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2018 New CPT codes

00731  Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified ...

Coding Questions and Answers


1. Will WC insurances reimburse Fluoroscopy procedures when performed in ASC setting? Where could I find ASC billing guidelines for WC claims?

Fluoroscopy procedures are considered to be a part of primary procedures are there would not be any separate payment. You could view
http://www.dol.gov/owcp/regs/feeschedule/fee/fee09/fs09ASCPaymentPolicy.doc for more information.

2. Are there any age criteria for Medicare to cover pap smears?

There are no certain age criteria to perform Pap smears. Medicare would cover Pap smears once in three years for the individuals who are not in the risk of cervical or vaginal cancer. For those high-risk patients Medicare would cover this test once in every 12 months. In addition Medicare would cover pap smears for the patients with childbearing age who have had an abnormal Pap test in the past 36 months.

High risk factors for cervical cancer are:

1. Early onset of sexual activity (under 16 years of age);

2. Multiple sexual partners (five or more in a lifetime);

3. History of a sexually transmitted disease (including HIV infection); and Fewer than three negative or any Pap smears within the previous 7 years.

High risk factors for vaginal cancer are:

1. DES (diethylstilbestrol) - exposed daughters of women who took DES during pregnancy

Reference:
http://www.cms.hhs.gov/Transmittals/Downloads/R1888A3.pdf

3. Will Medicare provide separate payment for CPT 90935 when submitted along with E & M codes?

No separate payment would be allowed to Inpatient Hospital follow up and Observation care codes when submitted along with the CPT codes 90935, 90937, 90945 and 90947 since all four of these codes include payment for any evaluation and management services related to the patient's renal diseases that are provided on the same date as the dialysis service except for the following evaluation and management services. Reimbursement would be made for both the Hemodialysis and E & M codes with the use of Modifier 25 that are listed below.

99201-99205 Office or other outpatient visit for a new patient

99211-99215 Office or other outpatient visit for an established patient

99238-99239 Hospital discharge day management services

99221-99223 Initial hospital care for a new or established patient

99241-99245 Office or other outpatient consultations, new or established patient

99251-99255 Initial inpatient consultations, new or established patient

99291-99292 Critical care services

Reference:
http://www.cms.hhs.gov/transmittals/downloads/R1810B3.pdf

4. Where can we find the list of all Denial Reason Codes?

You could view all of the following Health Care Code Lists @ http://www.wpc-edi.com/reference/

Claim Adjustment Reason Codes

Remittance Advice Remark Codes

Claim Status Category Codes

Claim Status Codes

Health Care Service Type Codes

Health Care Services Decision Reason Codes

Health Care Provider Taxonomy Code Set

Provider Characteristics Codes

Insurance Business Process Application Error Codes

5. Where can we find California Medi-cal insurance HCPCS codes and its Fee Schedule?

The updated list of CPT's and its current allowables can be viewed @
http://files.medi-cal.ca.gov/pubsdoco/Rates/rates_download.asp

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