2002: Using Modifiers -59 and -91
10/25/2002: Introduction to Privacy Regulations
10/18/2002: New Codes for Obstetrical Ultrasound
10/11/2002: National Coverage Determinations (NCDs)
10/04/2002: Implementing a Radiology Compliance Program
09/27/2002: New 2003 Lab CPT Codes
09/20/2002: Automated Order Entry
09/13/2002: National Coverage Policy for Lipids
09/06/2002: The Anti-Kickback Statute
08/23/2002: Using the New ABN Forms
08/16/2002: Advance Beneficiary Notices
08/09/2002: Medicare Coverage for PET Scans
08/02/2002: Reflex Testing
07/26/2002: 2003 Hematology CPT Code Changes II
07/19/2002: 2003 Hematology CPT Code Changes I
07/12/2002: Direct Billing Rules II
06/28/2002: Direct Billing Rules I
06/21/2002: Medicare Reimbursement for Lipid Panels
06/14/2002: Bone Density Studies
06/07/2002: CLIA Waived Testing Rules
05/31/2002: Blood Draws and the Anti-kickback Statute
National Coverage Determination (NCD) Updates
05/01/2002 - CodeMap® Quarterly Reports, Volume I, No. 2
01/15/2002 - CodeMap® Quarterly Reports, Volume I, No. 1