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Reimbursement issue regarding 26145 and exceeding the MEU of 6 by 3 units.
Scenario:
Provider bills 26145 x 9, exceeding the MUEs by 3 and states in the Op report that a "copious amount of hypertrophic tenosynovium was noted on the nine flexor tendons in the palm and a careful and sharp tenosynovectmoy of the nine tendons in the palm was then performed," would this statement satisfy MAI 3 requirement?
If so, why?
if not, why not?
if I could get a link to support either decision, this would be extremely helpful.
Thank you!
Appropriate sharing of records for patients with substance abuse disorders should be easier under a second final rule issued January 3 by HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA). But in some cases, the new rule adds considerations that might mitigate the advantage.
The CGS Medicare Jurisdiction C Supplier Manual states "ABNs are not required for care that is either statutorily excluded from coverage under Medicare (i.e. care that is never covered) or most care that fails to meet a technical benefit requirement (i.e. lacks required certification)." This leads me to believe that an ABN is not required in this situation, since CPMs are never covered if there has not been a TKR/TKA.
Is my thinking correct? Previously we have been obtaining the ABN and billing Medicare for the denial, which drags out the billing process. My manager is of the belief that it is required, and the language in the Supplier manual is not particularly clear.
Thanks for any help!
I was taking the AAPC module that I purchased: Specialty Practice Exam COSC
And on Case 20 it goes over a basic office visit for knee pain. All that is done is an e/m and an x-ray, 73562.
Question three asks if a modifier should be appended. I chose no, which it says is incorrect, the rational being:
The provider performs an E/M and radiology service. According to NCCI policy, when a provider performs a significant and separately identifiable E/M service with a procedure with XXX global days, append modifier 25 to the E/M service.
I am so confused. I have never used modifier 25 on an OV for just a knee xray since the xray has no gobal?
I would have gotten this wrong on the exam… Can anyone explain why this is correct?
I understand using it in cases with minor procedues like 20610 but an xray??