Code/Modifier Combination Invalid and Modifier Invalid/Missing & Anesthesia Services: Bundling Denials

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Code/Modifier Combination Invalid and Modifier Invalid/Missing Remark Code/ Message Number:  • 4: The procedure code is inconsistent with the modifier used or a required modifier is missing • MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct ... Read More

Diagnostic Cardiology Services: Medical Necessity Denials & EKG, EKG Rhythm Strip and Cardiac Echography: NCCI Bundling Denials

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Diagnostic Cardiology Services: Medical Necessity DenialsDenial Reason, Reason/Remark Code(s)  • CO-50, CO-57, CO-151, N-115 – Medical Necessity: An ICD-9 code(s) was submitted that is not covered under a LCD/NCD • CPT codes: 93307, 93320, 93325 Resolution/Resources • Refer to the ‘Transthoracic Echocardiography’ Local Coverage Determination • If the service being performed is not covered under the ... Read More

Coverage Article for Independent Diagnostic Testing Facility (IDTF) Coding Guidelines

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Desk and Site Reviews All new IDTF applications shall receive (1) a thorough desk review, and (2) a mandatory site review prior to the contractor’s enrollment of the applicant and issuance of a billing number. The general purpose of both reviews is to determine whether the information listed on Attachment 2 of the CMS-855B is ... Read More

Centralized Billing for Influenza Virus and Pneumococcal Vaccines

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Centralized billing is a process in which a provider, who provides mass immunization services for influenza virus and pneumococcal pneumonia virus (PPV) immunizations, can send all claims to a single contractor for payment regardless of the geographic locality in which the vaccination was administered. (This does not include claims for the Railroad Retirement Board, United ... Read More

Coding Guidelines: Modifiers (Index) and detail about Anesthesia Modifiers

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Modifiers indicate a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. When selecting the appropriate modifier to be reported with your claim, please ensure that the modifier is valid for the date of service being submitted. Examples of when modifiers may ... Read More

Hospital billing setup

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Hospitals This page provides basic information about being certified as a Medicare and/or Medicaid hospital provider and includes links to applicable laws, regulations, and compliance information. A hospital is an institution primarily engaged in providing, by or under the supervision of physicians, inpatient diagnostic and therapeutic services or rehabilitation services. Critical access hospitals are certified ... Read More

Coding Guidelines: Modifiers (Index) and detail about Anesthesia Modifiers

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Modifiers indicate a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. When selecting the appropriate modifier to be reported with your claim, please ensure that the modifier is valid for the date of service being submitted. Examples of when modifiers may ... Read More

What is Hospice, Hospice Terminal Diagnoses

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Hospice the term “hospice care” means the following items and services provided to a terminally ill individual by, or by others under arrangements made by, a hospice program under a written plan (for providing such care to such individual) established and periodically reviewed by the individual’s attending physician and by the medical director (and by ... Read More

Additional HCPCS Modifiers

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Modifier    Description AE    Registered Dietician AF    Specialty Physician AG    Primary Physician AH    Clinical Psychologist AI    Principal Physician of Record AJ    Clinical Social Worker AK    Non Participating Physician AM    Physician, team member service AS    Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery. Must be reported with a Assistant Surgeon modifier (i.e. ... Read More

Clinical Laboratory Fee Schedule (CLFS) Update CPT 80300 through CPT 80377

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Final Determinations Codes 80300 through 80377  (63 codes) Industry Recommendation: Various, from crosswalking to specific existing codes (e.g., G0434, G0431, etc.), to gapfilling. CMS Recommendation: Delay in pricing. Rationale: These codes represent various drugs of abuse testing codes, many of which are specific to individual drug testing. In the 2015 clinical laboratory fee schedule preliminary determinations ... Read More