• 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 the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Add on codes with N1 payment indicator in an ASC

Create Wiki
T

trichards139

Guest
Messages
22
Location
Claysville, PA
Best answers
0
If anyone can help me with this question I would very much appreciate it!!

Is it right or wrong to bill the add-on codes that have an N1 payment indicator for the ASC to Medicare? Good example is 64490 which is paid at a higher rate because the additional levels, 64491 & 64492 are included in the "package" rate for 64490.

Does anyone else bill the additional levels even though they won't get paid? I have read that you should bill them for future rate calculations and I've also read that Medicare does not want them billed. I feel it is not unbundling because they are add-on codes and some commercial payers do pay.

:confused: Thanks everyone!
 
You should bill the add-on codes unless your payer contract or policy specifies otherwise. The N1 status indicator is a reimbursement policy indicator that gives an instruction on how payment is to be made; it is not a bundling denial, nor is it a coding rule. The surgeries should be coded according to correct coding guidelines. I could be wrong, but I have never read anywhere that Medicare 'does not want' these codes to be billed.
 
You must log in or register to reply here.
Top