Wiki Cataract, Q1003, MAPs, and UB04s

[SUAWHITE]

As most ASC billers know, regular Medicare FFS requires billing on CMS1500. However, the Medicare Advantage Plans require UB04. We are having trouble selecting the correct revenue code for the additional NTIOL payment and code Q1003.

We have experienced differing responses to this query. One consultatant suggested we use the revenue code for IOLs (0276) while another stated that this should be denied because lens reimbursement is bundled in the cataract code (66982, 66984). We have tried leaving the revenue code blank . Obviously, this did not work. We had one carrier suggest using 0270 and another 0299!

Obviously, we want to do this the "right" way, but I am curious if other groups can share their experience with reimbursement from MAPs only and code Q1003. Thanks!

Susan White, COT, CPC

 

[hzucco]

I always used revenue code 276 on the UB. I bill with a copy of the sticker from the package the lens came from and attach it on a separte sheet showing proof of the lens. That may help. The Q code shows it is a NTIOL and not just the standard lens included in the 66984

Hope this helps.

Heather

 

[elenax]

I get reimbursed by Medicare for the Q code with no problem but unfortunately some commercials insurance are bundling the code. I have tried to appeal it with no sucess and I'm also doing UB04 w/276 revenue code.