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New code for Transesophageal Doppler Monitoring


Effective October 1, 2012, a new G code is used to report Transesophageal Doppler Monitoring, G9157 - Transesophageal Doppler used for cardiac monitoring

Effective October 1, 2012, you should no longer use Healthcare Common Procedure Coding System (HCPCS) code 76999 when billing for Esophageal Doppler monitoring. Medicare contractors will deny claim lines containing HCPCS code 76999 when billing for Esophageal Doppler monitoring.

Medicare contractors will deny claims for these services on or after October 1, 2012, submitted with HCPCS 76999 using Claim Adjustment Reason Code (CARC) 189: “’Not otherwise classified’ or ‘unlisted’ procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service.” and Remittance Advice Remarks Code M20: “Missing/incomplete/invalid HCPCS.”

However, Medicare will deny HCPCS G9157 when billed with modifier -TC (technical services) when services are provided in POS 21 using CARC 125 (Submission/billing error(s)), RARC M2 (Not paid separately when the patient is an inpatient.), and a Group Code of CO (Contractual obligation).

Medicare will allow HCPCS G9157 to be billed with either modifier -26 (professional component) or -TC (technical component) when services are provided in POS 24 for operative patients with a need for intra-operative fluid optimization.

Medicare will deny HCPCS G9157 when billed in any POS other than 21 or 24 using CARC 58 (“Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.) and Group Code CO.

Reference: http://cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7819.pdf

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