Wiki Nephrology/Dialysis Help needed

[cntrycmfort]

Supposedly there was a CCI edit(Jan 2013) in which the dialysis patients can not be billed inpatient hospital charges and get paid unless you have a modifier -25 on each charge. I was told this was done in error and should have been removed. However, I am still having issues with Medicare 1. paying much less on the MCP charge, 2. not paying the hospital charges at all 3. wanting all money back for mcp and inpatient.
Has anyone else run into this problem and have you seen any documentation stating that we are to be billing any differently?
Thanks
Sandy

 

[Hendricks17]

Dialysis MCP & Inpatient billing

Sandy
Our practice was getting denials in March & April. I copied the paragraph out of our Medicare Manual (80.1) stating "Inpatient physician's visits are covered in addition to the composite rate or MCP amount" & submitted with Basic/Comp notes showing the days in the unit were different from the days inpatient. We have been getting paid. I too was told that this would be corrected, however the CCI edits still show inpatient cpt codes in column 2.

I need to mention that our state went from NGS to WPS. With NGS we were told to bill our MCP with the full month date. 1st - end of month. Going to WPS they said they didn't care if we used the first or last day of the month but to use the "to and from" as being the same. Ex: 5/1/2013 - 5/1/2013. Once we stoped using the month date span, that helped.
Check with your carrier to see if that is an issue.

Good Luck