Article 28 /split billing

cwestman

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I'm wondering if someone could advise. We are an Article 28 Hospital with out patient Family practice and Cardiac services so billing for Medicare is split.
We received a denial from Medicare on CPT 93295,stating not billable to Medicare A.
I'm wondering if someone can advise which CPT should be used to bill the remote acquisition of and interpretation of the remote data.
Is there a global code Perhaps(?) 93297
The service was provided outside of the 90 day service period for a remote defibrillator(ICD) evaluation acquisition and interpretation by Cardiologist
Appreciate direction
Cheri Westman
 

thomas7331

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There is no global code for this service. 93294 (for pacemaker) and 93295 (for ICD) are the professional services - the technical counterpart for both of these is 93296.
 
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There is no global code for this service. 93294 (for pacemaker) and 93295 (for ICD) are the professional services - the technical counterpart for both of these is 93296.
Hi Thomas, if the 93294 and 93295 are for professional then the 93296 is the tech component - then both should be payable during the same time frame. is that correct?
 

thomas7331

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Hi Thomas, if the 93294 and 93295 are for professional then the 93296 is the tech component - then both should be payable during the same time frame. is that correct?
Yes, they represent two components of the same test - there is no overlap between the professional and technical component.
 

thomas7331

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Thank you Thomas - we are receiving denials from Medicare now for CO97. Have you encountered these type rejections?
CO97 is a common bundling denial. Which codes are being denied and what other codes are you billing on the same date of service? The professional component 93296 should not bundle to either 93294 or to 93295 - these pairs are not on the NCCI table so if one of these is denied, then it must be some other code that you are billing that is causing the denial, or else it is a payer error. However, if you are billing both 93294 and 93295 on the same date, then the 93294 will deny as bundled because you would be billing two technical components.
 
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CO97 is a common bundling denial. Which codes are being denied and what other codes are you billing on the same date of service? The professional component 93296 should not bundle to either 93294 or to 93295 - these pairs are not on the NCCI table so if one of these is denied, then it must be some other code that you are billing that is causing the denial, or else it is a payer error. However, if you are billing both 93294 and 93295 on the same date, then the 93294 will deny as bundled because you would be billing two technical components.
Thank you so much! In checking with the payor it was definitely their error. thanks again
 
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