rlh27
Networker
I've posted this in the general discussion and thought it might be better to post it here. It's a question from the billing department that I can't answer without help 
Here is a common scenario:
Patient is registered with 30 day Series Account. The Patient has multiple encounters during that period.
7/3 Patient seen for Ferumoxytol Infusion for treatment of iron deficiency anemia(non-ESRD)
Associated Dx, 280.9 IRON DEFIC ANEMIA NOS
585.3 CHR KIDNEY DIS STAGE III
7/11 Patient seen for Darbepoetin Alfa Injection(non-ESRD use) EC modifier(ESA administered to anemia not due to anticancer radiotherapy or anticancer chemotherapy)
Associated Dx, 285.21 ANEMIA IN CHR KIDNEY DIS
585.3 CHR KIDNEY DIS STAGE III
When the claim generates at the end of the 30 series account, all charges and dx codes are being billed on one claim. The 280.9 causes a Medicare rejection for the EPO as a result of:
CMS TRANSMITTAL 1413 CHANGE REQUEST 5818 DATED JANUARY 14, 2008
My ultimate question isn't regarding the coding accuracy or appropriateness of the EC modifier, but simply from a billing perspective, is it permissible to split daily bill a series account and ONLY apply the diagnosis codes that were indicated on the superbill/progress note for the particular date of service.
My end result would be billing all 7/3 charges with only 280.9 and 585.3, and filing a separate claim for 7/11 charges with only 285.21 and 585.3.
Keep in mind, in my patient accounting system, upon discharge and final bill, ALL diagnosis codes will be entered and represented on the coding screen.
Here is a common scenario:
Patient is registered with 30 day Series Account. The Patient has multiple encounters during that period.
7/3 Patient seen for Ferumoxytol Infusion for treatment of iron deficiency anemia(non-ESRD)
Associated Dx, 280.9 IRON DEFIC ANEMIA NOS
585.3 CHR KIDNEY DIS STAGE III
7/11 Patient seen for Darbepoetin Alfa Injection(non-ESRD use) EC modifier(ESA administered to anemia not due to anticancer radiotherapy or anticancer chemotherapy)
Associated Dx, 285.21 ANEMIA IN CHR KIDNEY DIS
585.3 CHR KIDNEY DIS STAGE III
When the claim generates at the end of the 30 series account, all charges and dx codes are being billed on one claim. The 280.9 causes a Medicare rejection for the EPO as a result of:
CMS TRANSMITTAL 1413 CHANGE REQUEST 5818 DATED JANUARY 14, 2008
My ultimate question isn't regarding the coding accuracy or appropriateness of the EC modifier, but simply from a billing perspective, is it permissible to split daily bill a series account and ONLY apply the diagnosis codes that were indicated on the superbill/progress note for the particular date of service.
My end result would be billing all 7/3 charges with only 280.9 and 585.3, and filing a separate claim for 7/11 charges with only 285.21 and 585.3.
Keep in mind, in my patient accounting system, upon discharge and final bill, ALL diagnosis codes will be entered and represented on the coding screen.