Expect Payment for Wrongly Denied Part B SNF Claims

Denied StampBest practices dictate that providers should appeal any claims believed to be wrongfully denied, but if your practice has received a string of claims denials for certain Medicare Part B services rendered to skilled nursing facility (SNF) patients in the past 18 months, you may just need to sit back and wait. The Centers for Medicare & Medicaid Services (CMS) and your Medicare administrative contractor (MAC) are already at work identifying all claims erroneously denied because of a claims processing issue in the 2012 annual update of the HCPCS codes for SNF consolidated billing.

The claims processing issue that caused certain claims for Part B SNF services to be either denied or paid in error has been corrected as of July 30, according to a Sept. 19 CMS Medicare FFS Provider e-News report.

Claims containing the following codes are being adjusted to account for the processing error:

CPT® codes for dates of service Jan. 1, 2011 and after, claims processed Jan. 3, 2011 through July 29, 2012:

  • 21554 (until March 11, 2012) Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater
  • 96522 (until July 29, 2012) Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial)
  • 96571 (until July 29, 2012) Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)

CPT® codes for dates of service Jan. 1, 2012 and after, claims processed Jan. 3, 2012 until July 29, 2012:

  • 0079T Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch (List separately in addition to code for primary procedure)
  • 00790 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified
  • 00792 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage (excluding liver biopsy)
  • 00794 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; pancreatectomy, partial or total (eg, Whipple procedure)
  • 00796 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; liver transplant (recipient)
  • 0163T Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (List separately in addition to code for primary procedure)
  • 01630 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified
  • 01632 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; radical resection [deleted since 2010]
  • 01634 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; shoulder disarticulation
  • 01636 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation

Check your MAC’s website and listserv messages for an indication of when it expects to complete the correction process so you can anticipate when your claims (along with any notifications for payment recovery) will be adjusted.

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