When a physician creates an arteriovenous graft in a patient for dialysis (36821, $656.05 [fac.]), it has a 90-day global post-op period. But if the graft occludes within the 90 days and the patient has to have a thrombectomy (36831, $453.36 [fac.]), would you use modifier 78 (unplanned return to OR) or 79 (unrelated procedure during post-op period) on the second procedure?

Download this month's tool from DecisionHealth Professional Services from Part B News' NEW Web site, www.partbnews.com. The Tool of the Month is a Recovery Audit Contractor (RAC) appeal tracking form. The purpose of this form is to allow providers to track all of the different timelines of an appeal your practice will encounter.

This chart shows the top 10 CPT codes with the highest percent growth in allowed charges from 2007 to 2008. Like last week's Benchmark, all data comes from an April 2009 report by the AMA called "Estimated change in SGR spending from 2007 to 2008." The presence of codes like 97110 (therapeutic exercises, $28.13) isn't a surprise, since its utilization has been growing for years (PBN 11/24/08).

You'll find in the latest batch of Correct Coding Initiative (CCI) edits that nearly a third of them include anesthesia codes, including hundreds of deleted pairs involving cardiovascular stress tests and anesthesia codes that have been around since 2003. The CCI changes take effect July 1.

Specialty groups affected by the recent and continuing cuts for dual-energy X-ray absorptiometry (DEXA) services are mounting an intense advocacy campaign to convince Congress to restore payment rates, Part B News has learned. There are already two bills in Congress that would return DEXA payment rates to their 2006 levels, when the primary DEXA code was paid approximately $140 on average, about 60% more than the $53 it will be in 2010, says Andrew Laster MD, president of the International Society for Clinical Densitometry (ISCD) and a practicing rheumatologist.

With the permanent recovery audit contractor (RAC) program on the verge of kicking off, you can keep the attentions of your regional RAC away from your practice by voluntarily handing overpayments directly to your carrier. This strategy will also reduce your compliance risk from recent legislation, experts say. Voluntary repayment to your carrier will preempt a RAC audit for that missing money that could include time-consuming medical record requests and other administrative hassles, a health care attorney tells Part B News.  

You've probably heard the phrase "patient-centered medical home" before. It's a key part of health care reform legislation because experts say it will improve quality of care and save money (PBN 5/18/09). Implementing a patient-centered medical home will mean changes to how your practice manages patients and the flow of health information. In the next three issues, Part B News will review specific areas - management, process or workflow, and roles and responsibilities - you must address in order to accomplish a successful transition to a medical home environment.

Don't give out your account information in response to a fax you receive that purports to be from your carrier or Medicare Administrative Contractor (MAC). As this issue of Part B News goes to press, we received a warning from CMS that scammers are sending these faxes to physician practices trying to get account information.

Your practice needs to know five key takeaways from CMS's "never events" additions to its Medicare National Coverage Determinations (NCD) Manual. Three relate to a recent transmittal ordering your carrier to deny you payment for never events and two are for when CMS will pay. The agency finalized three NCDs for never events - wrong surgery performed on a patient, a surgery performed on the wrong body part and a surgery on the wrong patient - in January (PBN 2/2/09). You are required to submit claims for these instances, but you won't get paid for the service.