E&M billed separate from PT/INR

Laura Wagner

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So I have an issue... one of our "coders" is trying to bill and E&M and PT/INR separately for the same date of service, the E& M to Medicaid A and PT/INR to Medicare B. I think it is unbundling and that they should go together to Medicare A since it is the same date of service. Help??
 

mitchellde

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what level E&M ar eyou billing? did the physician see the patient? or was the visit for a blood draw only. And no you cannot bill one service to Medicaid and a different service to Medicare.
 

Laura Wagner

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E/M level varies fom 99212 to 99215 and PT/INR was drawn same day. Correction E/M billed to medicare A and lab billed to medicare B.
 

mitchellde

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I am not understanding Medicare A is for the inpatient hospital bill, part B is the physician Bill. Am I missing something?
 

Laura Wagner

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No FQHC are able under the law able to bill Part A. I even think we are mandated to. So to the point and E&M can not be separated from the lab if they are performed on the same date of serveice. Correct?
 

mitchellde

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here is something that can maybe help. all services must be on one claim:
Beginning January, 1, 2011, Medicare required that Part A claims include line level details. CMS publication MM7038 states: “Beginning with dates of service on or after January 1, 2011, when billing Medicare, FQHCs must report all pertinent services provided and list the appropriate HCPCS code for each line item along with revenue code(s) for each FQHC visit. The additional line item(s) and HCPCS code reporting are for informational and data gathering purposes only, and will not be utilized to determine current Medicare payment to FQHCs. Until the FQHC prospective payment system is implemented in 2014, the Medicare claims processing system will continue to make payments under the current FQHC interim per-visit payment rate methodology.”

In a later publication, SE1039, Medicare states: “When reporting multiple services on FQHC claims, the 052X revenue line should include the total charges for all of the services provided during the encounter. For preventive services with a grade of A or B from the USPSTF, the charges for these services must be deducted from the total charge for purposes of calculating the beneficiary coinsurance correctly.”
 
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