Medicare CPT Codes Reimbursement | Medicare coding book



AARP MedicareRx Plans United Healthcare (PDF download)



united healthcare medigap (PDF download)


Medicare CPT Codes Reimbursement (pdf download)

Medicare Immunization Billing – Centers for Medicare & Medicaid …
Medicare will recognize Current Procedural Terminology (CPT) code 90653 for
dates … Since Medicare reimbursement rates change periodically, you can stay.

Frequently Asked Questions about Transitional Care Management
A2: There are two CPT codes that may be used to report TCM, effective January 1
… For code 99496 performed in a non-facility setting, the Medicare payment.

frequently-asked questions about billing Medicare for transitional care
Jan 1, 2013 … Effective January 1, 2013, Medicare pays for two CPT codes (99495 and … This
policy is discussed in the CY 2013 Physician Fee Schedule …

http://www.healthcare.philips.com/pwc_hc/main/homehealth/reimbursement/downloads/CPT_Coding_Helpful_Hints.pdf
(CPT) Coding – Philips Healthcare
reimbursement, inclusion of a specific code and fee schedule amount do not
guarantee payment. … CPT/Level 1 HCPCS codes under the Medicare Physician
.

http://www.asha.org/uploadedFiles/2013-Medicare-Fee-Schedule-SLP.pdf
2013 Medicare Fee Schedule for Speech-Language Pathologists
Jan 1, 2013 … analysis of the 2013 Medicare Physician Fee Schedule, including …. National
Medicare Part B Rates for Other CPT Codes of Interest to SLPs .

http://www.acro.org/washington/rvu.pdf
Introduction to Relative Value Units and How Medicare …
Medicare Reimbursement in Calculated. Medicare pays physicians for services
based on submission of a claim using one or more specific. CPT® codes.

http://www.tearlab.com/pdfs/Reimbursement/950035_REV_A_-_FAQ.pdf
FAQ Coverage and Reimbursement Information for CPT Code …
What is CPT Code 83861? 83861 … What fee schedule is 83861 paid from?
83861 is paid from the Medicare Clinical Laboratory Fee Schedule (CLFS), not
the …

http://oig.hhs.gov/oei/reports/oei-09-02-00030.pdf
Consultations in Medicare: Coding and Reimbursement – Office of …
Carriers Manual, Medicare allows reimbursement for consultations if … In its
comments to our draft report, CMS noted that the CPT codes for follow-up
inpatient …

https://www.acog.org/~/media/Departments/Coding/2013MedicarePreventiveServices.pdf
Medicare Screening Services 2013 – ACOG
Additionally, Medicare will continue to reimburse for certain screening services ….
A preventive medicine exam, as described by CPT-4 codes 99384 – 99397, …

http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20Management/PM%20Resource%20Guide/Ch-6-Coding-and-Billing-Basics-final.pdf
Ch 6 Coding and Billing Basics final – The American Academy of …
CPT does not determine the reimbursement for services. …. establishes the CPT
codes and the Medicare relative values assigned to those codes for the next.

http://stdtac.org/files/2013/08/CPT-CODE.Medicare.reimbursement.rates_.2013.pdf
CPT Code Medicare Reimbursement Rates – STD TAC
CPT CODE. NAT’L MEDICARE REIMBURSEMENT RATE. 99201. $43.89. 99202
. $74.51. 99203. $108.19. 99204. $164.67. 99205. $203.80. 99211. $20.41.

https://www.cookmedical.com/documents/10180/62938/ESC-WM-50099-EN-201305.pdf/4dafc118-c845-4739-a995-7772f9b7bc2d
2013 GI Endoscopy Coding and Reimbursement … – Cook Medical
sources that may include, but are not limited to, the CPT®, ICD-9, and MS-DRG
coding systems; Medicare payment systems; commercially available coding …

http://www.integration.samhsa.gov/Reimbursement_of_Mental_Health_Services_in_Primary_Care_Settings.pdf
Reimbursement of Mental Health Services in Primary Care Settings
Table 4.3: Types of E/M CPT Codes to Be Used with an ICD-9-CM. Diagnosis …
Table 4.4: Medicare & Medicaid Payment for Mental Health Services . . . . . . . 28 …

http://minneanalytics.org/files/Rich_Henriksen.pdf
Healthcare Coding, Billing & Reimbursement Overview – Minnesota …
CPT and HCPCS Level II codes determine reimbursement. ▫ most payors … Most
health plans follow Medicare coding and billing guidelines. □ Many health …

http://www.asipp.org/2014%20Final%20Rule%20Links/documents/FactSheeton2014Cuts.pdf
fact sheet – American Society Of Interventional Pain Physicians
Nov 27, 2013 … CMS posted the CY2014 final rules for physician payments, hospital …. continue
to reimburse under Medicare with CPT code 63650 and …

http://www.hologic.com/data/Reimbursement%20PDFs/MISC-00829HysteroscopicGynecologicalSurgery_36CF3607r3.pdf
Misc-00829 Hysteroscopic Gynecological Surgery 36cf – Hologic
Payment for a given procedure in a given locality is available in the Medicare …
This guide is not an affirmative instruction as to which CPT®/HCPCS codes and …

http://www.dexcom.com/sites/dexcom.com/files/reimbursement/files/reimbursement-codes.pdf
2013 Continuous Glucose Monitoring (CGM) Coding … – Dexcom
What type of healthcare provider/physician can bill CPT codes 95250 and 95251
… What is the difference between the Medicare physician fee schedule and the …

http://www.icadmed.com/support/reimbursement/documents/ReimbursementGuideRev_D_withcover_FINAL2_7_11.pdf
Reimbursement Guide – iCAD
Reimbursement rates shown are Medicare national … Procedures are reported
using Current Procedural Terminology (CPT) codes or Healthcare Common.

http://www.morganlewis.com/documents/erh/ERH_MedicareReimbursementForDrugsAndDevices_ELSCDeskbook.pdf
Medicare Reimbursement for Drugs and Devices – Morgan, Lewis …
HCPCS codes are codes developed by CMS to supplement AMA’s CPT codes.
These codes … additional Medicare reimbursement for that procedure. B. Special
 …

http://www.americanheadachesociety.org/assets/1/7/Headache_Coding_Corner_-_Part_5.pdf
CPT Coding and Resourc – American Headache Society
Part 5 – CPT Coding and Resource Based Value System (RBRVS): A Review of
… Medicare fee schedule for physician services based upon RBRVS.

Medicare CPT Code Prices | Medicare coding book



AARP MedicareRx Plans United Healthcare (PDF download)



united healthcare medigap (PDF download)


Medicare CPT Code Prices (pdf download)

Medicare Payment of Telemedicine and Telehealth Services
appropriate CPT procedure code for covered professional telehealth services …
differential for code Q3014 and it is not priced off of the Medicare Physician.

2014 Medicare Fee Schedule for Speech-Language Pathologists
Dec 27, 2013 … New CPT Codes for Speech-Language Evaluations . …. 11. Table 3. National
Medicare Part B Rates for Other CPT Codes of Interest to SLPs .

2013 Medicare Fee Schedule – American Speech-Language …
Nov 1, 2012 … National Medicare Part B Rates for Audiology Services (Updated ….. The value of
each CPT code is calculated by separating the cost of …

http://www.acro.org/washington/rvu.pdf
Introduction to Relative Value Units and How Medicare …
Medicare pays physicians for services based on submission of a claim using …
Each CPT® code has a Relative Value Unit (RVU) assigned to it which, when …
Practice Expense RVU – This component addresses the costs of maintaining a …

http://www.acr.org/~/media/ACR/Documents/PDF/Economics/Medicare/MPFS%20Final%20Rule%202014%20Summary
2014 Medicare Physician Fee Schedule Final Rule Summary of …
Nov 27, 2013 … CMS did not propose any new multiple procedure payment reduction ….. priced G
-codes and using the existing CPT code for PFS payment of …

http://www.acr.org/~/media/ACR/Documents/PDF/Membership/RFS/Journal%20Club/Radiology%20Management.pdf
Pricing Radiology Bundled CPT Codes Accurately – American …
dural Terminology (CPT)* coding and reimbursement as a result of the Centers
for Medicare and Medicaid Services’. (CMS) efforts to identify misvalued codes.

http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20Management/PM%20Resource%20Guide/Ch-6-Coding-and-Billing-Basics-final.pdf
Ch 6 Coding and Billing Basics final – The American Academy of …
Medicare, or it may be based on the cost of doing business for the practice. …
Procedure Coding System (HCPCS), which was created by the AMA, and the …

http://www.ngsmedicare.com/ngs/wcm/connect/84db4d2c-1be0-4fa8-a3aa-a73b66da7898/MMR_February_2014-02_Final.pdf?MOD=AJPERES&CACHEID=84db4d2c-1be0-4fa8-a3aa-a73b66da7898
Medicare Monthly Review (MMR) February 2014-02 – National …
Feb 2, 2014 … April 2014 Quarterly Average Sales Price Medicare Part B Drug Pricing Files and
… Procedure Coding System Code Jurisdiction List (MM8565).

https://www.acog.org/~/media/Departments/Coding/2013MedicarePreventiveServices.pdf
Medicare Screening Services 2013 – ACOG
This service is reported using HCPCS code Q0091 (Screening papanicolaou
smear; obtaining, … A screening pelvic examination (HCPCS code G0101)
should include …… preventative, and screening services are provided, no cost
sharing is …

http://www.carefusion.com/pdf/Interventional_Specialties/pleurx-reimbursement-IS1317-03.pdf
2013 coding and payment information – CareFusion
Reimbursement rates shown are Medicare national payments for … Diagnosis
codes indicate the reason or reasons a procedure was performed. Procedures
are …

http://www3.gehealthcare.com/en/Products/~/media/Downloads/us/Product/Reimbursement/Customer-Advisories/GEHealthcare-Customer-Advisory_Position-Emission-Tomography-PET-Reimbursement-Info-2013.pdf
Reimbursement Information for Positron Emission … – GE Healthcare
The following provides 2013 national Medicare physician fee schedule (MPFS)
and facility payment rates for example CPT codes that may be used. Payment …

http://www.americanheadachesociety.org/assets/1/7/Headache_Coding_Corner_-_Part_6.pdf
AHS’s Headache Coding Corner – A user-friendly guide to CPT and …
Part 6 – Coding Communication: Non-Face-To-Face New CPT Codes for
Telephone. Services … However, Medicare has assigned RVU’s and pricing for
the.

http://www.poc.roche.com/en_US/pdf/44156_Coag2009Handbook_FINAL_APPROVED.pdf
2009 Medicare Reimbursement Handbook for … – Point of Care
Reimbursement Pricing. How does Medicare pay for PT/INR tests performed in a
physician’s office? 10. Chart: Fees for Prothrombin Time Test, CPT Code 85610.

http://www.uth.edu/dotAsset/1f8ac0da-6fa7-423c-8c0e-cf7cb490a285.pdf
Global Surgery Fact Sheet
packages apply to procedure codes with global surgery indicators of 000, 010,
090, … post-operative period). • Codes with “YYY” are contractor-priced codes,.

http://www.facs.org/ahp/pqrs/2014/2014medicare-fee-sched.pdf
2014 Medicare Physician Fee Schedule (MPFS) Final Rule
Jan 27, 2014 … F. Geographic Practice Cost Indices (GPCIs). G. Allowed Expenditures …
Healthcare Common Procedure Coding System. HHS. [Department of] …

http://www.asge.org/assets/0/71312/82124/cf7b0d5c-0abe-482b-bace-44e8a06bf1a1.pdf
2013 Coding Update – American Society for Gastrointestinal …
New CPT and HCPCS codes for reporting preparation of fecal …. for the
treatment of a beneficiary as Medicare is not authorized to pay for any costs not
directly …

http://www.nestle-nutrition.com/nirf/cm2/upload/34032791-C22A-42F6-9A91-E7AE8A405B56/Informational_Primer_Medicare_Coverage_of_Enteral_Therapy.pdf
Medicare Coverage of Enteral Nutrition Therapy – Nestle-Nutrition.com
(DRGs and payment rates are accessible via a variety of government and private
….. Medicare Pricing, Data Analysis and Coding (PDAC) HCPCS Review: …

http://www.paml.com/Files/BillingHandbook/Billing_Guide_PAML.pdf
2013 Billing Guide – PAML
If the alpha-numeric “ICD-9” code is not known, a narrative diagnosis (full
description … reason(s) specified for possible denial and estimated cost of test(s)
with …

http://www.bcbsnc.com/assets/services/public/pdfs/bluemedicare/prior_approval/cpt_codes.pdf
Codes that require Prior Approval for Blue Medicare HMO
Jan 1, 2014 … The DME is a rental item, including rent to purchase OR … Note: Unlisted or
miscellaneous CPT/HCPCS codes should only be used if a more …

http://www.clslaboratory.com/Files/BillingHandbook/Billing_Guide_CLS.pdf
2013 Billing Guide – CLS
Apr 1, 2013 … form of ICD-9 codes, narrative diagnoses or symptoms. … reason(s) specified for
possible denial and estimated cost of test(s) with the patient …

California Doctors Among Those Charging Medicare the Most for …

California Doctors Among Those Charging Medicare the Most for Office Visits


Caption will go here. (John Moore/Getty Images)

More complicated office visits are billed at a higher reimbursement level and can cost patients more in higher copays. (John Moore/Getty Images)

By Lisa Aliferis, April Dembosky and Lisa Pickoff-White

When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor’s time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.

Most doctors’ billing patterns to the Medicare program fall in the middle ground between simple and complex.

In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine — and bill — a large proportion of their office visits as complex.

Now an analysis of Medicare billing data — which was made public for the first time last month — shows that three California doctors are among the top five nationally in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty.

  • In Orange County, Dr. Louis VanderMolen, a hematologist-oncologist, billed Medicare for 6,340 of these visits in 2012, the most of any doctor in the country and significantly more frequently than similar specialists nationwide. Almost 79 percent of his office visits were billed at the highest level, whereas other hematologist-oncologists only billed 12 percent of their office visits the same way.
  • In the Santa Cruz County community of Freedom nearly every one of cardiologist Jeffrey Mace‘s patients received – and was charged for – the highest complexity visit. Mace billed Medicare for these high level visits almost 10 times more often than other cardiologists in California, and the third most in the country.
  • Cardiologist Jay Schapira ranks fifth in the country for the number of times he billed the most complex type of visit to his office in Los Angeles. His average patient received four of these visits in a year, compared to the one visit typical of other cardiologists in the state.

“That’s unusual for a doctor who’s not seeing patients in the hospital,” said Lamar Blount, a Medicare billing expert with the Health Law Network consultancy in Atlanta. “Usually cardiac patients in the hospital are the ones that are about to die.”

KQED conducted this analysis in conjunction with ProPublica, which published its national investigation on Thursday.

These billing patterns raise questions for Medicare as a whole and for individual patients who pay a percentage copay. The higher level visits cost more. “Twenty percent of $200, for example, is obviously more than 20 percent of $100,” said Christina Melnykovych, president of Coding Continuum and an expert in insurance billing. “There’s a direct correlation between the service level billed and the paid amount, and thus the copay impacts the patient.”

All established patient office visits are coded under a category called “evaluation and management.” These visits are billed at one of five levels, with “5″ being the most complex. Established patients are people the provider has seen at least once before. First-time doctor appointments are coded differently.

The Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment for this story and in a statement said they have not seen the data analysis.

“Some providers have sicker patients, thus are more likely to bill at [evaluation and management] coding levels that carry higher payments. Every day we work with providers to make patient care the priority, and at the same time ensure they use [evaluation and management] codes that reflect the level of service provided,” the agency said. “It’s our assessment that it would be highly unusual for a provider to knowingly use the highest (level) code … for all or nearly all of his or her outpatient visits.”

Only one percent of California doctors billed Medicare at the highest level for all of their office visits for their established patients.

Coding experts stress that while the numbers cited for the doctors above do not by themselves indicate wrongdoing, they do raise eyebrows.

‘I’m Not An Average Cardiologist’

We tried to reach all of the doctors named in this report, with repeated phone calls plus faxes detailing our questions. Drs. VanderMolen and Schapira did not respond to our requests.

Dr. Mace sent us a written statement in which he vigorously defended his billing patterns. “I’m not an average cardiologist,” he wrote.I spend a great deal of time taking care of patients. I generally spend 12-16 hours per day in the practice of medicine. I do not take any lunch breaks. I am on call 24 hours a day, seven days a week and do not take vacations. By being available and devoting a great deal of resources to the patients, I hope that this comprehensive care translates to improved quality of life for my patients and hopefully, improved quantity of life (longevity).”

But billing for an individual visit is not about a physician’s dedication. Experts say it is about the patient’s complaint that day. “What was it about the patient’s clinical presentation and condition that warranted billing a level 5 service?” Melnykovych said.

In his statement, Mace said he had been “subject to several audits” over many years in regards to this level 5 billing code. He says that Medicare “has found all of the office visits reviewed to be correctly coded.”

While the established office visits are not based on time, per se, as a metric for coding, the American Medical Association assigns average time that would normally go along with different visit levels. For a level 5 visits, it’s 40 minutes, Melnykovych said.

If VanderMolen spent the average 40 minutes during all the 6,340 visits which he billed Medicare, that would mean he saw patients 16 hours a day — presuming he worked every weekday in 2012. Medicare paid VanderMolen nearly $750,000 for these level 5 visits in 2012. He was reimbursed another $1.6 million by Medicare for other services performed.

Overpayment can happen for many reasons, including simple error. “But that doesn’t preclude the federal government or any payer from coming to the (doctor) and getting their money back,” Melnykovych said.

Sometimes the excuse is legitimate. Blount said if a doctor is affiliated with a teaching hospital – Schapira is a professor at the school of medicine at UCLA – that could explain a higher volume of patients at higher level codes. In his statement, Mace said that he is “currently on staff at Stanford.” A spokesman for Stanford Hospital and Clinics said in an email to KQED that Mace is an “independent community cardiologist who has ‘courtesy admitting’ privileges at Stanford Hospital & Clinics. Dr. Mace is not on Stanford’s faculty.”

VanderMolen’s website says that he “has had several university, hospital, and other appointments.” It does not indicate any current affiliations with any academic medical centers. 

Problems can also arise from the billing set up at a doctor’s office. Many doctors don’t actually do their own billing, Blount says. They dictate their office notes from a visit or fill out a checklist, and then a clerk in the billing department enters a code.

“Many times a physician is not even aware of what their claims are or how their claims are coded,” Blount says.

He has also seen a rising trend in unintended coding errors that mirror the rise of the implementation of electronic medical record systems. Many of these systems include an automated coding function. A physician will type in medical observations and treatment protocols, and then an algorithm will determine the code.

“Those algorithms are subject to human error,” Blount says. “Some mistakes are being made by the electronic medical record vendors in how they designed the product that they’re selling.”

Regardless, according to Medicare rules the ultimate responsibility for billing always rests with the doctor.

Frequent visits

It’s not just the total number of visits that could raise red flags among auditors — repeat complex visits by individual patients could also be a cause for concern.

Dr. Gary Ordog is listed in Medicare’s billing database as an outpatient emergency medicine doctor in Newhall, a suburb of Los Angeles. Typically, this kind of physician sees patients at an outpatient urgent care center for any range of simple, non-urgent complaints, like sore throats, to more urgent matters, like a broken wrist.

According to KQED’s analysis, Ordog’s patients received – on average — 30 of the most complex office visits in 2012. The average for other emergency medicine doctors is 1 complex visit per patient.

“That’s a little suspect,” says Patrice Morin-Spatz, a medical coding expert and trainer.

This is not the first time questions have arisen around Ordog’s medical practices. In the mid-2000s, Ordog served numerous times as an expert medical witness in court cases arguing that mold in residential units and work environments made his patients severely ill.

The California Medical Board tried to revoke Ordog’s medical license in 2006 for “repeated negligent acts, incompetence, making false statements, and inadequate record keeping,” according to legal documents. He was put on probation and permitted to continue practicing medicine but prohibited from participating in any litigation. Ordog was found to have violated the terms of his probation by preparing reports for four patients in workers’ compensation claims. He signed a settlement agreement in September that extended his probation until March 2015.

Ordog did not respond to repeated requests for comment made via phone, fax, and to his attorney.

How We Did This

KQED partnered with ProPublica to analyze provider billing patterns for regular office visits for Medicare patients. ProPublica released its national report Thursday. We used data released in April by the Centers for Medicare and Medicaid Services showing the payments made to providers in Medicare’s Part B program in 2012.

KQED focused its analysis only on California providers who billed Medicare for at least 100 office visits for established patients in 2012.

We looked at the doctors who billed Medicare at the highest level (5) for the majority of their office visits. We also looked for other unusual patterns, including providers whose patients received an unusually high number of level 5 visits, or doctors who provided level 5 visits to an unusually high percentage of their patients.

Matt Levin and Brittany Patterson contributed to this report.

Related

3 Key Considerations for Medicare Advantage Investment Success

In April, CMS announced Medicare Advantage plans will see a 0.4 percent base payment increase in 2015.


However, the program still faces cuts ($156 billion from 2013 to 2022) under the Patient Protection and Affordable Care Act, and there’s general consensus in the industry that Medicare Advantage plans will actually experience an average revenue reduction of about 3 percent in 2015, according to Krista Bowers and William Eggbeer, both managing directors at healthcare strategy consulting firm BDC Advisors.

Still, Medicare Advantage is still a sound investment under optimal conditions, Ms. Bowers and Mr. Eggbeer wrote in a blog entry responding to the 2015 payment rates.  “In the right situations, Medicare Advantage will continue to provide health systems with a better strategic and economic model than traditional fee-for-service and/or the Medicare Shared Savings Program,” they wrote.

Medicare Advantage plans can still be successful if they consider the following three foundational requirements, according to Ms. Bowers and Mr. Eggbeer.

1. Geography. Medicare Advantage plan revenue varies significantly depending on geographic location. Therefore, Ms. Bowers and Mr. Eggbeer strongly recommend conducting county-level reviews for markets before taking on Medicare Advantage risk.

2. Revenue development. CMS star ratings and risk coding are the driving forces behind Medicare Advantage revenue development, according to BDC. After 2014, only plans with quality ratings of four or five stars will be eligible for quality bonus payments. Risk coding is used to calculate individual rates for Medicare Advantage members. Accurate coding can make a notable difference in terms of making or losing money, so ensuring physicians are coding correctly is crucial.

3. Care management costs. Successful Medicare Advantage plans must make sure a robust chronic condition management program is in place to address their members’ total cost of care, from preventive services to post-acute care. “Having a care model designed to manage the senior population, specifically, is a prerequisite,” Ms. Bowers and Mr. Eggbeer wrote. “We encourage a thorough capabilities review and adoption of a model that drives continual improvement when taking on Medicare Advantage risk.”

More Articles on Medicare Advantage:
6 Observations and Things to Know About CMS’ Final Medicare Advantage Payment Rates
5 Key Things to Know About Medicare Advantage Enrollment
CMS Proposes Medicare Advantage Cuts 

 


© Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

more breaking news from medicare regarding icd-10-cm transition

I provided education via a webinar on Wednesday, March 5 regarding the latest information on the ICD-10-CM transition. In Medlearn article SE1410 Medicare allowed the use of the General Equivalence Mappings (GEMs) for use just during the transition. I expressed my dismay that Medicare would allow the GEMs for actual coding plus stated my belief that the use of the GEMs would result in error and loss of case mix points.

Medicare has just revised SE1410 to now remove all references to the GEMs and the new grid is attached below.

This means that any episode that crosses over the October 1, 2014 implementation date will need to be coded in ICD-9-CM and ICD-10-CM based on the M0090 date of the OASIS, the ‘from’ date on the episode and the ‘through’ date on the episode. Actual coding processes must be used. This does increase the burden to agencies however it will result in fewer errors and rejections of claims. My real concern was that because the GEMs are not complete codes in some cases and include only 7th character A, the MAC systems would not accept the codes and/or HIPPS codes would be affected.

Do not forget that Selman-Holman & Associates, LLC and CoDR—Coding Done Right is standing by to assist you with your consulting, coding and education needs!!

214-550-1477

www.selmanholman.com

www.codingdoneright.com

MORE BREAKIING NEWS FROM MEDICARE REGARDING ICD

Condition Code 58 for Medicare | Credentialing for Medicare

Condition Code 58 for Medicare (pdf download)

Medicare Secondary Payer Billing & Adjustments – CGS
using Process A. If payment denied or applied to deductible, bill Medicare ….
Enter your provider number for the primary payer (if known), on line A. FL 58 …. If
WC, enter condition code ’02’ to indicate the condition is employment related.

Home Health Medicare Billing Codes Sheet – CGS
Other value codes may be required when Medicare is the secondary payer. See
the …. U538I Enter condition code 47 to indicate transfer between HHAs … 58.
Insured’s last name, first name. N. C5. 5. SEX. N/A. Insured’s sex code. N. C5. 5.

Medicare Secondary Payer (MSP) Billing – Cahaba GBA
Medicare secondary using Process B. If payment denied, bill. Medicare
conditionally …. INSURED NAME FL 58. Enter the Insured‟s …. If WC, enter
condition code „02‟ to indicate the condition is employment related. 1. OCC CDS
/DATE FL …

http://www.dpw.state.pa.us/cs/groups/webcontent/documents/manual/s_001889.pdf
UB-04 Billing Guide for PROMISe™ Intermediate Care Facilities for …
Jun 17, 2013 … days are Medicare Coinsurance Days and there were 30 days in the service
period; enter 30 with the … Form Locators 18 – 28 (Condition Codes) – Enter X2.
….. provider number. Do not use slashes, hyphens, or spaces. 58.

http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/ub04_instructions.pdf
UB-04 Claim Form Instructions
Enter the four digit code that identifies the specific type of bill and … 1 = Inpatient (
Including Medicare Part A) …. occurrences to identify conditions that may affect ….
Medicaid” payer information is entered in locator. 50. 58. Insured’s Name.

https://www.bluecrossma.com/staticcontent/npi_docs/UB_04FormLocatorAppendices.pdf
UB-04 Form Locator Appendices
Required for claims related to one of the following conditions: …. 58. Terminated
Medicare Advantage enrollee whose three day hospital stay was waived. 59 …. **
For Medicare, use this code only for reporting Part B co-insurance amounts.

http://www.hrsa.gov/ruralhealth/policy/confcall/rhccallarchive/rhcclaims5010.pdf
RHC claims issues and 5010 requirements – HRSA
claims can be sent directly to the Medicare payer. ✓ Many Practice … FL 18 – 28
= condition codes – rarely used … FL 58 – FL 62 = Required = Patient Insurance.

http://www.the-aaa.org/meetings_education/condition_codes/AAA%20Condition%20Code%20Audio%20Conference%20Slides.pdf
Condition Code Implementation
Intent of Condition Codes was that this one … No Longer Applicable to Medicare
… Condition Codes have been cross walked to “best fit” ICD9. Code ….. Page 58
 …

https://www.zolldata.com/uploadedFiles/ZOLL_Data_Management/Products/ImplementingConditionCodesinRescueNetBilling.pdf
Implementing Condition Codes in RescueNet Billing – Zoll
CMS released the medical conditions list on December 23, 2005 in Pub 100-04.
… these codes as defined in the CMS Medical Conditions List, as the ICD9 code.

http://www.valueoptions.com/providers/Forms/Administrative/Tips_for_Completing_the_UB04.pdf
Tips for Completing the UB04 (CMS-1450) Claim Form – ValueOptions
Mar 25, 2013 … Tips for Completing the UB04 (CMS-1450) Claim Form …. Conditional The
occurrence code and the … 58a, b, c Insured’s Name (last, first name …

http://www.ama-assn.org/resources/doc/cpt/icd9cm_coding_guidelines_08-09_sm.pdf
2009 ICD-9-CM – American Medical Association
The Centers for Medicare and Medicaid Services (CMS) …. H. ICD-9-CM code for
the diagnosis, condition, …… code V58.0, Encounter for radiation therapy,.

http://www.ngsmedicare.com/ngs/wcm/connect/6651c4804b71f3f6907c9dcada937a59/MMR+June+2012+BulletinFinal.pdf?MOD=AJPERES&CACHEID=6651c4804b71f3f6907c9dcada937a59
Medicare Monthly Review June 2012-06 Bulletin – National …
Jun 1, 2012 … Clarification on Submitting Claims When Condition Code 44 Criteria Have …
Clarification of Medicare Conditional Payment Policy and Billing Procedures for
… Level of Care. Certifications and Recertifications (MM7701). 58. S …

http://housedocs.house.gov/energycommerce/ppacacon.pdf
Compilation of Patient Protection and Affordable Care Act – House of …
Jun 9, 2010 … United States Code section numbers … a preexisting condition . ….. change and
State Medicaid, CHIP, and health subsidy programs ……….. 133.

http://www.sgo.org/wp-content/uploads/2012/09/Medicare-Global-Surgery-Modifiers.pdf
Medicare Global Surgery Modifiers – SGO
Append modifier 22 to the CPT code for the procedure performed. … technical
difficulty, severity of the patient’s condition, or physical … ICD-9-CM V58.1 may be
.

http://www.ime.state.ia.us/docs/UB04_BillingInstructions.pdf
Iowa Medicaid Enterprise UB-04 Claim Form Health Insurance …
or conditional of the individual recipient’s situation. … reported using value codes
in fields 39a-41d. … OPTIONAL Enter the zip code for the patient’s address. 9e …..
58. Insured’s name. REQUIRED. Enter the last name, first name, and middle.

http://www.utsystem.edu/compliance/SWCAcademy%20presentations/Materials/2013-03-27%20Medical%20Necessity%20and%20Short%20Stays.pdf
Surviving the Ongoing Focus on Medical Necessity and Short Stays
Mar 27, 2013 … The Medicare Administrative Contractors (MAC) via pre- pay reviews ….. When
Condition Code 44 is appropriately used, the hospital reports on.

http://www.aao.org/aaoe/coding/upload/covered-dx-for-eye-codes.pdf
Typical covered diagnosis codes
All Medicare LCDs for Eye codes contain a list of covered di- … conditions
classified elsewhere and ….. primary diagnosis code and V58.69 long-term cur-.

https://www.medicaid.state.ar.us/Download/provider/training/Billing101.pdf
Billing for 2013 – Arkansas Medicaid
Medicare and TRICARE) and recovers public health plan expenditures when
third-party ….. Plan Description 58, 78, 88. • Beneficiaries are not ….. Condition
Codes. *Inpatient paper claims must not use new condition codes 80, 81, or 82.

http://www.hscsn-net.org/training/CMS%201500_508.pdf
Completing a CMS 1500 Form – hscsn
In the office situation, all information required to complete the CMS form is found:
…. carriers use this box for approved condition codes that may be found on the.

http://manuals.momed.com/collections/collection_gen/General_Section01.pdf
General Section 1 – Participant Conditions of Participation
Section 1 – Client Conditions of Participation …. IDENTIFICATION OF P
ARTICIPANTS BY ELIGIBILITY CODES ………………………….. … Medicare Part A,
Part B and Part C .. ….. ME CODE. DESCRIPTION. 58. Pregnant women who
qualify under the.

Target Coding Novitas Medicare for Chiropractic