Medicare Denials - Infusion Coding Guidelines

Messages
4
Best answers
0
Recently, Medicare has denied some infusion, injection, and hydration charges on our observation claims due to not having an initial service billed for each date of service on the claim. Our HIM Dept is stumped because we have always followed the coding guidelines that only 1 initial service can be reported PER ENCOUNTER rather than PER DOS. Is anyone else experiencing a similar issue or can anyone provide an update to the coding guidelines that we may have missed?

Thanks!
 

kschulte71

Networker
Messages
38
Location
Hondo, TX
Best answers
0
Our issue is denials because the initial is being billed on the ED Visit claim and then billed in Inpatient for the add on codes. My add on codes are being denied due to no initial service not being billed on the same claim. With Medicare, I cannot combine claims so it creates a denial. Any help would be greatly appreciated.
 

thomas7331

True Blue
Messages
2,351
Best answers
5
I'm confused by your question - inpatient facility claims are not submitted with CPT codes - how are you getting an inpatient infusion add-on code to Medicare to even get a denial? Also, an ED visit claim within 72 hours of admission to the same facility would have to be combined with the inpatient claim per my understanding of Medicare rules, so I don't know why you're saying you can't combine them.
 

kschulte71

Networker
Messages
38
Location
Hondo, TX
Best answers
0
We are a Critical Access Hospital and for Medicare, we have to send them separate as one in an Outpatient Service and the other is Impatient. If we don't, they are denied. I am not sure why our coders are adding the CPT to the claims but they are.
 

mmoore70

Contributor
Messages
22
Best answers
0
Medicare denials/infusions and IVP's

Recently, Medicare has denied some infusion, injection, and hydration charges on our observation claims due to not having an initial service billed for each date of service on the claim. Our HIM Dept is stumped because we have always followed the coding guidelines that only 1 initial service can be reported PER ENCOUNTER rather than PER DOS. Is anyone else experiencing a similar issue or can anyone provide an update to the coding guidelines that we may have missed?

Thanks!
I was interested in what the outcome was for the denials you're receiving for your above dilemma. We are having the same issues and several charges on hold/denied because of this. We have also followed guidelines that allow one initial per encounter not dos. We are at a loss at what the correct procedure should be and why all of sudden this has become an issue. The insurance dept is ready to pull their hair out over these denials and as a coder, I don't feel comfortable changing these services/codes just to get payment. Actually, me and the other coder refuse to unless we can get some kind of expert advice or something showing where this was changed. Thanks!
 
Top