- 93451 - RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
- 93452 - L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
- 93453 - R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
- 93454 - CATH PLMT & NJX CORONARY ART ANGIO IMG S&I
- 93455 - CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
- 93456 - CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
- 93457 - CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I
- 93458 - CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
- 93459 - CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
- 93460 - R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I
- 93461 - R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I
- 93462 - LEFT HEART CATH BY TRANSEPTAL PUNCTURE
- 93463 - MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
- 93464 - PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE
- 93563 - NJX SEL HRT ART CONGENITAL HRT CATH W/S&I
- 93564 - NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I
- 93565 - NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I
- 93566 - NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
- 93567 - NJX SUPRAVALV AORTOG HRT CATH W/S&I
- 93568 - NJX PULMONARY ANGIO HRT CATH W/S&I
- 95800 - SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
- 95801 - SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL
- 96446 - CHEMOTX ADMN PRTL CAVITY PORT/CATH
Sunday 27 March 2011
2011 CPT changes in Interventional cardiology
PECOS
Provider Enrollment, Chain, and Ownership System (PECOS)
Providers and suppliers must have Internet Explorer version 5.5 or higher and have the most recent version of Adobe Acrobat Reader before initiating an enrollment action using Internet-based PECOS.
The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855) to:
• Submit an initial Medicare enrollment application
• View or change your enrollment information
• Track your enrollment application through the web submission process
• Add or change a reassignment of benefits
• Submit changes to existing Medicare enrollment information
• Reactivate an existing enrollment record
• Withdraw from the Medicare Program
• View or change your enrollment information
• Track your enrollment application through the web submission process
• Add or change a reassignment of benefits
• Submit changes to existing Medicare enrollment information
• Reactivate an existing enrollment record
• Withdraw from the Medicare Program
Advantages of Internet-based PECOS
• Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)
• Tailored application process means you only supply information relevant to YOUR application
• Gives you more control over your enrollment information, including reassignments
• Easy to check and update your information for accuracy
• Less staff time and administrative costs to complete and submit enrollment to Medicare
• Tailored application process means you only supply information relevant to YOUR application
• Gives you more control over your enrollment information, including reassignments
• Easy to check and update your information for accuracy
• Less staff time and administrative costs to complete and submit enrollment to Medicare
Using Internet-based PECOS Is Easy!
Before initiating an enrollment action using Internet-based PECOS, you should review the applicable "Basics of Internet-based Provider Enrollment, Chain and Ownership System (PECOS)" Fact Sheet(s) listed in the Downloads and Links section below.
Individual Physicians and Non-Physician Practitioners
Physicians and non-physician practitioners may access Internet-based PECOS by using the User IDs and passwords that they established when they applied on-line to the National Plan and Provider Enumeration System (NPPES) for their National Provider Identifiers (NPIs). If they did not establish User IDs and passwords at that time (for example, they may have submitted paper NPI applications to the NPI Enumerator and had no reason to establish User IDs and passwords), they may do so now by going to the NPPES hyperlink listed below and following the directions on the screens. If they have forgotten their User IDs or passwords, or otherwise need assistance in this regard, they may contact the NPI Enumerator at 1-800-465-3203 or customerservice@npienumerator.com.
1. Log onto Internet-based PECOS with your NPPES User ID and password.
Click on "PECOS" in the "Related Links Outside CMS" section below.
2. Complete, review, and submit an electronic enrollment application.
Internet-based PECOS will walk you through the application process and supply you with a 2-page Certification Statement for each enrollment application you submit.
Click on "PECOS" in the "Related Links Outside CMS" section below.
2. Complete, review, and submit an electronic enrollment application.
Internet-based PECOS will walk you through the application process and supply you with a 2-page Certification Statement for each enrollment application you submit.
3. Mail the original signed Certification Statement from Internet-based PECOS and supporting documents to the Medicare contractor within 7 days of your electronic submission.
The effective date of filing an enrollment application is the date the Medicare contractor receives the signed and dated (blue ink recommended) Certification Statement. Note: A Medicare contractor will not process an Internet enrollment application without the signed and dated
The effective date of filing an enrollment application is the date the Medicare contractor receives the signed and dated (blue ink recommended) Certification Statement. Note: A Medicare contractor will not process an Internet enrollment application without the signed and dated
Certification Statement.
Organizational Providers and Suppliers
Obtaining access to Internet-based PECOS by organizational providers and suppliers (e.g., professional associations, professional corporations, limited liability corporations) involves several steps, and the first step must be taken by the Authorized Official (AO) of the DMEPOS supplier.
2011 CPT updates in interventional cardiology
33620 Application of right and left pulmonary artery bands (eg, hybrid approach stage 1)
33621 Transthoracic insertion of catheter for stent placement with catheter removal and closure (eg, hybrid approach stage 1)
33622 Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2, Norwood, bidirectional Glenn, pulmonary artery debanding)
37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
37221 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
37223 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty
37225 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty
37229 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
37230 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
37231 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
37232 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
37233 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
37234 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
37235 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
Workflow process in Medical Billing
The following details provides the workflow of Medical billing process.
1. The doctor sees the patient. After seen the patient, Dr front office person send the all information pertaining to the patient which includes Patient Demographics (Face sheet), super bills/charge sheets, insurance verification data and a copy of the insurance card to Indian Billing office via FTP/fax .
2. In Billing office, Scanning department retrieves the files and prints them and ties up with the control log for number of files and pages.
4. Illegible /missing documents are identified and a mail is sent to the Billing office for rescanning.
6. Coding and pre-coding of the super bill/charge sheet and demographics for insurance, doctors, modifiers, CPT and diagnosis are done wherever required.
7. The claims data entry operator creates a charge, according to the billing rules pertaining to the specific carriers and locations .All charges are accomplished within the agreed turnaround time with the client.
8. Charges are verified by audit department for accuracy and compliance with rules.
9. Claims are filed and information sent to the Transmission department.
10. Transmission department prepares a list of claims that go out on paper and through the electronic media. Once claims are transmitted electronically, confirmation reports are obtained from clearing house and filed after verification. Paper claims are printed and attachments done if required and put into envelopes and sent to the US for postage and mailing.
11. Clearing house transmission rejections/errors are analyzed and take corrective action and again transmit the claims to clearing house
12. Once recieve the EOB( Expalnation of Benefits-Payments), Cash applied team receives the cash files and post the payment in the respective accounts. This would helps to reconcile the deposits at the end of each month. while psoting the EOBS, Overpayments are immediately identified and sene the information to Dr office to refund the amount into the respective insurances.
13. All rejected/denied claims, research the reason for denial with remark codes in the EOB’s or Explanation of Benefits received and take appropriate action to resolving the issue.
14. AR analysts are the key to any group. They record the processing time of each insurance companies and identify all claims falling above the processing time. Then the claims are researched for completeness and accuracy and insurance carriers are called if required. AR analysts are responsible for the cash collection and resolving all problems to enable the account to have clean AR.
15. Insurance Calling team, calls to the insurance companies to identify the reasons for non-payment of the claims.Calling details are passed on to the AR Analysts for resolution. Calling team works during the American Time zones.
16. Patient calling team calls up the patients to confirm receipt of bill and when they are going to pay. Based on client’s approvals budget plans and discounts for immediate payments are also undertaken.
Medical billing
Medical billing involves preparation of medical bills on behalf of the doctor for the treatments performed on the patients. The work also involves sending the medical bills to the respective insurance company with whom the patient is a beneficiary.
Saturday 26 March 2011
Medicare common denials
Denial Code (Remarks): PR 1
Denial reason: Deductible amount
Denial Action: Billed to secondary insurance/patient
Denial reason: Deductible amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): PR 2
Denial reason: Coinsurance amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): PR 3
Denial reason: Copay amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): CO 4
Denial reason: The procedure code is inconsistent with the modifier used or a required modifier is missing.
Denial Action: Use appropriate modifier with respective of procedure
Denial Code (Remarks): CO 5
Denial reason: The procedure code/bill type is inconsistent with the place of service.
Denial Action: Correct the Place of service or correct the procedure with respect of place of service.
Denial Code (Remarks): CO 6
Denial reason: The procedure/revenue code is inconsistent with the patient's age.
Denial Action: Correct the procedure code with respect of patient's age
Denial Code (Remarks): CO 7
Denial reason: The procedure/revenue code is inconsistent with the patient's gender.
Denial Action: Correct the procedure code with respect of patient's gender (Sex-Male/Female)
Denial Code (Remarks): CO 9
Denial reason: The diagnosis is inconsistent with the patient's age.
Denial Action: : Correct the diagnosis code with respect of patient's age
Denial Code (Remarks): CO 10
Denial reason:The diagnosis is inconsistent with the patient's gender.
Denial Action: : Correct the diagnosis code with respect of patient's gender (Sex-Male/Female)
Denial Code (Remarks): CO 11
Denial reason: The diagnosis is inconsistent with the procedure.
Denial Action: : Correct the diagnosis code.
Denial Code (Remarks): CO 13
Denial reason: The date of death precedes the date of service.
Denial Action: : Correct the Date of service
Denial Code (Remarks): CO 14
Denial reason: The date of birth follows the date of service.
Denial Action: : Correct the Date of service
Denial Code (Remarks): CO 15
Denial reason: Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.
Denial Action: : Submit the claims with Authorization number or valid authorization
Denial Code (Remarks): CO 16
Denial reason: Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)
Denial Action: : Check with other remark codes started as N/M and correct the claims
Denial Code (Remarks): PR 1
Denial reason: Deductible amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): PR 2
Denial reason: Coinsurance amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): PR 3
Denial reason: Copay amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): CO 4
Denial reason: The procedure code is inconsistent with the modifier used or a required modifier is missing.
Denial Action: Use appropriate modifier with respective of procedure
Denial Code (Remarks): CO 5
Denial reason: The procedure code/bill type is inconsistent with the place of service.
Denial Action: Correct the Place of service or correct the procedure with respect of place of service.
Denial Code (Remarks): CO 6
Denial reason: The procedure/revenue code is inconsistent with the patient's age.
Denial Action: Correct the procedure code with respect of patient's age
Denial Code (Remarks): CO 7
Denial reason: The procedure/revenue code is inconsistent with the patient's gender.
Denial Action: Correct the procedure code with respect of patient's gender (Sex-Male/Female)
Denial Code (Remarks): CO 9
Denial reason: The diagnosis is inconsistent with the patient's age.
Denial Action: : Correct the diagnosis code with respect of patient's age
Denial Code (Remarks): CO 10
Denial reason:The diagnosis is inconsistent with the patient's gender.
Denial Action: : Correct the diagnosis code with respect of patient's gender (Sex-Male/Female)
Denial Code (Remarks): CO 11
Denial reason: The diagnosis is inconsistent with the procedure.
Denial Action: : Correct the diagnosis code.
Denial Code (Remarks): CO 13
Denial reason: The date of death precedes the date of service.
Denial Action: : Correct the Date of service
Denial Code (Remarks): CO 14
Denial reason: The date of birth follows the date of service.
Denial Action: : Correct the Date of service
Denial Code (Remarks): CO 15
Denial reason: Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.
Denial Action: : Submit the claims with Authorization number or valid authorization
Denial Code (Remarks): CO 18
Denial reason: Duplicate claim/service.
Denial Action: : Check with other remark codes started as N/M and correct the claims
Denial Code (Remarks): CO 22
Denial reason: Payment adjusted because this care may be covered by another payer per coordination of benefits.
Denial Action: : Submit the claims to other health care insurance.
Denial Code (Remarks): CO 24
Denial reason: Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.
Denial Action: : Submit the claims to other health care insurance.
Denial Code (Remarks): PR 26
Denial reason: Expenses incurred prior to coverage.
Denial Action: : Bill to patient.
Denial Code (Remarks): PR 27
Denial reason: Expenses incurred after coverage terminated.
Denial Action: : Bill to patient.
Denial Code (Remarks): CO 29
Denial reason: The time limit for filing has expired.
Denial Action: : Appeal the claim with the proof of clearing house reports.
Denial Code (Remarks): PR 31
Denial reason: Claim denied as patient cannot be identified as our insured.
Denial Action: : Correct the patient name, DOB and Policy number
Denial Code (Remarks): CO 45
Denial reason: Charges exceed your contracted/ legislated fee arrangement. This change to be effective 6/1/07: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability).
Denial Action: : Take write off
Denial Code (Remarks): CO 50
Denial reason: These are non-covered services because this is not deemed a `medical necessity' by the payer.
Denial Action: : Check the Diagnosis codes
Denial Code (Remarks): CO 58
Denial reason: Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.
Denial Action: : Correct the place of service.
Denial Code (Remarks): CO 96
Denial reason: Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)
Denial Action: : Correct the diagnosis codes
Denial Code (Remarks): CO 97
Denial reason:Payment adjusted because the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated
Denial Action: : submit the claims with appropriate modifier
Denial Code (Remarks): OA 100
Denial reason:Payment made to patient/insured/responsible party
Denial Action: : Payment made to patient by medicare. So bill to patient for collect the payment.
Denial Code (Remarks): OA 109
Denial reason: Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
Denial Action: : Check whether it is RR medicare/DMERC and submit the claims to appropriate carrier
Denial Code (Remarks): PR 140
Denial reason: Patient/Insured health identification number and name do not match.
Denial Action: : Correct the plicy number/patient name and submit the claims.
Denial Code (Remarks): CO 167
Denial reason: This (these) diagnosis(es) is (are) not covered.
Denial Action: : Submit the claims with correct diagnosis codes
Denial Code (Remarks): CR 181
Denial reason: Payment adjusted because this procedure code was invalid on the date of service
Denial Action: : Submit the claims with Valid CPT
Denial Code (Remarks): CR 182
Denial reason: Payment adjusted because the procedure modifier was invalid on the date of service
Denial Action: : Submit the claims with Valid modifier
Denial Code (Remarks): CO B10
Denial reason:t Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
Denial Action: : Always payment has been reduced for multiple procedure. While submitting the multiple procedure, submit the high amount line item in first.
Denial Code (Remarks): OA B13
Denial reason:t Previously paid. Payment for this claim/service may have been provided in a previous payment.
Denial Action: : Claim has been already paid, Check with EOB
Denial Code (Remarks): CO B14
Denial reason:t Payment denied because only one visit or consultation per physician per day is covered.
Denial Action: : Take write off for duplicate claim or check the DOS and submit the claims
Denial Code (Remarks): CO B16
Denial reason:t Payment adjusted because `New Patient' qualifications were not met.
Denial Action: : Submit the claims with established patient visit
Denial Code (Remarks): PR B9
Denial reason:t Services not covered because the patient is enrolled in a Hospice.
Denial Action: : Submit the claims with GV modifier
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