Biomedical subjects
Publications and source records attributed to Cindy C Parman.
Payment for IMRT planning bundles, or includes, many services represented by other procedure codes when performed on the same date. As a result, radiation therapy providers must maintain an awareness of bundling edits and coding guidelines to ensure complete and accurate reimbursement for this advanced technology.
Before reporting the new Category III CPT codes, contact payors to determine both acceptance of these temporary codes and reimbursement allowances. Documentation must clearly support all services performed, and the requirements for an online medical evaluation should be followed, with the encounter recorded in the individual patient medical record. Hospitals should also review the quarterly changes to OPPS codes and descriptors and ensure that Charge Description Masters are updated as new codes become effective.
The decision to report a consultation code is based on a number of factors, including: the existence of a request from a physician or other authorized source for opinion or advice, documentation of the face-to-face patient encounter, and a written report of the findings, opinions or advice to the attending physician. Depending upon practice location, relationship with the referring physician population, number of self-referred patients, and other factors, some practices will report primarily consultation codes, whereas others may assign more codes for new patient visits.
In summary, documentation of the procedure performed and individual insurance payor guidelines will determine the procedure code billed for telemetry services. Because codes accepted for these services and reimbursement guidelines may vary, it may be necessary to obtain specific guidance before claim submission.
Although CMS reimburses for routine care associated with clinical trials, it is essential that the correct diagnosis code, modifier, and, where necessary, HCPCS Level II procedure code be assigned to accurately report these qualifying trial services. Remember that not all insurance payors will provide reimbursement for services rendered as part of a clinical trial, and individual payor policies should be obtained and followed for these services.
Doppler pulsed wave or continuous wave and color-flow velocity services are reported with add-on codes in addition to the basic echocardiography study. To be reimbursed, payor medical necessity guidelines must be met, and documentation in the echography report must clearly support all services performed.
Keep in mind that this is not the end of the 2005 coding changes; there are also new HCPCS level II codes to contend with the advent of the Medicare Final Rules for physician and outpatient hospital-fee schedules. For now, we can prepare for the CPT changes by verifying charge master updates, ensure that fee tickets were corrected, and review any other documents or electronic systems where procedures are captured for billing purposes.
When diagnosis codes are reported and sequenced on an insurance claim, official guidelines are available to provide instructions for the correct assignment of ICD-9-CM codes. These instructions are intended to ensure that the correct reason for the diagnostic service is reported and that procedures are reimbursed when they are medically necessary.