National Heritage Insurance Company (NHIC) issued a notification update Oct. 14 to clarify its coding and utilization guidelines for certain male external catheters supplied to Medicare beneficiaries.
Monday, October 5th, 2009
If your practice can’t seem to successfully bill for the professional component lately, there could be a logical explanation. It could be something as simple as an incorrect modifier.
According to First Coast Service Options Inc. (FCSO), an excessive number of claims from providers are being denied because they request payment for the professional component using the wrong modifier with the CPT® or HCPCS Level II code.
Prevent Delays and/or Denial
When billing for the professional component of a procedure, hospital outpatient departments, ambulatory surgical centers (ASCs), and other practitioners should properly identify the service by adding modifier 26 Professional component to the appropriate CPT® or HCPCS Level II code — not the new modifier effective July 1, PC Wrong surgery on patient.
Medicare automatically denies all lines related to an erroneous surgery with dates of service on or after Jan. 15, including claims for related hospitalizations.
Claims Appeal
FCSO advises providers appeal claims billed in error with modifier PC and subsequently denied for wrong surgery. Correcting and resubmitting these claims won’t work. Only an appeal will remove the edit logic that was installed for the beneficiary and date of service of the wrong surgery based on the initial claim.
Monday, January 5th, 2009
The U.S. Food and Drug Administration (FDA) has approved Vasovist® (gadofosveset trisodium), a new injectable contrast imaging agent for use in patients undergoing magnetic resonance angiography (MRA).
Monday, December 29th, 2008
The 2009 Medicare Physician Fee Schedule (MPFS) final rule, published Nov. 19, 2008, produced a number of policy changes for health care professionals. Included in these changes is the payment amount for HCPCS Level II code Q3014 Telehealth originating site facility fee.
Tuesday, November 18th, 2008
A federal district court last month found Medicare and some of its contractors had unlawfully limited payments for DuoNeb, an inhalation drug used to treat chronic obstructive pulmonary disease, according to The New York Times. Read more »
Tuesday, November 18th, 2008
Hospitals can add to their list of covered services new HCPCS Level II code C9899, Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage, that will be effective for services furnished on or after Jan. 1, 2009. Use form TOB-12X for claims of this nature.
This code was missing from an earlier Centers for Medicare & Medicaid Services (CMS) transmittal. Transmittal 1628, issued Nov. 3, rescinds transmittal 1597, issued Sept. 12. Read more »
Monday, November 3rd, 2008
The Centers for Medicare & Medicaid Services (CMS) may have posted HCPCS Level II Halloween day, but there is little terrifying in the more than 400 additions, deletions, changes, and administrative adjustments.
The file, which will most assuredly be updated by year’s end and is slated to be altered quarterly through next year, included 160 new, 187 changed, and 77 deleted codes and modifiers. A number of codes received administrative changes or were re-used codes with new descriptions.
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