Results 1 to 8 of 8

Billing in Units for Medicare

  1. #1
    Location
    New Port Richey & Gulf to Bay
    Posts
    107
    Question Billing in Units for Medicare
    Exam Training Packages
    My Fellow Coders,

    I'm on the hunt for information about billing in units for Medicare. Does anybody have any information pertaining to billing in units? I've currently exhausted all of my leads.

    For example:

    The pathologist charges 88305 for three different specimens. Being three different specimens, can you bill in units?

    Thank You,
    Kevin

  2. #2
    Default Each specimen is serately billable.
    Per CPT, a specimen is any tissue or tissues submitted for individual and separate exam and diagnosis. If the pathologist was given three separate specimens and he/she did a gross and micro exam on all three and diagnosed them separately, you bill 88305 x3 (assuming they are Level IV exams, of course).

  3. #3
    Default
    Kevin,
    I been doing Pathology billing for years and have always billed in unit form to Medicare and all other carriers. Billing one unit on each line will lead to denials, because Medicare and everyone else will think that these are duplicate specimens. I have only run into one code 83912 that can't be billed in unit form to Medicare. I looks like your in FL like myself and the same rules would apply. As for actual info from Medicare on billing in unit form; I don't have any. But if you follow my advise you should have no problems.

    Thomas

  4. #4
    Default
    On CMS website go to search and type MUE. This is medically unlikely edits, this search will give you all you need to know on updated MUE.

  5. #5
    Location
    St Louis West Missouri Chapter
    Posts
    79
    Default Regarding MUE...
    I've been down this road before with CMS/MUE.
    You open up an Excel spreadsheet with cpt codes, and a 1,2 or 3 next to them. It doesn't tell you anything about any edits!
    Where do you find the actual wording of the edits?
    I've been tearing my hair out trying to figure this out!

    ~Kat

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Default
    Kevin,

    When it is medically necessary to evaluate both bone structure and bone marrow, and both services can be provided with one biopsy, only one code (CPT code 38221 or CPT code 20220) can be reported. If two separate biopsies are necessary, then both can be reported using modifier -59 on one of the codes. Pathological interpretation codes 88300-88309 may be separately reported for multiple separately submitted specimens. If only one specimen is submitted, only one code can be reported regardless of whether the report includes evaluation of both bone structure and bone marrow morphology or not.

    http://www.cms.hhs.gov/NationalCorre....asp#TopOfPage

    Look under NCCI Policy Manual and then click on the first PDF
    Last edited by RebeccaWoodward*; 02-25-2009 at 08:05 PM.

  7. #7
    Location
    North Carolina
    Posts
    3,126
    Default
    Kat,

    See if this link helps........

    http://www.trailblazerhealth.com/Pub...anual/NCCI.pdf

  8. #8
    Location
    St Louis West Missouri Chapter
    Posts
    79
    Default
    Thanks, Rebecca. I need to sit down and read this...

    ~Kat

Similar Threads

  1. Reporting Modifying Units to Medicare
    By 2618216km in forum Anesthesia
    Replies: 2
    Last Post: 12-11-2014, 04:26 PM
  2. Multiple E/M units to Medicare
    By Jmeannm in forum E/M
    Replies: 1
    Last Post: 06-26-2012, 03:45 PM
  3. 11045 and Medicare units allowed
    By lwcarter in forum Plastic Surgery
    Replies: 4
    Last Post: 02-21-2012, 10:51 PM
  4. Billing multiple units to Medicare
    By TERESA TAYLOR in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 05-06-2011, 11:29 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.