Search Result - JF Part B

Q1. Will the 'Q' codes continue to be used when billing 11056 and 11721 or will they also change under ICD 10?

Also, will any of the modifiers be changed with ICD 10?

A1. The Q codes will continue to be used when billing 11056 and 11721. ICD-10 changes the diagnosis requirements and not the modifiers.

Q2. Multiple intravitreal injections (67028) are done the same day due to treatment for endophthalmitis, usually with three different medications. The medication is drawn under sterile conditions into three separate syringes with the appropriate dosage.  The patient does get three separate injections into the eye.  In the past used the 59 modifier to differentiate each additional injection; with the new X modifiers, is the XU modifier appropriate?  In addition, if it is the patient's first visit, a paracentesis (67015) would be done to withdraw fluid for pathology so the patient gets four separate sticks into the eye...one for the fluid withdrawal and three for the medication injections.  Would the 67028 still be bundled in this case under 67015 or could we also use the XU modifier when billing in conjunctions with 67015?

A2. The XU modifier wouldn't be used. Because the 67028 is bundled into the 67015, the -59 would be appropriate to indicate that these were separate medically necessary services. Medicare would generally expect only one 67028 billed per date of service; in the rare circumstance that additional services are medically necessary and correctly coded as separate injections, you would use the -5976, but payment may require consideration at appeals.  The procedure has a fee schedule indicator of 2 (multiple procedure) so multiple lines will be reduced by the system.

Q3. Per 1995 exam guidelines, if a provider documents an exam element as, "Mouth-no lesions, oral mucosa is pink and moist"- does this support the exam system for ear, nose, mouth and throat (ENMT)? Does the documentation have to address all 4 areas to support the ENMT system?

A3. Yes, the above statement would support an exam item for ENMT. Not all four must be addressed, only those areas that are medically necessary. Assuming this aspect of the exam is appropriate.

Q4. If the provider is unable to obtain, past/family/social history (PFSH), from the patient, i.e. patient intubated, and there is no family member that can be reached. Can the provider document the reason they are unable to obtain the PFSH and that statement give them credit.

A4. Yes, this information is in the 95/97 evaluation and management guidelines.

Q5. What is the status on allowing the low dose CT lung cancer screening?

A5. The MACs have not received any coding instructions to allow this service. CMS did give S8032 but this code is not valid for Medicare.

Q6. When billing for Q9975 (Elocate) only 1 unit is being paid even though total units are entered.  It appears that Q9975 has not been added to the anti-hemophilic factor product edit.  How should one bill for multiple units?

A6. Q9975 was not set up to manually price so it wasn't looking at the number of units being billed. The system has been updated and claims should start paying correctly.

Q7. What is meant by a family of codes?

A7. CMS defines "Family of codes" is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved.

Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters. One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

Q8.Will the system be updated to except CPT code 96450 when billed without the drug in place of service inpatient (21) or outpatient (22)?

A8. The system will be update to allow: CPT 96440, 96446, 96450 and 96542 when billed without the drug, only in POS 21, 22 or 24.

Q9. We bill 88305 with modifier 91 and sometimes they are denied. Are we using the correct modifier?

A9. Procedure code 88305 may be denying because of Medically Unlikely Edits (MUE). This code is an unlisted code in the MUE. The procedure code is listed on the physician's fee schedule, so modifier 76 should be used instead of modifier 92.

Q10. Does the KX modifier need to be added to the supply code on permanent pacemaker claims?

A10. Yes, refer to Change Request 9078.