NDC to HCPCS Crosswalk List of codes
A critical component to filing claims with a NDC Code is to ensure that the appropriate HCPCS/CPT code is billed with the NDC Code. A NDC to HCPCS crosswalk identifies the assigned HCPCS/CPT code(s)...
View ArticleReporting NDC code for Unclassified drugs
Unclassified DrugsAn unclassified drug is defined as a drug that does not have a specific, designated HCPCS/CPT code. Unclassified HCPCS/CPT codes should only be used when a specific HCPCS/CPT code is...
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Drug invoice example and reporting NDC code based on invoice
Surgical Implanted Pain Medication Pumps (SIPMP) Compound Drug Billing GuidelinesThe following billing guidelines must be followed when submitting claims for SIPMP compounded drug(s) refills in order...
View ArticleEMC loop segment for NDC qualifier, NDC CODE, AND NDC quantity
Field Name Field Description Loop ID SegmentHCPCS/CPT Procedure Code Enter the appropriate HCPCS/CPT Code aligned with the NDC Code billed, if applicable. 2400 SV101HCPCS/CPT UnitsEnter the applicable...
View ArticleInpatient Rehabilitation Facility Billing Requirements
• Indicate “11X” or “12X” type of bill• First digit – type of facility ( 1-Hospital)• Second digit – bill classification (1-Inpatient Hospital, including Medicare Part A or 2-Inpatient Hospital for...
View ArticleOutpatient Rehabilitation Facilities Billing Requirements
• Multiple dates of service should not be grouped on one line.• Indicate “74X” or “75X”’ type of bill, which is field 4 on paper claimso First digit – Type of facility (7)o Second digit – bill...
View ArticleCPT CODE G0839 and who is covered benefit
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)HCPCS/CPT CodesG0389 – Ultrasound exam for AAA screeningICD-10-CM CodesSee https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html for...
View ArticleWhat is Modifiers - For Beginners
ModifiersA modifier provides a physician with the means to indicate that a service/procedure is altered by some specific circumstance, but not changed in its definition or code. By modifying the...
View ArticleDocumentation is required when billing modifier 24
Based on widespread probes of office evaluation and management (E/M) services, First Coast has discovered that the 24 modifier for E/M services, when billing within a global surgery period, has been...
View ArticleE/M Service: Global Surgery Denials
Denial Reason, Reason/Remark Code(s)•CO-97 - Global Surgery Denials: Services submitted for the same patient by the same doctor on the same day as or within the post-op period of a major/minor...
View ArticleCPT CODE A9270 , REVENUE CODE 0637 - self administered drug codes
How to bill non-covered self-administered drugsThe Centers for Medicare & Medicaid Services (CMS) provides instructions to contractors regarding Medicare payment for drugs and biologicals...
View ArticleCPT code 43235, 43236, 43237, 43238, 43239 and covered DX
LCD for Diagnostic and Therapeutic Esophagogastroduodenoscopy (L29167)Coding Information for CPT/HCPCS CodesBill Type Codes:Contractors may specify Bill Types to help providers identify those Bill...
View ArticleCRNA services modifiers
CRNA ServicesAAAnesthesia services personally performed by an anesthesiologist. The -AA modifier is used for all basic procedures.P1Normal healthy patient.P2Patient with mild systemic disease.P3Patient...
View ArticleWhere to use Modifier 77
Modifier 77Key Points/Instruction/What you need to knowModifier 77 is used to report a repeat procedure by another physician and is appended to the repeat procedure to:•Report the same service provided...
View ArticleModifier and corrrect coding initative applied hospital and facility
Coding a Facility Claim Procedure, Modifier and Diagnosis Codes - A critical element in claims filing is the submission of current and accurate codes to reflect the services provided. Correct...
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Modifier KX for use with Therapy Services
Modifier KX is used to confirm requirements outlined in the appropriate Local Coverage Determination (LCD), are met for the procedure billed.By adding modifier KX to a claim, you are stating that your...
View ArticlePayment Guide for Modifier 20, 52 and 22
Allowable AdjustmentsEffective January 1, 2000, the replacement code (CPT 69990) for modifier -20 - microsurgical techniques requiring the use of operating microscopes may be paid separately only when...
View ArticleProcedures Billed With Two or More Surgical Modifiers
Carriers may receive claims for surgical procedures with more than one surgical modifier. For example, since the global fee concept applies to all major surgeries, carriers may receive a claim for...
View ArticleMedicare part B modifiers full list
Modifiers to be used for Part BProgramCategoryModifier CodeDescriptionPART - BPhysician Quality Reporting1PPhysician Quality Reporting System – Performance measure exclusion modifier due to medical...
View ArticleDifference between modifiers 52, 53
Documentation Requirements for Modifier 52 & 53Modifier 52 – Reduced Services* Surgical Procedures: An operative report and a concise statement on how the service performed differs from the...
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