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New Facet Codes with Medicare

  1. #21
    Default
    Medical Coding Books
    Thanks a lot


    Jesenka

  2. #22
    Location
    Philadelphia, PA
    Posts
    95
    Default
    Hi

    At my ASC, we bill everybody by Medicare guidelines (RT/LT), unless otherwise specified in payor contract, There is a section in the ACS claims processing manual, i believe, on the CMS Website, that will explain the bilateral requirement of RT/LT.

    That being said, Unless the commercial contract states specifically how to bill we follow Medicare guidelines. I know that our WC requires RT/LT as well as the majors...Aet/Bcbs/Cigna/UHC...etc...

    I will search for the link and post back to you..have a nice day!!

  3. #23
    Location
    Philadelphia, PA
    Posts
    95
    Default Billing Bilateral Procedures/Medicare
    Here is what i found...

    http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0742.pdf in case this link is dead: try this: MLN Matters Number: SE0742 Revised

    Billing Bilateral Procedures:
    Bilateral procedures should be reported as a single unit on two separate lines or with “2” in the units field on one line, in order for both procedures to be paid. While

    MLN Matters Number: SE0742 Related Change Request Number: N/A

    use of the -50 modifier is not prohibited according to Medicare billing instructions, the modifier is not recognized for payment purposes and if used, may result in incorrect payment to ASCs. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedure discounting.
    The following provides a hypothetical example that illustrates this payment policy:
    Correct Reporting
    Example
    HCPCS
    Description
    PI
    Units
    ASC-Reported Charges
    Unadjusted Medicare Payment Rate*
    Unadjusted Medicare Payment* to Provider with Multiple Procedure Reduction
    Unadjusted Beneficiary Payment* to Provider with Multiple Procedure Reduction
    15823
    Revision of Upper Eyelid
    A2
    1
    $1,000
    $800
    $800 x .80 = $640
    $800 x .20 = $160
    Claim 1:
    Bilateral Procedure Reported on Two Lines
    15823
    Revision of Upper Eyelid
    A2
    1
    $1,000
    $800
    ($800 x .50) x .80 = $320
    ($800 x .50) x .20 = $80
    Because the provider reports the bilateral procedure on two separate lines, and because the multiple procedure reduction applies to 15823, the provider receives total unadjusted payment (from Medicare and the beneficiary) of $1,200 for both procedures.
    Claim 2:
    Bilateral Procedure Reported on One Line with Two Units
    15823
    Revision of Upper Eyelid
    A2
    2
    $2,000
    $800 X 2
    [$800 + ($800 x 0.50)] x .80 = $960
    [$800 + ($800 x 0.50)] x .20 = $240
    Because the provider reports the bilateral procedure using “2” in the units field, and because the multiple procedure reduction applies to 15823, the provider receives total unadjusted payment (from Medicare and the beneficiary) of $1,200 for both procedures.
    Incorrect Reporting
    Claim 3:
    Bilateral Procedure Reported on One Line with Bilateral Modifier
    15823 50
    Revision of Upper Eyelid
    A2
    1
    $2,000
    $800
    $800 x .80 = $640
    $800 x .20 = $160
    Because the provider reports the bilateral procedure using the bilateral modifier, the provider receives total unadjusted payment (from Medicare and the beneficiary) of $800 for only one of the procedures.

  4. Default 64495 in ASC
    Quote Originally Posted by tincyr View Post
    Not a problem overriding the LT/RT, but what about the statement that 64492 and 64495 are only to be billed once per day. What do you do in this case when you have bilateral injections, 3 levels each?
    We have to list it on two seperate lines 64495 on the first line gets the 50 and the 64495 on the second line has no modifier but in ASC side you have to list them seperately no RT and LT is acceptable for this procedure in the ASC and we are being paid accordingly.

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