Temporary Workaround Billing for Organ Donor Complications

Medicare will now separately pay for complication services for a person who donates an organ to a Medicare beneficiary, according to the Centers for Medicare & Medicaid Services (CMS) change request (CR) 7816. With customary claims, the patient is always the beneficiary, so the patient relationship has always been a one-to-one match. When a person donates an organ, however, the one-to-one patient relationship no longer exists.

CMS has a temporary workaround to allow 837I claims for organ donor complications into Medicare systems. According to MLN Matters® article 7816, to code claims for organ donor complications during the temporary process, providers should:

  • Show the patient relationship of 18 (Self) in Form Locator (FL) 59 (Patient’s Relation to Insured) on all 837I claims.
  • Submit the Medicare beneficiary’s information in the following FLs: 08 (Patient Name/Identifier), 09 (Patient Address), 10 (Patient Birth Date), and 11 (Patient Sex).
  • Add a value of 39 along with the donor’s name to the 837I Loop 2300, Billing Note Segment NTE02 (NTE01 = ADD).

Providers using the UB-04 paper claim and direct data should:

  • Show the patient relationship of 39 (Organ Donor) in Form Locator (FL) 59 (Patient’s Relation to Insured); and
  • Submit the Medicare beneficiary’s information in the following FLs: 08 (Patient Name/Identifier), 09 (Patient Address), 10 (Patient Birth Date), and 11 (Patient Sex).

For complete instructions, read CR 7816, or MLN Matters® MM7816.

2017-code-book-bundles-728x90-01

Latest posts by admin aapc (see all)

Leave a Reply

Your email address will not be published. Required fields are marked *