Wiki Moderate Sedation

[kendalb]

A patient presented in the ED with a dislocated hip. Moderate sedation (99143) was used to put the patients hip back in place. Medicare is rejecting the code stating that it is invalid. I looked the code up in the Medicare fee schedule and it has a status indicator of N which states that it is a none covered service. What do I do next? Should the charge be removed?

 

[mhstrauss]

A patient presented in the ED with a dislocated hip. Moderate sedation (99143) was used to put the patients hip back in place. Medicare is rejecting the code stating that it is invalid. I looked the code up in the Medicare fee schedule and it has a status indicator of N which states that it is a none covered service. What do I do next? Should the charge be removed?

Are you looking at the 2016 fee schedule? I'm showing it has an indicator of "C"...Carrier Priced, and it does show up as payable on my Novitas fee schedule:

99143 Mod sedat phys/qhp <5 yrs C

99143
$61.80
$58.71
$67.52
$66.17
$66.17
$64.85
#
99143
$39.81
$37.82
$43.49
$42.62
$42.62
$41.77

What other codes were billed for that DOS?

 

[kendalb]

Listed below are the other services that were billed on the ED visit.

27257-hip dislocation
99283-25- intermediate ED
73501RT-Hip U/Pelvis 1 view RT

There are also pharmacy charges on the account.

I did find it in the SC Part B fee schedule 2016 but it is not in the Medicare (South Carolina) fee schedule. I tried to bill the charge out and it was rejected by Medicare stating it was invalid/ non-covered.

 

[mhstrauss]

Listed below are the other services that were billed on the ED visit.

27257-hip dislocation
99283-25- intermediate ED
73501RT-Hip U/Pelvis 1 view RT

There are also pharmacy charges on the account.

I did find it in the SC Part B fee schedule 2016 but it is not in the Medicare (South Carolina) fee schedule. I tried to bill the charge out and it was rejected by Medicare stating it was invalid/ non-covered.

I'm confused by your reference to 2 different fee schedules...it seems like Medicare (South Carolina) IS the SC Part B fee schedule ?? Sorry I'm not understanding!

The only other issue I can think of is maybe a bit obvious, but I'll point it out anyway, since it seems to be quite unusual for someone under 5 to have Medicare...99143 is "patients younger than 5 years of age". How old is your patient?

 

[kendalb]

I figured it out. We have it built under the wrong revenue code. The correct revenue code is 370 and not 450.

Thanks for your help!!!