Wiki Add on codes with N1 payment indicator in an ASC

[trichards139]

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.

Thanks everyone!

 

[thomas7331]

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.

 

[trichards139]

Thank you so much