Billing CPT codes 17000, 11421, and 10060 to Medicare

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I currently work for a FQHC and I have been having problems with billing certain office procedures to Medicare. The following CPT codes are 17000, 11421, and 10060 are being denied by Medicare. When we bill out the claim, we just add the G code and no office visit because when the provider sees the patient it is only for that procedure. Can anyone help or give me any ideas on how to get Medicare to process these claims? Thank you!
 
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It is more along the lines of that they are not processing the claims. They are stuck in suspense and I have tried everything I know. I am stuck. I have called Medicare and they are no help.
 

hperry10

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Medicare PPS

Hi there,

I work for an FQHC as well. Medicare no longer pays FQHC's for stand alone procedures. You can only add a Gcode to qualifying services. The only covered codes are included in the following link.

https://www.cms.gov/Medicare/Medica...cific-Payment-Codes.pdf?agree=yes&next=Accept

This link is for FAQ's of Medicare PPS.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-PPS-FAQs.pdf

From page 7 of the FAQ's

Q8. How do I bill for procedures if no other service is furnished?
A8. Except for certain preventive services, procedures are not separately billable. If the procedure is
furnished on the same date of service as a qualifying visit, the charges for the procedure would go on the
claim with the payment code and qualifying visit code, and the FQHC would be paid the lesser of the
total charges or the adjusted PPS rate. If there is no qualifying visit associated with the procedure, no
claim is submitted and no payment is made.

The PPS system has cost our clinic a lot of money because we now have many visits that we do not get paid for. It has caused us to rethink the services we provide. If it is warranted you can add an E/M code to the visit, but in many cases it is not warranted so the procedures have to be written off. You will have to review each claim to see if an E/M is warranted and write if off if not. They will not even process thru the website for a denial. There is no way around this unfortunately, I am aware of one FQHC that we have spoken with and were told that they just add an E/M to every procedure so they will get paid. Our clinic knows this is wrong and has to write these off. Please let me know if you have any questions about this.

Heather
 
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Honolulu Hawaii
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Q8. How do I bill for procedures if no other service is furnished?
A8. Except for certain preventive services, procedures are not separately billable. If the procedure is
furnished on the same date of service as a qualifying visit, the charges for the procedure would go on the
claim with the payment code and qualifying visit code, and the FQHC would be paid the lesser of the
total charges or the adjusted PPS rate. If there is no qualifying visit associated with the procedure, no
claim is submitted and no payment is made.

The PPS system has cost our clinic a lot of money because we now have many visits that we do not get paid for. It has caused us to rethink the services we provide. If it is warranted you can add an E/M code to the visit, but in many cases it is not warranted so the procedures have to be written off. You will have to review each claim to see if an E/M is warranted and write if off if not. They will not even process thru the website for a denial. There is no way around this unfortunately, I am aware of one FQHC that we have spoken with and were told that they just add an E/M to every procedure so they will get paid. Our clinic knows this is wrong and has to write these off. Please let me know if you have any questions about this.

Heather

Would it be inappropriate to code these procedure visits using an E/M code?
 
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