June 26
IN THIS ISSUE / June 26, 2019
- CMS/NCCI changes to PTP edits go into effect next week
- DW Insights and Inquiries: Conceptualizing atypical fibroxanthomas, pleomorphic dermal sarcomas, and undifferentiated pleomorphic dermal sarcomas
- Beyond the specialty: How AccessDerm helps primary care providers
- How do melanoma patients view skin self-examinations?
- Delaware governor signs critical step therapy bill
CMS/NCCI changes to PTP edits go into effect next week
Have you noticed any issues to your claims processing when reported with modifiers lately? This is because effective Jan. 1, 2019, the Centers for Medicare and Medicaid Services National Correct Coding Initiative (CMS/NCCI) implemented unexpected changes on how some code combinations were impacted with the use of modifiers.
Effective July 1, 2019
Effective July 1, 2019, claims for outpatient facility services submitted to MACs will allow modifier 59 on either the column one or column two code of a PTP edit with a modifier indicator of “1”.
The problem
The NCCI edits have changed column1/column2 sequencing for Procedure to Procedure (PTP) edits. According to CMS, about 10-13 years ago, the instruction that required the placement of a modifier on the column two code was rescinded and Medicare Administrative Contractors (MACs) were instructed to accept a modifier on either column code. As far as they were concerned, the changes will have little to minimal impact on claim processing.
Unfortunately, this instruction was not implemented by the MACs. As a result, the payers and coding community have continued to follow the instruction that allows the modifier to be placed on the column two code only, or the claim is deemed with ‘incorrect use of modifier’ and denied.
Following the AAD coding team concerns regarding the change in code combination and the placement of modifier 59 being required on the column two code of a PTP edit with a modifier indicator of “1”, a CMS and NCCI workgroup conducted an internal investigation. It found that MACs adjudicating practitioner claims do in fact require that modifier 59 be on the column two code of a PTP edit with a modifier indicator of “1”.
What you should know now
Currently, physicians can submit a claim for two codes corresponding to one of the PTP code pair edits, and it will be denied if modifier 59 is applied to the wrong code. If this occurs, physicians can pursue a redetermination with a corrected claim by appending the modifier to the correct code.
Learn more about modifier 59, including helpful tables that outline the impacted code combinations when specific procedures are performed and reported during the same encounter, in the Practice Management Center. For more coding help, visit the Academy’s Coding Resource Center.
Related Content:
- AAD product: 2020 Coding Billing for Dermatology
- Ask an expert: AADA Coding Questions Community
- AAD product: Principles of Documentation for Dermatology, Third Edition
- AAD product: Coding Value Pack
DW Insights and Inquiries: Conceptualizing atypical fibroxanthomas, pleomorphic dermal sarcomas, and undifferentiated pleomorphic dermal sarcomas
The classification of fibrohistiocytic tumors is ambiguous and controversial. This has been compounded by the evolving nomenclature as understanding of the genetic and molecular basis of these tumors improved. Previously, fibrohistiocytic tumors encompassed the superficial AFX [atypical fibroxanthoma] and its deep dermal/subcutaneous version, the malignant fibrous histiocytoma (MFH). Since 2002, the World Health Organization (WHO) has started dismantling the term MFH due to the heterogeneity of these tumors, most of which are better aligned under other classifications. The term MFH has been completely eliminated from the 2013 WHO classification of sarcomas.
So much for dismantling. If you PubMed search MFH today, you will see that the term is alive and well. Perhaps it will never be expunged from the pathology lexicon — regardless, the key to proper communication between a pathologist and clinician is a common understanding of a disease process and its implications. Keep reading!
Beyond the specialty: How AccessDerm helps primary care providers
With just a few minutes a day and a smartphone, dermatologists have the potential to make a significant impact in their community by using the Academy’s volunteer teledermatology platform, AccessDerm. A few weeks ago, Dermatology World Weekly spoke with Cory Simpson, MD, about why he uses AccessDerm, how it works, and why others should get involved. This week we interview Sharon Katzenbach, CRNP, a primary care provider at Puentes de Salud, a charity clinic in Philadelphia, about how AccessDerm helps her treat patients with skin conditions. Read about how AccessDerm has helped primary care providers.
Related Content:
How do melanoma patients view skin self-examinations?
In a JAMA Dermatology study, researchers interviewed 37 Australian patients who had a history of a primary localized melanoma to gauge their views on the importance of skin self-exam (SSE) and what role they see for new digital technologies to support these exams.
The results showed that patients viewed SSE as important for early identification of melanoma, although they did not report conducting them regularly. Lack of confidence in identifying concerning lesions, reliability on clinicians, and fear of recurrence all contributed to low engagement in SSE. Patients had a positive response to using digital technologies to assist with routine SSE and found the key motivating factors in favor of these tools were the ability to track changes in lesions over time and use automated reminders to perform SSE.
Read about how the Academy responded to the U.S. Preventative Services Task Force’s (USPSTF) recommendation statement on behavioral counseling for skin cancer prevention in Dermatology World.
Related Content:
- Treating metastatic melanoma – Dermatology World (April 2018)
- Melanoma: A family affair – DW Insights and Inquiries (November 2016)
- Melanoma in situ: The power of one (centimeter)? – DW Insights and Inquiries (September 2016)
- AAD product: Simulated Patient Encounters
Delaware governor signs critical step therapy bill
Delaware Gov. John Carney has signed step therapy legislation into law. Specifically, HB 105 will require health insurers to expeditiously grant a step therapy override determination request if, in the professional judgment of the prescribing physician, the step therapy requirement would be medically inappropriate for that patient. The legislation will go into effect March 2020.
