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Donated neurostimulator implant (medicare)

  1. #1
    Location
    Knoxville, Tn Chapter
    Posts
    15
    Default Donated neurostimulator implant (medicare)
    Medical Coding Books
    Hi Everyone,

    Need a little help here.

    If our ASC bill's for a neurostimulator implant, but the implant itself is donated, which modifier should we use on a Medicare patient?

    Any feedback is appreciated.

    Thanks,
    A Leach, CPC

  2. #2
    Default
    Medicare does not reimburse for Neurostimulators. You can check addendum BB, they have an N1 Payment indicator.

  3. #3
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    but the reimbursement for the stimulator itself is packaged into the procedure code for the implantation of the device, so a modifier will be necessary..but I've never had this issue so I'm not sure of the modifier. I'm sure someone else will respond (calling Rebecca....lol)
    Mary, CPC, CANPC, COSC

  4. #4
    Default
    I would like to know what modifier to use. We have only had this procedure once since I have been here and I checked on this. No modifier was used and we was still reimbursed (for codes 63685 and 63650). They did reimburse at a higher rate for these procedures. If there is a required modifier, please let me know!! Thanks

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    I can't say I've had this happen before.

    Look at the FB modifier: Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples)


    http://www.cms.hhs.gov/MLNMattersArt...ads/MM5263.pdf

    Additional link.......

    http://www.cms.hhs.gov/MLNMattersArt...ads/MM4250.pdf



    Could this work?
    Last edited by RebeccaWoodward*; 09-14-2009 at 02:59 PM.

  6. #6
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by rebeccawoodward View Post
    I can't say I've had this happen before.

    Look at the FB modifier: Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples)


    http://www.cms.hhs.gov/MLNMattersArt...ads/MM5263.pdf

    Additional link.......

    http://www.cms.hhs.gov/MLNMattersArt...ads/MM4250.pdf
    Could this work?

    BINGO...I knew you would come through!! Your awesome!! thanks
    Mary, CPC, CANPC, COSC

  7. #7
    Location
    Knoxville, Tn Chapter
    Posts
    15
    Talking Thanks!
    I will try this and see what happens.

    Thanks every one for responding. You all are great.

    April Leach, CPC

  8. #8
    Default
    Would that decrease the reimbursement for Medicare with the implant being donated? Ours was not donated the facility purchased it.
    Last edited by bethh05; 09-15-2009 at 04:11 PM.

  9. #9
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by bethh05 View Post
    Would that decrease the reimbursement for Medicare with the implant being donated? Ours was not donated the facility purchased it.
    are you billing for the physician?
    Mary, CPC, CANPC, COSC

  10. Default
    For the facility.

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