Medicare (Georgia) keeps rejecting my nurse injection chg. It is giving several reason: missing/incomplete invalid referring provider primary identifier; missing/incomplete/invalid provider name; claim/service lacks info which is needed for adjusdication. Has anyone had this problem?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki 96372 - Medicare (Georgia) keeps rejecting
- Thread starter sus008
- Start date
are you billing as nurse?
this is still a serv provided by your practice and should be billed as doctor who treated patient, my guess on why missing invalid provider and other rejection kinda all go hand in hand when i see them the service does not get billed as nurse because doctor is signing prov on chart. hope this helps
this is still a serv provided by your practice and should be billed as doctor who treated patient, my guess on why missing invalid provider and other rejection kinda all go hand in hand when i see them the service does not get billed as nurse because doctor is signing prov on chart. hope this helps
kbarron
Guest
We have to use a referring MD here in NH for any blood draws. We use the MD of the practice or in case there are multiple providers, the MD of the day.
mitchellde
True Blue
Yes there is a CMS bulletin regarding this and when a procedure is performed such as an injection done by nursing staff then the ordering physician is the referring provider. You do need to put his name and NPI in the appropriate spots on the claim.
kbarron
Guest
however 96372 is a medication administration code. Is this a medication that MCR covers? I know on UB -04 you need condtion codes.
mitchellde
True Blue
Yes but when you are billing for the nurse to give the injection it is an incident to claim of sorts since you are using the providers NPI as the rendering/supervising when you do that, following the guidance in CR144, you must use the ordering providers name and NPI as the referring provider even if it matches the rendering/supervising.
kbarron
Guest
I verify all nusring visits that use a 99211 as sometimes the MD does not sign the note and there needs to be medical necessity for this code. You would have to see if this is a Medicare covered code any way.
mitchellde
True Blue
?? This is not a 99211 this is for a 96372 injection admin, which is covered by Medicare, it is rejecting for referring provider per the poster. So the answer to her post is yes she needs a referring provider on the claim. I am not sure where you are picking up the 99211. also the medication was apparently not in question.
kbarron
Guest
Overthinking!. We have a practice that insists when a medication is given, always use 99211.
mitchellde
True Blue
You cannot use the 99211 to administer the injection as a code exists for this purpose. There are numerous transmittals that state this.
kbarron
Guest
Yes there is,,,and no matter how many times I have told this practice they insist on using it..specifically for PT INR.. when this is only reason for the visit, I cannot justify 99211 when I ask for the note they do not have one..then a few days later...provider sends me a note stating this charge is correct....we have a few pt who bring in their own med, nurse documents vitals, states nl and give shot... So I go by what the provider says.
mitchellde
True Blue
You should go by documentation. It is wrong to use the 99211. I disagree with doing just what the provider says when I know it is wrong, I would change the code and face the consequences.
kbarron
Guest
I did a couple years ago...I was removed from my coding position. In Sept..the whole upper management was relieved of their positions...new manager put me back to coding...came very close to giving it up..I am still rusty,,,2 yrs out of coding and there were alot of changes...however the provider is still doing the same thing he did 2 1/2 yrs ago...I have been researching to be better able to state my point.
mitchellde
True Blue
There was a decision health article in 2002 Feb 11, written by Kathleen Mueller who was the compliance officer for CMS, She issued a warning about using the 99211 for blood draws and injections and cited a solo practitioner and his office manager that were fined heavily for using the 99211 for this purpose when they were aware that it was incorrect. Their rationale was that it was being paid. I hope you can get this resolved as it is a huge issue.
kbarron
Guest
I will look for that article....I have been googleing @ work..but never seem to be able to spend much time research...I want to thank you for all your help..you have enlightend me on quite a few things today. Thanks for your time!...Off to play BINGO!.We will talk again...my work email is kbarron@hugginshospital.org Thank you again.