Intra-operative Nerve Monitoring Coding Guide. March 1, 2011

Size: px
Start display at page:

Download "Intra-operative Nerve Monitoring Coding Guide. March 1, 2011"

Transcription

1 Intra-operative Nerve Monitoring Coding Guide March 1, 2011 Please direct any questions to: Patty Telgener, RN Vice President, Reimbursement Services Emerson Consultants (303) (office) (303) (cell) KB 3/11

2 TO OUR PARTNERS IN HEALTH CARE This document provides general reimbursement information provided to assist in obtaining coverage and reimbursement for healthcare services. These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. All products should be used according to their labeling. Current Procedural Terminology (CPT) is copyright 2010 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a trademark of the American Medical Association. KB3/11 2

3 Overview Intra-operative testing and monitoring of nerves is performed during otolaryngology, neurosurgical, orthopedic, and other procedures in which nerves can be at risk. Cranial nerve monitoring, such as facial nerve monitoring, can be used with primary procedures that include posterior fossa surgery for tumor removal, excision of acoustic neuroma, parotidectomy, and middle ear surgery. Laryngeal nerve monitoring in this context is generally related to thyroidectomy, parathyroidectomy and anterior cervical spine procedures. Peripheral nerve monitoring can be used with primary procedures that may include neuroplasty of the hand or foot, neuroplasty of major peripheral nerves of the arm or leg, nerve decompression, and excision of neuromas of hand, foot and major peripheral nerves. Testing associated nerves intra-operatively during surgical procedures can help prevent damage to nerves and other structures and can alert the surgeon of impending complications. Intra-operative nerve monitoring can be used to properly distinguish nerves, such as those embedded in tumor or scar tissue, that can be difficult to locate. It can identify signs that a nerve is becoming damaged from stretching or ischemia by monitoring abnormal discharges. Intra-operative nerve monitoring can also help differentiate between viable and nonviable portions of nerves. Documentation The medical necessity for nerve monitoring for each individual patient should be documented. It is helpful to include this information in the operative report itself. The operative report should clearly document the specific use of nerve monitoring, including the clinical information provided by the monitoring and how it helped with the surgical dissection. As appropriate, the operative report should document that the nerve monitoring was performed throughout the surgical procedure. The start and end times for nerve monitoring should be explicitly documented. Diagnosis Coding The diagnosis codes assigned generally reflect the reason for the primary procedure, rather than the associated nerve monitoring. Some Medicare contractors and commercial payers may have medical policies defining the ICD-9-CM codes for the primary diagnoses for which they feel nerve monitoring is medically necessary. Nerve monitoring performed and billed with other diagnosis codes will be denied. Providers should review Medicare Local Coverage Decisions for nerve monitoring to see if the ICD-9-CM diagnosis codes being used are listed as covered. Providers should also contact commercial payers for their coverage policies. Physician Coding and Reimbursement The following codes for electromyography testing, together with code 95920, may be appropriate to report intra-operative nerve monitoring. Payment shown is the Medicare national average under the RBRVS physician prospective payment system and does not include geographical variations. Because the primary procedure typically takes place in a facility, eg. a hospital, the RVUs and physician payment for nerve monitoring are shown for the facility setting only. All of the nerve monitoring codes below are designated as diagnostic tests by CMS so they have both a professional component, ie. interpreting the results, and a technical component, ie. using equipment to perform the test. Modifier 26 is appended to the codes to indicate that facility equipment was used so the physician is being reimbursed for the professional service only. Please see Coverage Rules, Medicare, Monitoring by the Operating Physician section on page 7. Intra-operative Neurophysiology Testing The key element in coding intra-operative nerve monitoring is code This code describes ongoing electrophysiology testing and monitoring performed during surgical procedures. KB3/11 3

4 Code is an add-on code and can never be reported by itself. It must always be used together with another code for the specific type of baseline nerve testing, such as EMG testing hour 3.14 $107 Instructions in the CPT manual specifically define the additional codes with which can be reported. These include EMG codes 95860, 95861, 95867, 95868, and 95870, as described below. Technically, code may not be reported with other EMG codes. Notes: Code is defined ʻper hourʼ. Time spent interpreting accompanying baseline EMG tests does not count toward the time for 95920; only the additional time spent for nerve monitoring is counted. Monitoring must last at least 31 minutes for code to be reported. Code is not reported when monitoring lasts less than 30 minutes. For longer monitoring, portions of an hour are counted only when nerve monitoring lasts over 30 minutes. For example, 3 hours 15 minutes of intra-operative nerve monitoring is reported as three units of 95920, and 3 hours 45 minutes of nerve monitoring is reported as four units of Code is used just once per hour even if multiple studies are performed. Cranial Nerve Monitoring e.g. Facial and Laryngeal Nerve Cranial nerve monitoring uses codes or for EMG of cranial nerve supplied muscles plus for intra-operative neurophysiology testing. Note that laryngeal nerve monitoring uses the same codes as all other cranial nerve monitoring because the recurrent laryngeal nerve is a branch of the vagus nerve, the 10 th cranial nerve. For nerve monitoring, these baseline EMG codes are reported together with code Cranial Nerve Monitoring e.g. Facial and Laryngeal Nerves, Unilateral Procedure Needle electromyography, cranial nerve supplied muscle(s), unilateral 1.20 $ hour 3.14 $107 Cranial Nerve Monitoring e.g. Facial and Laryngeal Nerves, Bilateral Procedure Needle electromyography, cranial nerve supplied muscle(s), bilateral 1.77 $ hour 3.14 $107 Notes: KB3/11 4

5 Code is used for EMG of one or more muscles supplied by a cranial nerve on one side of the body. Code is used for EMG of one or more muscles supplied by cranial nerves on both sides of the body. Code for unilateral and for bilateral cannot be reported together. Intra-operative Nerve Monitoring during Procedures on the Larynx Needle EMG of the larynx is performed to diagnose laryngeal nerve and muscle disorders, and for intraoperative monitoring during procedures performed on the larynx. Technically, this code cannot be paired with Instructions in the CPT manual list the specific EMG codes with which may be reported. Code is not included in this list. It should be noted that the list of associated codes for was last updated with CPT 2005 and code was new for CPT Notes: Needle electromyography, larynx 2.39 $81 Code is inherently bilateral. Intra-operative Nerve Monitoring with EMG Endotracheal Tube Code is commonly reported for laryngeal nerve monitoring via an EMG endotracheal tube. Technically, however, this code cannot be paired with unless a base code for another test can be paired with CPT 95867or plus are appropriate for laryngeal nerve monitoring via an EMG tube. Use of an EMG tube to monitor the vagus and recurrent laryngeal nerve does not alter the use of these codes. Peripheral Nerve Monitoring For nerve monitoring, each of these baseline EMG codes is reported together with code Nerve Monitoring for One Extremity Needle electromyography; one extremity with or without related paraspinal areas 1.46 $ hour 3.14 $107 Nerve Monitoring for Two Extremities KB3/11 5

6 Needle electromyography; two extremities with or without related paraspinal areas 2.33 $ hour 3.14 $107 Other Peripheral Nerve Monitoring Needle electromyography; limited study of muscles in one extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters 0.55 $ hour 3.14 $107 Notes: Codes and can be reported only once per patient. Codes and require evaluation of extremity muscles innervated by three nerves, with a minimum of five muscles studied per limb. 1 Code is reported for a limited study of one extremity (one arm or one leg) that does not meet the criteria for to Code is also used for study of a non-limb muscle, such as intercostal or abdominal wall, or for cervical or lumbar paraspinal muscles when the muscles of the corresponding limb are not also being tested. Other Peripheral EMG Technically, these codes cannot be paired with As noted, instructions in the CPT manual list the specific EMG codes with which may be reported. The codes below are not included on the list Needle electromyography; three extremities with or without related paraspinal areas 2.80 $ Needle electromyography; four extremities with or without related paraspinal areas 2.99 $ Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied 4.20 $143 Notes: Codes and can be reported only once per patient. Codes and require evaluation of extremity muscles innervated by three nerves, with a minimum of five muscles studied per limb. 1 Both audio and visual readings are required to assign codes 95863, and Federal Register, October 31, 1997, p KB3/11 6

7 Additional Notes All of the EMG codes are designated as diagnostic tests by CMS. To be eligible for Medicare coverage, diagnostic tests are subject to specific requirements for physician supervision. The requirements do not apply when the tests are furnished to hospital inpatients. However, they do apply when the tests are furnished to hospital outpatients. CMS provides a code-by-code listing which indicates the exact level of physician supervision required for each diagnostic test. This list is incorporated into the Medicare Physician Fee Schedule Relative Value File and is updated quarterly. For January 2011, the EMG codes and are listed with value 09, defined as "concept does not apply", specifically when they are submitted with modifier -26. Coverage Rules Medicare Monitoring by the Operating Physician The operating surgeon should not report any of the nerve monitoring codes separately. Medicare does not pay separately for nerve monitoring when performed by the same surgeon who performed the primary procedure. Specifically, many Medicare coverage policies for CPT code states 2 : This test must be requested by the operating surgeon and the monitoring must be performed by a physician, other than: - the operating surgeon; - the technical/surgical assistant; or - the anesthesiologist rendering the anesthesia Specifically with regard to code for intraoperative neurophysiology testing, some Medicare policies also go on to state 3 : "Due to the potential risk for morbidity with many surgeries and the need for explicit and focused attention to both the monitoring and the procedure, Medicare does not expect to see operating surgeons submitting claims for this code." Beyond this, NCCI policy states 4 : Intraoperative neurophysiology testing (CPT code 95920) should not be reported by the physician performing an operative procedure since it is included in the global package. The physician performing an operative procedure should not bill other neurophysiology testing codes for intraoperative neurophysiology testing (e.g., 92585, 95822, 95860, 95861, 95867, 95868, 95870, 95900, 95904, ) since they are also included in the global package. However, when performed by a different physician during the procedure, intraoperative neurophysiology testing is separately reportable by the second physician. Consultants have also advised that the EMG codes and were created and assigned RVUs on the basis of being performed by a physician other than the operating surgeon. Therefore, our best understanding of this issue is that the operating surgeon should not report the EMG codes and Additional information on this topic is available by contacting the local Medicare contractor, the AMA, and the AAO-HNSF. Monitoring by another Physician As noted, the National Correct Coding Policy on intra-operative neurophysiology testing code states that when performed by a different physician during the procedure, intraoperative neurophysiology testing is separately reportable by the second physician. 2 Example, Highmark Medicare Services, Local Coverage Determination L27469, Intraoperative Neurophysiologic Testing, revision date 9/9/ Example, Cigna Government Services, Local Coverage Determination L24058, Intraoperative Neurophysiologic Testing, review date 2/3/ Source: National Correct Coding Policy Manual, version 16.3, Chapter 8, section C, no.22; see also Chapter 11, section L, no.5. KB3/11 7

8 Therefore, a second physician such as a neurologist or neurophysiologist who performs these services during a procedure may report codes 95865, 95867, and 95920, for them and be reimbursed for them. Special rules apply when the second physician is in a group practice with the operating surgeon. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. However, physicians in the same group practice who are in different specialties may bill and be paid separately. 5 Therefore, a second physician in the same group but a different specialty from the operating surgeon may bill separately for intra-operative monitoring, but a second physician in the same group and same specialty may not. Physician Billing for Monitoring by Others Physicians may not bill for services performed by others in a facility, even if they are supervised by the physician. This means that a physician cannot bill for monitoring performed by an OR technician, nurse, physical therapist or any other professional employed by the hospital, regardless of the degree of physician supervision. Moreover, a physician cannot bill for monitoring performed by others in a facility even if they are employees of the physician, such as a Physician Assistant or Advanced Registered Nurse Practitioner. The services of these professionals may not be billed under the physicianʼs ID number. This is because there is no incident to billing in the facility setting for any service. 6 If the physician employs the professional who performs the monitoring or if the physician provides the equipment used, the physician may however be able to look to the hospital for additional reimbursement under a separate arrangement. Separate Billing by Non-Physicians An independent Physician Assistant, neurophysiologist, audiologist 7, nurse practitioner or other electrophysiology-certified provider working within the scope of his or her license who personally performs nerve monitoring can bill under his or her own Medicare provider number. 8 Remote Monitoring Typically, the monitoring physician is present in the operating room where the procedure is being performed. However, this is not always required. Some Medicare contractors allow remote monitoring, for example by digital transmission or video, as long as certain conditions are met. 9 Generally, the physician performing the service remotely must be monitoring in real-time and must be solely dedicated to performing this service. The physician monitoring remotely must also have the capacity for continuous or immediate contact with the operating surgeon. Alternately, a trained technician must be in continuous attendance in the operating room with the capacity for real-time communication with the remotely monitoring physician. Some contractors allow simultaneous monitoring of more than one patient. However, only the time devoted to each individual patient is counted. The time may be cumulative though it need not be continuous. Physicians should contact Medicare contractors and commercial payers for specific guidance on remote monitoring policies and requirements. Commercial Payers 5 Medicare Claims Processing Manual, Chapter 12, section Medicare Benefit Policy Manual, Chapter 15, section 60.1.B 7 American Academy of Audiology, Scope of Practice 8 Medicare Benefit Policy Manual, Chapter 15, section 60.2 and section 80; see also sections 190, 200, and Examples: Trailblazer Health Enterprises, Local Coverage Determination L26800, Intraoperative Neurophysiologic Monitoring, revision date 10/18/2010; Cigna Government Services, Local Coverage Determination L24058, Intraoperative Neurophysiologic Testing, review date 2/3/2010; WPSIC, Local Coverage Determination L10944, Intraoperative Neurophysiologic Testing, revision date 12/1/2010 KB3/11 8

9 Many commercial payers follow Medicare policies, guidelines and edits. However, some commercial payers may have different interpretations and practices. Physicians should contact local payers to verify coverage, appropriate coding, and payment. KB3/11 9

10 Facility Coding and Reimbursement Facility, coding and reimbursement depend on the setting, e.g. In-patient or outpatient, and the type of facility such as hospital or Ambulatory Surgery Center. Also note that facilities do not append TC to the CPT codes. It is understood that the facility is billing for the technical component. Hospital Outpatient Hospitals use CPT codes to report outpatient services. Payment shown is the Medicare national average under the APC hospital outpatient prospective payment system and does not include geographical variations. The Status Indicator shows how each code is handled for payment purposes. Cranial and Peripheral Nerve Monitoring Used With CPT Description APC Notes: Needle electromyography; one extremity with or without related paraspinal areas Needle electromyography; two extremities with or without related paraspinal areas Needle electromyography, cranial nerve supplied muscle(s), unilateral Needle electromyography, cranial nerve supplied muscle(s), bilateral Needle electromyography; limited study of muscles in one extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters APC Weight Status Indicator CY2011 Payment Level II Nerve and Level II Nerve and Level II Nerve and Level II Nerve and 0215 Level I Nerve and Muscle Tests S $45 hour N/A N/A N N/A Coding guidelines given for physicians apply to hospital outpatient services as well. NCCI edits bundle EMG codes and and nerve monitoring code with a variety of ENT primary procedures, including the parathyroidectomy and exploration procedures represented by and NCCI edits also bundle many of the other EMG codes and with a variety of peripheral nerve surgical procedures. Hospitals should review current NCCI edits when reporting these codes. The EMG codes are paid separately in addition to the payment for the primary surgical procedure. Status Indicator S indicates that payment is always made at 100% of the rate and is not reduced even when other separately payable services are also billed. The intra-operative nerve monitoring code 95920, however, is not paid separately. Status Indicator N indicates that payment for intra-operative nerve monitoring is ʻpackagedʼ and included with payment for the primary procedure, so no separate payment is made. Many commercial payers use Medicareʼs APC methodology or a similar type of fee schedule to reimburse hospitals for outpatient services. However, some payers may have different practices or policies. Hospitals should contact local payers regarding separate payment for code Other EMG (Not Used with 95920) CPT Description APC Needle electromyography; three extremities with or without related paraspinal areas APC Weight Status Indicator CY2011 Payment Level II Nerve and S $81 KB3/11 10

11 95864 Needle electromyography; four extremities with or without related paraspinal areas Muscle Tests Level II Nerve and Level II Nerve and Needle electromyography, larynx Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all Level II Nerve and sites of each muscle studied Hospital Inpatient Hospitals assign ICD-9-CM procedure codes for inpatient services. The ICD-9-CM codes then form the basis for the DRG system that Medicare uses to reimburse hospitals for inpatient stays. ICD-9-CM provides a specific code for intra-operative nerve monitoring: intra-operative neurophysiologic monitoring For Medicare, a single DRG is assigned for the entire hospital stay and the associated payment is designed to encompass all services rendered during the stay. So hospital payment for nerve monitoring is included as part of the overall surgical DRG payment. Some commercial payers also use DRGs to reimburse hospital inpatient services, or they may use a per diem or per case method. Under all of these methodologies, separate payment is not made for intraoperative nerve monitoring. Ambulatory Surgery Center Medicareʼs list of ʻASC Covered Surgical Procedures for CY 2011ʼ includes only primary surgical procedures. The payment to the ASC for the primary surgical procedure includes the nerve monitoring services. Nerve monitoring services have not been designated as ʻintegral to covered surgical proceduresʼ in the ASC setting as other ancillary services have. They are not separately payable to the facility. Payment by commercial payers may vary depending on the ASCʼs contract and the patientʼs benefits. ASCs should contact local payers to verify coverage, coding, and payment. KB3/11 11

12 Frequently Asked Questions (Note: Please refer to complete NIM coding guide for more details and references.) 1. Who can bill for intra-operative nerve monitoring? Under Medicare rules, the following providers can bill if they have a separate provider number from the operating surgeon: - A physician who is not performing the surgical procedure. - An audiologist trained and certified in electrophysiologic monitoring. - A physical therapist trained and certified in electrophysiologic monitoring. - A neurophysiologist, neurologist or physiatrist. For other payers, physicians should contact their provider relations representative. 2. If the operating surgeonʼs partner performs the nerve monitoring, can this be billed separately? In general, the operating surgeonʼs partner cannot bill for nerve monitoring separately. From the payer perspective, a physician and the physicianʼs partners are the same person. Since the operating surgeon cannot bill nerve monitoring separately, a partner cannot either. One common exception is when the operating surgeon and the partner are in different specialties, in which case some payers allow them to bill separately. (Medicare Claims Processing Manual, Chapter 12, 30.65) 3. Can an anesthesiologist bill for EMG tube placement? No. Under Medicare rules, anesthesiologists cannot separately code or bill the use of a scope or laryngoscope in placing an endotracheal tube. This is considered integral to the anesthesia service. (Source: NCCI Policy Manual, version 16.3, Chapter 2, section B, no. 4) 4. Can the hospital outpatient surgery department bill for intra-operative nerve monitoring? Under Medicare APCs, the hospital can bill for the technical component of the EMG codes such as CPT or CPT and receive separate payment. However, Medicare considers the intraoperative nerve monitoring code a ʻpackagedʼ service. The hospital can and should submit the code but payment for is included in the payment for the primary procedure, so no separate payment is made for code Hospital should contact commercial payers for separate payment information for Can an ASC bill for intra-operative nerve monitoring? For Medicare, the answer is no. The nerve monitoring services codes are not listed as approved codes for ASCs and are not separately payable to the facility. The payment to the ASC for the primary surgical procedure includes the nerve monitoring services. Payment by commercial payers may vary depending on the ASCʼs contract and the patientʼs benefits. ASCs should contact local payers to verify coverage, coding, and payment. 6. Can a company that provides intra-operative nerve monitoring get reimbursed for the monitoring in a hospital or ASC? A company that provides intra-operative nerve monitoring services that performs and bills for the nerve monitoring under its own Medicare provider number may be reimbursed. The payment ʻpackagingʼ and edit ʻbundlingʼ rules do not apply because the provider is billing completely independently of the physician or facility. 7. What monitoring codes are used during thyroid surgery? CPT code for bilateral cranial nerve monitoring is used because the EMG tube monitors the nerve bilaterally. However, if monitoring unilaterally CPT95867 can be used. The nerve being monitored is a branch of a cranial nerve. 8. When is code used? KB3/11 12

13 The AMA has published that needle EMG of the larynx is performed for intra-operative monitoring during procedures performed on the larynx. 9. Why isnʼt cross-referenced as one of the EMG codes with which code can be reported? The list of associated codes for was last updated with CPT Code was new in CPT We have alerted the AMA to the discrepancy. 10. How many units can be billed for code 95920? Code is defined as ʻper hourʼ. It is used just once per hour even if multiple EMGs are performed. For example, if a patient was monitored for three hours, the provider would bill 3 units for Portions of an hour are counted only when nerve monitoring lasts over 30 minutes. For example, 3 hours 15 minutes of intra-operative nerve monitoring is reported as 3 units of 95920, and 3 hours 45 minutes of intra-operative nerve monitoring is reported as 4 units of Note that monitoring must last at least 31 minutes for code to be reported. Code is not reported when monitoring lasts less than 30 minutes. 11. How many units can be billed for CPT or 95868? The cranial nerve monitoring codes and are defined as ʻcranial nerve supplied muscle(s)ʼ so only one code is used regardless of how many muscles are being tested. KB3/11 13

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010 Intraoperative Nerve Monitoring Coding Guide March 1, 2010 Please direct any questions to: Kim Brew Manager Reimbursement and Therapy Access Medtronic ENT (904) 279-7569 Rev 9/10 KB TO OUR PARTNERS IN

More information

KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment

KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment KYPHON Balloon Kyphoplasty Procedure Reimbursement Guide ICD-9-CM Diagnosis Codes Providers should report the ICD-9-CM diagnosis code that most accurately describes the patient s condition. Please refer

More information

NVM5. Intraoperative Monitoring (IOM) Reimbursement Guide

NVM5. Intraoperative Monitoring (IOM) Reimbursement Guide 2014 NVM5 Intraoperative Monitoring (IOM) Reimbursement Guide 2014 NVM5 Intraoperative Monitoring (IOM) Reimbursement Guide CONTENTS OVERVIEW OF THE NVM5 INTRAOPERATIVE MONITORING SYSTEM 1 PURPOSE OF THIS

More information

Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment

Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment The information in this quick guide is provided by our Healthcare Economics Department, which supports Respiratory

More information

Rotator Cuff Repair Surgical Procedures

Rotator Cuff Repair Surgical Procedures Rotator Cuff Repair Surgical Procedures 2011 Reimbursement and Coding Reference Guide for Physicians and Hospitals This coding reference guide is intended to illustrate the common CPT * codes, ICD-9 CM

More information

Coding and Payment Guide for the Physical Therapist. An essential coding, billing, and payment resource for the physical therapist

Coding and Payment Guide for the Physical Therapist. An essential coding, billing, and payment resource for the physical therapist Coding and Payment Guide for the Physical Therapist An essential coding, billing, and payment resource for the physical therapist 2014 Contents Introduction...1 Coding Systems... 1 Claim Forms... 3 Contents

More information

Coverage and Authorization Services is available to respond to your coding questions toll-free at 800-292-2903.

Coverage and Authorization Services is available to respond to your coding questions toll-free at 800-292-2903. For Urinary Control Commonly Billed Codes October 2010 Medtronic provides this information for your convenience only. It is not intended as a recommendation regarding clinical practice. It is the responsibility

More information

Global Surgery Fact Sheet

Global Surgery Fact Sheet DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Global Surgery Fact Sheet Fact Sheet Definition of a Global Surgical Package Medicare established a national definition

More information

REIMBURSEMENT GUIDE. CD Horizon Spire. Spinal System. and. CD Horizon Spire Z. Spinal System

REIMBURSEMENT GUIDE. CD Horizon Spire. Spinal System. and. CD Horizon Spire Z. Spinal System REIMBURSEMENT GUIDE CD Horizon Spire Spinal System and CD Horizon Spire Z Spinal System REIMBURSEMENT GUIDE The CD Horizon Spire Plate is a posterior, single-level, non-pedicle supplemental fixation device

More information

istent Trabecular Micro-Bypass Stent Reimbursement Guide

istent Trabecular Micro-Bypass Stent Reimbursement Guide istent Trabecular Micro-Bypass Stent Reimbursement Guide Table of Contents Overview Coding 3 4 Coding Overview Procedure Coding Device Coding Additional Coding Information Coverage Payment 10 11 Payment

More information

Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.

Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session. Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons

More information

Functional Anaesthetic Discography (F.A.D. ) Procedure

Functional Anaesthetic Discography (F.A.D. ) Procedure Functional Anaesthetic Discography (F.A.D. ) Procedure Reimbursement Guide The Functional Anaesthetic Discography (F.A.D. ) Procedure is a way to aid in diagnosing the source of low back pain using a minimally

More information

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management Coding and Payment Guide for Anesthesia Services An essential coding, billing, and reimbursement resource for anesthesiology and pain management 2011 Contents Introduction...1 Coding Systems... 1 Claim

More information

Medicare Outpatient Therapy Billing

Medicare Outpatient Therapy Billing DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Medicare Outpatient Therapy Billing August 2010 / ICN: 903663 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare

More information

Medicare Physician Fee Schedule Modifiers

Medicare Physician Fee Schedule Modifiers Basics of MPFS Part 3 Medicare Physician Fee Schedule Modifiers Presented by Part B Provider Outreach and Education July 16, 2013 Disclaimer This information released is the property of Cahaba GBA and

More information

Ms. Jackson is the Manager of Health Finance and Reimbursement, Division of Health Policy and Practice Services, Washington, DC.

Ms. Jackson is the Manager of Health Finance and Reimbursement, Division of Health Policy and Practice Services, Washington, DC. Electrodiagnostic Testing with Same Day Evaluation Management By: Shane J. Burr, MD; Scott I. Horn, DO; Jenny J. Jackson, MPH, CPC; Joseph P. Purcell, DO Dr. Burr practices general inpatient and outpatient

More information

US Reimbursement Guide

US Reimbursement Guide US Reimbursement Guide The information with this notice is general reimbursement information only. It is not legal advice, nor is it about how to code, complete or submit any particular claim for payment.

More information

2013 MPFS Indicator Descriptors

2013 MPFS Indicator Descriptors 2013 MPFS Indicator Descriptors Here is an overview of the layout. Use the key on the following pages to interpret indicators. Indicator NOTE - # NOTE - C PROCEDURE/MOD PAR Amount NON-PAR Amount Limiting

More information

ADVANCED MONITORING PARAMETERS 2015 QUICK GUIDE TO HOSPITAL CODING, COVERAGE AND PAYMENT

ADVANCED MONITORING PARAMETERS 2015 QUICK GUIDE TO HOSPITAL CODING, COVERAGE AND PAYMENT ADVANCED MONITORING PARAMETERS 2015 QUICK GUIDE TO HOSPITAL CODING, COVERAGE AND Overview: Coding and Payment Systems The procedures described are performed in the hospital setting, usually as an intraoperative

More information

WELLCARE CLAIM PAYMENT POLICIES

WELLCARE CLAIM PAYMENT POLICIES WellCare and Harmony Health Plan s claim payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the

More information

Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee

Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee Anesthesia Services Policy Number ANES08272009RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 08/27/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable

More information

CODE AUDITING RULES. SAMPLE Medical Policy Rationale

CODE AUDITING RULES. SAMPLE Medical Policy Rationale CODE AUDITING RULES As part of Coventry Health Care of Missouri, Inc s commitment to improve business processes, we are implemented a new payment policy program that applies to claims processed on August

More information

istent Trabecular Micro-Bypass Stent Reimbursement Guide

istent Trabecular Micro-Bypass Stent Reimbursement Guide istent Trabecular Micro-Bypass Stent Reimbursement Guide Table of Contents Overview Coding 2 3 Coding Overview Procedure Coding Device Coding Additional Coding Information Coverage Payment 8 9 Payment

More information

Oregon CO-OP Modifier Table - December 2013

Oregon CO-OP Modifier Table - December 2013 Oregon CO-OP Modifier Table - December 2013 Modifier Modifier Description Pricing Functionality 22 Increased Procedural Services Modifier 22 should only be reported with procedure codes that have a global

More information

Modifier Reference PAYMENT POLICY ID NUMBER: 10-011. Original Effective Date: 05/14/10. Revised: 05/31/12 DESCRIPTION:

Modifier Reference PAYMENT POLICY ID NUMBER: 10-011. Original Effective Date: 05/14/10. Revised: 05/31/12 DESCRIPTION: Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

Billing and Coding Guidelines: NEURO-005 Nerve Conduction Studies and Electromyography. Contractor Name Wisconsin Physicians Service (WPS)

Billing and Coding Guidelines: NEURO-005 Nerve Conduction Studies and Electromyography. Contractor Name Wisconsin Physicians Service (WPS) Billing and Coding Guidelines: NEURO-005 Nerve Conduction Studies and Electromyography Contractor Name Wisconsin Physicians Service (WPS) Contractor Number 00951, 00952, 00953, 00954 05101, 05201, 05301,

More information

Professional/Technical Component Policy

Professional/Technical Component Policy Policy Number 2015R0012C Professional/Technical Component Policy Annual Approval Date 1/27/2014 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible

More information

Corporate Reimbursement Policy

Corporate Reimbursement Policy Corporate Reimbursement Policy Code Bundling Rules Not Addressed in ClaimCheck or Correct Coding Initiative File Name: code_bundling_rules_not_addressed_in_claim_check Origination: 6/2004 Last Review:

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: electrodiagnostic_studies 2/2008 10/2015 10/2016 10/2015 Description of Procedure or Service Electrodiagnostic

More information

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Anesthesia Policy Description: Definitions: This policy addresses

More information

Ambulatory Surgery Center Coding and Payment Guide 2015

Ambulatory Surgery Center Coding and Payment Guide 2015 Targeted Drug Delivery Ambulatory Surgery Center Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party

More information

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014 Medicare 101: Basics of Modifier Billing Part B Provider Outreach and Education February 26, 2014 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: 1-800-791-2345

More information

Policy #: 111 Latest Review Date: January 2010

Policy #: 111 Latest Review Date: January 2010 Name of Policy: Co-surgeons and Team Surgeons Policy #: 111 Latest Review Date: January 2010 Category: Administrative Policy Grade: N/A Background: As a general rule, benefits are payable under Blue Cross

More information

Payment Policy. Evaluation and Management

Payment Policy. Evaluation and Management Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions

More information

Reporting of Devices and Leads When a Credit is Received

Reporting of Devices and Leads When a Credit is Received Reporting of Devices and Leads When a Credit is Received Cardiac Rhythm Management and Electrophysiology Updated January 2014 Medicare Reporting Requirements For Full or Partial Credits of Devices and

More information

Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852)

Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Contractor Information Contractor Name CGS Administrators, LLC Article

More information

Physician Coding and Payment Guide 2015

Physician Coding and Payment Guide 2015 Targeted Drug Delivery Physician Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party sources and is subject

More information

Physician Fee Schedule BCBSRI follows CMS Physician Fee Schedule (PFS) Relative Value Units (RVU) for details relating to

Physician Fee Schedule BCBSRI follows CMS Physician Fee Schedule (PFS) Relative Value Units (RVU) for details relating to Policy Coding and Guidelines EFFECTIVE DATE: 09 01 2015 POLICY LAST UPDATED: 09 02 2015 OVERVIEW This Policy provides an overview of coding and guidelines as they pertain to claims submitted to Blue Cross

More information

1) There are 0 indicator edits, which are never correctly reported together;

1) There are 0 indicator edits, which are never correctly reported together; Medical Coverage Policy Coding and Guidelines sad EFFECTIVE DATE: 11/15/2011 POLICY LAST UPDATED: 11/1/2013 OVERVIEW This Policy provides an overview of coding and guidelines as they pertain to claims

More information

Modifier -25 Significant, Separately Identifiable E/M Service

Modifier -25 Significant, Separately Identifiable E/M Service Manual: Policy Title: Reimbursement Policy Modifier -25 Significant, Separately Identifiable E/M Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM028 Last Updated:

More information

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Observation Care Services Description:

More information

Physician rates effective January 1, 2016 through December 31, 2016.

Physician rates effective January 1, 2016 through December 31, 2016. Endovascular Repair of Abdominal Aortic Aneurysm Coverage, Coding and Reimbursement Overview Physician 2016 Edition Reimbursement Amounts are Listed at National Medicare Rates and Do Not Include the 2%

More information

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services MEDICARE CLAIMS PROCESSING MANUAL Accessed September 25, 2005 100.1 - Payment for Physician Services in Teaching Settings Under the MPFS Payment is made for physician services furnished in teaching settings

More information

Medical Practitioner Reimbursement

Medical Practitioner Reimbursement INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Medical Practitioner Reimbursement L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 1 6 P U B L I S H E D : F E B R U A R Y 25,

More information

Comparison of the Prospective Payment System Methodologies Currently Utilized in the United States

Comparison of the Prospective Payment System Methodologies Currently Utilized in the United States Comparison of the Prospective Payment System Methodologies Currently Utilized in the United States 1 Can you speak the jargon of Prospective Payment Systems? MS- DRGs APCs IPF-PPS RBRVS HHRGs RUGs MS-LTC

More information

FAQs on Billing for Health and Behavior Services

FAQs on Billing for Health and Behavior Services FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare

More information

IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule

IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule a) In accordance with Sections 8(a), 8.2 and 16 of the Workers' Compensation Act [820 ILCS 305/8(a), 8.2 and 16] (the Act),

More information

Technical Component (TC), Professional Component (PC/26), and Global Service Billing

Technical Component (TC), Professional Component (PC/26), and Global Service Billing Manual: Policy Title: Reimbursement Policy Technical Component (TC), Professional Component (PC/26), and Global Service Billing Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number:

More information

Modifiers 80, 81, 82, and AS - Assistant At Surgery

Modifiers 80, 81, 82, and AS - Assistant At Surgery Manual: Policy Title: Reimbursement Policy Modifiers 80, 81, 82, and AS - Assistant At Surgery Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM013 Last Updated: 8/29/2014

More information

ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES

ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES Table of Contents ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES For treatment before 2/1/09 Introduction and Purpose Reference Materials Section 1. Ambulatory

More information

Modifier -52 Reduced Services

Modifier -52 Reduced Services Manual: Policy Title: Reimbursement Policy Modifier -52 Reduced Services Section: Administrative Subsection: Policy Number: RPM 003 Date of Origin: Insert date approved Last Updated: same IMPORTANT STATEMENT

More information

STATE OF NEVADA DEPARTMENT OF BUSINESS & INDUSTRY DIVISION OF INDUSTRIAL RELATIONS WORKERS COMPENSATION SECTION

STATE OF NEVADA DEPARTMENT OF BUSINESS & INDUSTRY DIVISION OF INDUSTRIAL RELATIONS WORKERS COMPENSATION SECTION STATE OF NEVADA DEPARTMENT OF BUSINESS & INDUSTRY DIVISION OF INDUSTRIAL RELATIONS WORKERS COMPENSATION SECTION NEVADA MEDICAL FEE SCHEDULE MAXIMUM ALLOWABLE PROVIDER PAYMENT February 1, 2012 through January

More information

COM Compliance Policy No. 3

COM Compliance Policy No. 3 COM Compliance Policy No. 3 THE UNIVERSITY OF ILLINOIS AT CHICAGO NO.: 3 UIC College of Medicine DATE: 8/5/10 Chicago, Illinois PAGE: 1of 7 UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE CODING AND DOCUMENTATION

More information

There are two levels of modifiers: Level 1 (CPT) and Level II (CMS, also known as HCPCS).

There are two levels of modifiers: Level 1 (CPT) and Level II (CMS, also known as HCPCS). PROVIDER BILLING GUIDELINES Modifiers Modifiers are two digit or alphanumeric characters that are appended to CPT and HCPCS codes. The modifier allows the provider to indicate that a procedure was affected

More information

Class Action Settlement Recap

Class Action Settlement Recap Class Action Settlement Recap Enhancements to Claim Payment Policy, Processing and Payment Disclosure, and an Appeals Process for Class Action Settlement Providers The following enhancements are effective

More information

TELEMEDICINE POLICY. Page

TELEMEDICINE POLICY. Page TELEMEDICINE POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 4.8 T0 Effective Date: May, 203 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS.. APPLICATION... OVERVIEW... REIMBURSEMENT

More information

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services:

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services: PROVIDER BILLING GUIDELINES Anesthesia Background Qualified medical professionals administer anesthesia to relieve pain while at the same time monitoring and controlling the patients health and vital bodily

More information

Biodesign ADVANCED TISSUE REPAIR

Biodesign ADVANCED TISSUE REPAIR Biodesign ADVANCED TISSUE REPAIR 2013 CODING AND REIMBURSEMENT GUIDE FOR RECTOVAGINAL FISTULA The information provided herein reflects Cook Medical's understanding of the procedure(s) and/or devices(s)

More information

National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: January 1, 2014

National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: January 1, 2014 National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: January 1, 2014 Current Procedural Terminology 2013 American Medical Association. All Rights Reserved. Current Procedural

More information

eglobaltech CBR201406 Electrodiagnostic Testing Moderator: Molly Wesley July 09, 2014 3:00 p.m. ET

eglobaltech CBR201406 Electrodiagnostic Testing Moderator: Molly Wesley July 09, 2014 3:00 p.m. ET CBR201406 Electrodiagnostic Testing July 09, 2014 3:00 p.m. ET Contents Miscellaneous Topics... 2 NCS Codes (95905, 95907 95913)... 4 EMG Codes (95860, 95861, 95863 95870)... 4 NCS & EMG Combination Codes

More information

NOVOSTE BETA-CATH SYSTEM

NOVOSTE BETA-CATH SYSTEM HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve

More information

Frequently Asked Questions About the 2014 Medicare Physician Fee Schedule

Frequently Asked Questions About the 2014 Medicare Physician Fee Schedule Frequently Asked Questions About the 2014 Medicare Physician Fee Schedule The Center for Medicare & Medicaid Services will NOT cut Medicare physician reimbursement for EEG and other services, according

More information

CODING SHEETS CHRONIC INTRACTABLE SPASTICITY. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE

CODING SHEETS CHRONIC INTRACTABLE SPASTICITY. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE CODING SHEETS CHRONIC INTRACTABLE SPASTICITY Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572 CODMAN

More information

professional billing module

professional billing module professional billing module Professional CMS-1500 Billing Module Coding Requirements...2 Evaluation and Management Services...2 Diagnosis...2 Procedures...2 Basic Rules...3 Before You Begin...3 Modifiers...3

More information

ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE

ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE Overview This guide includes an overview of Medicare reimbursement methodologies and potential coding options for the use of select remote

More information

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES REIMBURSEMENT POLICY OBSERVATION CARE EVALUATION AND MANAGEMENT CODES Policy Number: ADMINISTRATIVE 232.8 T0 Effective Date: April, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...

More information

Coding and Payment Guide for the Physical Therapist. An essential coding, billing, and payment resource for the physical therapist

Coding and Payment Guide for the Physical Therapist. An essential coding, billing, and payment resource for the physical therapist Coding and Payment Guide for the Physical Therapist An essential coding, billing, and payment resource for the physical therapist 2013 Contents Introduction...1 Coding Systems... 1 Claim Forms... 3 Contents

More information

Basics of Billing & Coding Intraoperative NeuroMonitoring. Sarah J Raddatz, BS CPC Director

Basics of Billing & Coding Intraoperative NeuroMonitoring. Sarah J Raddatz, BS CPC Director Basics of Billing & Coding Intraoperative NeuroMonitoring Sarah J Raddatz, BS CPC Director Disclaimer The following presentations are not to be considered a replacement for the Current Procedural Terminology

More information

2016 Medicare Fee Schedule for Audiologists. American Speech-Language-Hearing Association

2016 Medicare Fee Schedule for Audiologists. American Speech-Language-Hearing Association 2016 Medicare Fee Schedule for Audiologists American Speech-Language-Hearing Association 1 st Edition November 10, 2015 General Information This document was developed by the American Speech-Language-Hearing

More information

Miscellaneous Services

Miscellaneous Services Miscellaneous Services Acute Physical Medicine and Rehabilitation (Acute PM&R) Inpatient PM&R is limited to Department-contracted facilities. Please see the Department s Acute PM&R Billing Instructions

More information

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee New Patient Visit Policy Number NPV04242013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 12/16/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to

More information

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE 11:3-29.1 Purpose and scope (a) Every policy of automobile insurance

More information

Coding Endoscopic Sinus Surgery

Coding Endoscopic Sinus Surgery Coding Endoscopic Sinus Surgery Audio Seminar/Webinar July 31, 2008 Practical Tools for Seminar Learning Copyright 2008 American Health Information Management Association. All rights reserved. Disclaimer

More information

2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010

2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 Consultations The Centers for Medicare/Medicaid Services (CMS) finalized its proposal to require claims for consultation services

More information

Coding and Payment Guide for Anesthesia Services. An essential coding, billing and reimbursement resource for anesthesiology and pain management

Coding and Payment Guide for Anesthesia Services. An essential coding, billing and reimbursement resource for anesthesiology and pain management Coding and Payment Guide for Anesthesia Services An essential coding, billing and reimbursement resource for anesthesiology and pain management 2016 Contents Introduction...1 Coding Systems... 1 Claim

More information

Anthem Blue Cross and Blue Shield (Anthem) CLAIMS XTEN TM RULES Version 4.4 Effective December 8, 2012

Anthem Blue Cross and Blue Shield (Anthem) CLAIMS XTEN TM RULES Version 4.4 Effective December 8, 2012 Rules Edit logic Example Suppted After Hours 99050 not Reimbursable with Preventive Diagnosis This will deny 99050 (services provided when the office is usually closed) when billed with a preventive diagnosis

More information

Pennsylvania Workers Compensation Billing Tutorial. Step 1: Find the Charge Classes by Zip Code

Pennsylvania Workers Compensation Billing Tutorial. Step 1: Find the Charge Classes by Zip Code Step 1: Find the Charge Classes by Zip Code http://www.portal.state.pa.us/portal/server.pt/community/charge_classes_by_zip_co de/10428 The Pennsylvania Workers' Compensation Fee Schedule for Part B providers

More information

ICD-10-CM and ICD-10-PCS Frequently asked questions for HIM and Patient Financial Services Leaders

ICD-10-CM and ICD-10-PCS Frequently asked questions for HIM and Patient Financial Services Leaders ICD-10-CM and ICD-10-PCS Frequently asked questions for HIM and Patient Financial Services Leaders Executive questions What is the current status of ICD-10? The U.S. Department of Health and Human Services

More information

Question and Answer Submissions

Question and Answer Submissions AACE Endocrine Coding Webinar Welcome to the Brave New World: Billing for Endocrine E & M Services in 2010 Question and Answer Submissions Q: If a patient returns after a year or so and takes excessive

More information

TELEMEDICINE POLICY. Page

TELEMEDICINE POLICY. Page TELEMEDICINE POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 4.23 T0 Effective Date: July, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS.. APPLICATION... OVERVIEW... REIMBURSEMENT

More information

Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery...

Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery... Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery... 6 Other Complex or High Risk Procedures... 7 Radiology,

More information

GEORGIA MEDICAID TELEMEDICINE HANDBOOK

GEORGIA MEDICAID TELEMEDICINE HANDBOOK GEORGIA MEDICAID TELEMEDICINE HANDBOOK CONNECTING GEORGIA OVERVIEW The Department of Community Health s (DCH) Telemedicine and Telehealth policies are slated to improve and increase access and efficiency

More information

2015 CPT Codes for Cardiac Device Monitoring

2015 CPT Codes for Cardiac Device Monitoring 2015 CPT Codes for Cardiac Device Monitoring CPT 1 copyright 2014. American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CPT Code IMPLANTABLE

More information

Clinical Indicators: Parotidectomy

Clinical Indicators: Parotidectomy Clinical Indicators: Parotidectomy Procedure CPT Days 1 Excision of parotid tumor or parotid gland; lateral lobe, without 42410 90 nerve dissection Excision of parotid tumor or parotid gland; lateral lobe,

More information

Page 1 of 11. MLN Matters Number: SE1010 REVISED Related Change Request (CR) #: 6740. Related CR Release Date: N/A Effective Date: January 1, 2010

Page 1 of 11. MLN Matters Number: SE1010 REVISED Related Change Request (CR) #: 6740. Related CR Release Date: N/A Effective Date: January 1, 2010 News Flash Version 3.0 of the Measures Groups Specifications Manual released in November 2009 for 2010 PQRI has been revised. Version 3.1 of the 2010 PQRI Measures Groups Specifications Manual and Release

More information

Update: The Care of the Patient with Amyotrophic Lateral Sclerosis

Update: The Care of the Patient with Amyotrophic Lateral Sclerosis Update: The Care of the Patient with Amyotrophic Lateral Sclerosis Case Presentation: Part I A 54-year-old woman presents to the neurology clinic referred by her primary care physician for evaluation of

More information

Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service

Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service Manual: Policy Title: Reimbursement Policy Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM027 Last Updated:

More information

Unlisted Procedure Codes Frequently Asked Questions

Unlisted Procedure Codes Frequently Asked Questions Unlisted Procedure Codes Frequently Asked Questions Use of an unlisted code is common when a physician performs a new procedure or utilizes new technology when no other CPT code adequately describes the

More information

2010 CPT Codes for Cardiac Device Monitoring

2010 CPT Codes for Cardiac Device Monitoring 2010 CPT Codes for Cardiac Device Monitoring CPT copyright 2009. American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CPT Code IMPLANTABLE

More information

CMS Eliminates Medicare Payment for Consultation Codes. Prepared by the UFJHI Office of Physician Billing Compliance

CMS Eliminates Medicare Payment for Consultation Codes. Prepared by the UFJHI Office of Physician Billing Compliance CMS Eliminates Medicare Payment for Consultation Codes Outline Reasons for Change Effective Date New Modifier Impact on Other Payers Impact on Medicare Secondary Claims Code Selection Office/Outpatient

More information

Mississippi Medicaid. Provider Reference Guide. For Part 203. Physician Services

Mississippi Medicaid. Provider Reference Guide. For Part 203. Physician Services Mississippi Medicaid Provider Reference Guide For Part 203 Physician Services This is a companion document to the Mississippi Administrative Code Title 23 and must be utilized as a reference only. January

More information

Contractor Number 11302. Oversight Region Region IV

Contractor Number 11302. Oversight Region Region IV Local Coverage Determination (LCD): Spinal Cord Stimulators for Chronic Pain (L32549) Contractor Information Contractor Name Palmetto GBA opens in new window Contractor Number 11302 Contractor Type MAC

More information

Monterey County HEALTH INFORMATION MANAGEMENT CODING SUPERVISOR

Monterey County HEALTH INFORMATION MANAGEMENT CODING SUPERVISOR Monterey County 50T22 HEALTH INFORMATION MANAGEMENT CODING SUPERVISOR DEFINITION Under direction, supervises the work of staff who review, interpret, code and abstract medical records information according

More information

Fact Sheet on the Resource Based Relative Value Scale (RBRVS) Fee Schedule Effective January 1, 2014

Fact Sheet on the Resource Based Relative Value Scale (RBRVS) Fee Schedule Effective January 1, 2014 Fact Sheet on the Resource Based Relative Value Scale (RBRVS) Fee Schedule Effective January 1, 2014 1. When did the new RBRVS-based fee schedule become effective? 1.1. The RBRVS-based physician and non-physician

More information

I. Hospitals Reimbursed Under Medicare's Prospective Payment System. A. Hospital Inpatient Prospective Payment System

I. Hospitals Reimbursed Under Medicare's Prospective Payment System. A. Hospital Inpatient Prospective Payment System PROCEDURAL GUIDANCE on HOSPITAL and FACILITY REIMBURSEMENT UNDER INDIANA'S WORKERS COMPENSATION PROGRAM Effective for procedures rendered on and after July 1, 2014 by Trudy H. Struck I. Hospitals Reimbursed

More information

Diabetes Outpatient Self-Management Training (NCD 40.1)

Diabetes Outpatient Self-Management Training (NCD 40.1) Policy Number 40.1 Approved By UnitedHealthcare Medicare Reimbursement Policy Committee Current Approval Date 02/11/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare

More information

Telemedicine and Telehealth Services

Telemedicine and Telehealth Services INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Telemedicine and Telehealth Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 8 P U B L I S H E D : F E B R U A R Y

More information

Routine Venipuncture and/or Collection of Specimens

Routine Venipuncture and/or Collection of Specimens Manual: Policy Title: Reimbursement Policy Routine Venipuncture and/or Collection of Specimens Section: Laboratory & Pathology Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM012 Last Updated:

More information