Wiki ASC " N1" Indicator

[KoBee]

Trying to understand the N1 indicator, here is an example. CPT 55700, 76942, 77021. I was told we should $0.00 the radiology codes for both professional and facility. Is this correct? I understood it only on the facility side but I'm told on both. Can someone assist or have experience in this.


Professional claim
55700
76942-26 $0.00
77021-26 $0.00

Facility
55700
76942-TC $0.00
77021-TC $0.00

 

[thomas7331]

That's absolutely incorrect. To start with, the N1 indicator is a facility indicator only, it has no bearing on the professional component. If you zero the professional services, your physician won't be correctly paid for their work. Second, N1 is a reimbursement indicator, not a coding guideline. It only tells how Medicare is going to pay for that service - it doesn't mean you don't charge for it. You may need to roll the charge into the charge for the surgery itself, but you shouldn't just discount your services to zero dollars just because of the N1 indicator, unless that's your facility's policy, though I wouldn't agree with it if that's the case. The N1 indicator also doesn't tell you how other payers that don't follow the Medicare guidelines are going to pay, so it's possible your facility will be missing revenue from other payers by doing this.