A Perianayaki
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HI all,
Panel codes:
MY UNDERSTANDING:
1. TWO PANEL codes cannot be billed together on the same day.
2. If so only the individual components code of the other comprehensive panel(82435) code can be billed with the Major panel codes (80050).
3. Panel codes and its individual components cannot be billed together on the same day by the same provider.
4. I am not sure same day Panel codes by one provider and its components by another provider can be billed? Expertise please post your responses.
5. I have noticed physician billing the panel code (80050) and facility billing its components (85025,84443,80053)alone for the same day. Why facility doing so??????? Any inputs would be greatly appreciated!!!
APOLOGISE FOR THE TOO MANY OF EXAMPLES AND LENGTHY REPORT.
The following are my queries:
1. Two comprehensive panel codes cannot be performed on the same day. Eg., (80047 and 80061).
- This rule is applicable to same day same provider
Example: Physician A – Performs (80047 and 80061 ) on the same DOS.
- Also applicable to same day different provider /Facility too.
Example: Physician A – Performs (80061) on the same DOS.
Physician B – Performs (80047 ) on the same DOS.
2. I have come across claims which is billed both comprehensive and individual component codes.
Like (80053 and 80050),(80050 and 85025),(80050 and 84443).
- Can we bypass the edit by appending modifier?
- Example: Physician A – Performs (80053 and 80050 ) on the same DOS. Do we bill the claim like this?
- Also applicable to same day different provider /Facility too.
Example: Physician A – Performs (80050) on the same DOS.
Physician B – Performs (80053 ) on the same DOS.
1. Can we bill the claim like this?
2. What can be done with this case? No modifier required for this case? OR
3. The rule will not be applicable if component codes are performed by another provider?
3. One more scenario what I have come across is (on the same day)
Comprehensive panel code billed – 80050 - billed by Provider
Billed by Facility on the same day with revenue codes
Component codes – 85025
– 84443
– 80053
Since my knowledge is very less on the Facility , can the provider and facility bill the same procedure codes on the same BUT in different way. Is there any policies like that? Kindly let me know.
4. There are certain cases component codes are billed with QW : Sample code sets are: 80053 and 82947 – QW modifier.
5. There are certain cases component codes are billed with 90 : Sample code sets are: 80055 and 85025 – QW modifier.
What can be done with the above scenario? Do you feel claim submission is correct?
6. There are cases 80069 CPT code is billed with CE modifier with its components codes also billed with CE on the same day. What can be done with this case?
CPT – 80053-CE, 84443-CE,85025-CE, 80050-CE on the same day.
Any assistance would be greatly appreciated!!!
TIA
Perianayaki
Panel codes:
MY UNDERSTANDING:
1. TWO PANEL codes cannot be billed together on the same day.
2. If so only the individual components code of the other comprehensive panel(82435) code can be billed with the Major panel codes (80050).
3. Panel codes and its individual components cannot be billed together on the same day by the same provider.
4. I am not sure same day Panel codes by one provider and its components by another provider can be billed? Expertise please post your responses.
5. I have noticed physician billing the panel code (80050) and facility billing its components (85025,84443,80053)alone for the same day. Why facility doing so??????? Any inputs would be greatly appreciated!!!
APOLOGISE FOR THE TOO MANY OF EXAMPLES AND LENGTHY REPORT.
The following are my queries:
1. Two comprehensive panel codes cannot be performed on the same day. Eg., (80047 and 80061).
- This rule is applicable to same day same provider
Example: Physician A – Performs (80047 and 80061 ) on the same DOS.
- Also applicable to same day different provider /Facility too.
Example: Physician A – Performs (80061) on the same DOS.
Physician B – Performs (80047 ) on the same DOS.
2. I have come across claims which is billed both comprehensive and individual component codes.
Like (80053 and 80050),(80050 and 85025),(80050 and 84443).
- Can we bypass the edit by appending modifier?
- Example: Physician A – Performs (80053 and 80050 ) on the same DOS. Do we bill the claim like this?
- Also applicable to same day different provider /Facility too.
Example: Physician A – Performs (80050) on the same DOS.
Physician B – Performs (80053 ) on the same DOS.
1. Can we bill the claim like this?
2. What can be done with this case? No modifier required for this case? OR
3. The rule will not be applicable if component codes are performed by another provider?
3. One more scenario what I have come across is (on the same day)
Comprehensive panel code billed – 80050 - billed by Provider
Billed by Facility on the same day with revenue codes
Component codes – 85025
– 84443
– 80053
Since my knowledge is very less on the Facility , can the provider and facility bill the same procedure codes on the same BUT in different way. Is there any policies like that? Kindly let me know.
4. There are certain cases component codes are billed with QW : Sample code sets are: 80053 and 82947 – QW modifier.
5. There are certain cases component codes are billed with 90 : Sample code sets are: 80055 and 85025 – QW modifier.
What can be done with the above scenario? Do you feel claim submission is correct?
6. There are cases 80069 CPT code is billed with CE modifier with its components codes also billed with CE on the same day. What can be done with this case?
CPT – 80053-CE, 84443-CE,85025-CE, 80050-CE on the same day.
Any assistance would be greatly appreciated!!!
TIA
Perianayaki