sarahsalgado
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Wondering what criteria other plans are using to determine if the payment methodology when a hospital facility bills surgery services under a revenue code that is not a surgery revenue code.
Our current processing method is:
When a claim arrives with a surgery HCPCS billed with a non-surgery revenue code the processing hierarchy is to review the surgery HCPCS under the ASC Groupers for Medicaid. If the HCPCS codes falls under the ASC Group list the claim is processed under an outpatient surgery claim under the Medicaid ASC Group guidelines. If the HCPCS code does not fall under the ASC Group listing the claim will then be processed under the under the contract rate amount for the revenue code billed.
There has been some question that the claim should be denied for incorrect billing due to a surgery CPT code can only be billed with a surgery revenue code. Please advise if any plan has any contract.
Example: Rev 510 billed with a Biopsy Surgery Code Rev 920 or 761 billed with Debridment or Wound Care Surgical Codes
Where can I find this documentation for these guidelines. Need assistance ASAP
Our current processing method is:
When a claim arrives with a surgery HCPCS billed with a non-surgery revenue code the processing hierarchy is to review the surgery HCPCS under the ASC Groupers for Medicaid. If the HCPCS codes falls under the ASC Group list the claim is processed under an outpatient surgery claim under the Medicaid ASC Group guidelines. If the HCPCS code does not fall under the ASC Group listing the claim will then be processed under the under the contract rate amount for the revenue code billed.
There has been some question that the claim should be denied for incorrect billing due to a surgery CPT code can only be billed with a surgery revenue code. Please advise if any plan has any contract.
Example: Rev 510 billed with a Biopsy Surgery Code Rev 920 or 761 billed with Debridment or Wound Care Surgical Codes
Where can I find this documentation for these guidelines. Need assistance ASAP