Billing 29826

primrose1

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A co-worker of mine is resistant to the changes for this code. She's still wanting to bill out the old RVU's as a primary procedure along with the other scope/open codes and wants "to see what happens" as far as who reimburses what (i.e., Medicare, work comp, no-fault, commercial plans, etc). Am I wrong in thinking we shouldn't do this and go strictly by the new guidelines, reduce the RVU's and list as an add-on code to the other procedures regardless of the patient's insurance? :(
 

mitchellde

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The codes are effective for the date they are implemented. This was implemented Jan 1 2012, so the answer to her action is absolutely not. There is a regulation that was written back in 02 or 03 I cannot remember exactly which year that stated there is no grace period for the usage and acceptance of the new codes. She must accept the new change and roll with it the way it is. to do otherwise is non-compliant.
 

primrose1

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What about billing for work comp? They have their own guidelines; some of the info we received from our Work Comp Board is that 29826 has not changed since 2010 and they do not follow the AMA................?????????? :eek:
 

mitchellde

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Work Comp is always different, they are a non HIPAA entity and therefore do not have to follow any of the HIPAA conventions. SO they can dictate the version of CPT that they use, it should be in the work comp provider manual or information for your state which year of CPT they are currently using, I occasionally find this with their fee schedule. But this applies only to work comp.
 

primrose1

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I guess NYS is still using December 2010 rates. So I guess this means if it's a work comp patient we're billing for, 29826 would still be the primary code......(?). What a mess!
 

mitchellde

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Yes that is correct. It usually helps if you have one person dedicated to just work comp so they can learn all the work comp peculiarities. If you can segment the duties this way it has always been the best way for me.
 

primrose1

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Since work comp is sticking with the old way for the shoulder scope code, I'm going to assume that they're staying with the 29877 also for payments. And no-fault since our EOB's make reference to the NYS guidelines. Just more to remember and try and figure out for now!

Thanks for all of your help/input!

Kris
 
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