Wiki UB-04 Question

[rlh27]

I have coded for physician practices only and I have no idea about hospital.

The billing office approached me and asked me if billing a certain way would be compliant.

The scenario is as follows:

They just started billing for a newly acquired cancer center. For each patient in one day, the patient will have numerous charges and numerous diagnosis codes. Sometimes the diagnosis code for one procedure will cause the denial of another procedure.

Billing would like to know if instead of billing every single procedure on a single form, can they split the procedures up by applicable diagnosis codes in order to avoid these denials.

If anyone can help, I'd be grateful.

 

[mitchellde]

No they cannot bill multiple claims for the same day. Perhaps they need a modifier, can you post an example using codes?

 

[rlh27]

Thank you so much for your response! I asked billing to give me a clear and concise example of the issue. Here it is:

Here is a common scenario:

Patient is registered with 30 day Series Account. The Patient has multiple encounters during that period.

7/3 Patient seen for Ferumoxytol Infusion for treatment of iron deficiency anemia(non-ESRD)

Associated Dx, 280.9 IRON DEFIC ANEMIA NOS
585.3 CHR KIDNEY DIS STAGE III


7/11 Patient seen for Darbepoetin Alfa Injection(non-ESRD use) EC modifier(ESA administered to anemia not due to anticancer radiotherapy or anticancer chemotherapy)

Associated Dx, 285.21 ANEMIA IN CHR KIDNEY DIS
585.3 CHR KIDNEY DIS STAGE III

When the claim generates at the end of the 30 series account, all charges and dx codes are being billed on one claim. The 280.9 causes a Medicare rejection for the EPO as a result of:

CMS TRANSMITTAL 1413 CHANGE REQUEST 5818 DATED JANUARY 14, 2008


My ultimate question isn't regarding the coding accuracy or appropriateness of the EC modifier, but simply from a billing perspective, is it permissible to split daily bill a series account and ONLY apply the diagnosis codes that were indicated on the superbill/progress note for the particular date of service.

My end result would be billing all 7/3 charges with only 280.9 and 585.3, and filing a separate claim for 7/11 charges with only 285.21 and 585.3.

Keep in mind, in my patient accounting system, upon discharge and final bill, ALL diagnosis codes will be entered and represented on the coding screen.