Wiki Status Indicator

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ssanc2209

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Good Morning
I have a question regarding Status Indicators on Q4154 Biovance for hospital billing.
It is my understanding that this is not separately payable but is part of a package with CPT 15272-15278
The status indicator I see on CMS is N

I am being told that this has a status indicator of N1 but i do not see that and that this can be billed with JC or JD modifier.

Can anybody shed any light on this?

Thank you
 
You're correct, the OPPS status indicator is N for hospital billing. (Payment indicator N1 applies to ASC billing, not hospital, but it means approximately the same thing.) It is a packaged code which just means that the reimbursement for the product is included in the APC payment made for the procedure - it's not itemized as a separate payment. I've found that many people misinterpret this as meaning the code is to be denied or bundled, which isn't the case.

JC or JD modifier would be appropriate for this code, but it will not change how it is paid.
 
Thank you Thomas
So now for this Allograft (Q4154) I feel that it should be in our charge master as a revenue code 278(implants-other) but am being told that this rev code is only for High Dollar implants.
I was told i should use Revenue code 636 (drugs)

Is this something that you are familiar with ?

Thank you
Sara
 
ssanc2209 said:
Thank you Thomas
So now for this Allograft (Q4154) I feel that it should be in our charge master as a revenue code 278(implants-other) but am being told that this rev code is only for High Dollar implants.
I was told i should use Revenue code 636 (drugs)

Is this something that you are familiar with ?

Thank you
Sara
Click to expand...
I have seen it billed with revenue code 0278 where I work, but I don't know the specific regulations or payer policies for assignment of revenue codes. But I don't think it should make any difference one way or the other as far as reimbursement. Revenue code assignment is not really an area of coding, more of finance and contracting. You may want to check the guidance in the National Uniform Billing Manual on this.
 
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