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You can rest assured that when you break procedure codes into groups, it’s easier to compare and apply proper codes. Sleep medicine is a sub-specialty of neurology, which can seem very daunting to coders and physicians due to technicalities in the guidelines and procedure code descriptions. The good news is that code selection is simple […]
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Obstructive sleep apnea causes those who suffer from it to sleep poorly and always feel tired. Obstructive sleep apnea is also indicative for heart problems and complications. It is not a good idea to ignore obstructive sleep apnea and the potential problems that it may be causing to one’s body. Inspire Medical System’s Inspire® therapy […]
The post Getting Inspire Therapy for Sleep Apnea Covered appeared first on AAPC Knowledge Center.
UnitedHealthcare, one of nation’s leading health plans, will provide coverage for Inspire, Inc.’s novel obstructive sleep apnea (OSA) therapy starting in August. This determination comes almost one year to the day after Aetna agreed to cover Inspire’s neurostimulation device. And over the past year, BlueCross BlueShield joined the movement and is now offering several plans […]
The post Innovative Obstructive Sleep Apnea Therapy Coverage Expands appeared first on AAPC Knowledge Center.
Pulm picks up report and does interpretation 95800 with Mod -26
But, if Total Recording Time (TRT) is less than 6 hours, Pulm also adds a Mod -52 for reduced services.
The question remains if Cardio needs to add Mod -52 to their charges even if their work was done when handing off equipment.
We cannot find definite answer to this and want to bill correctly.
Has anyone ever encountered billing for a HST when the patient is in a SNF. We are a private group practice and not sure if we could bill this and be reimbursed. The insurance is Medicare.
Any advice would be greatly appreciated. We typically bill 95806 with POS 12.
Thank you,
Michelle
Any thoughts or suggestions are much appreciated!
Please let me know your thoughts, and if you have any references please include those too. I’ve been searching, but need a little more help.
Thanks – Kathleen
Procedure Codes: D-9941 or L-8048/L-8043 (Unspecified Maxillofacial
Prosthesis provided by non-physician.)
Or K-0183 (Nasal applicator device used with CPAP.
CPT 21085- Complete Oral Appliance Therapy
CPT 21110- Used for all Oral Appliances, patient is responsible for
obtaining authorization prior to payment or receiving appliance.
AND
HCPC INSURANCE CODE:
21089 or 5999 Unlisted Maxillofacial Prosthetic Procedure
S8260 Oral Orthotic for treatment of sleep apnea,
Includes fitting, fabrication, and materials
S8262 Mandibular orthopedic repositioning device
E0485 Oral device/appliance used to reduce upper airway collapsibility, adjustable
or non-adjustable, prefabricated, includes fitting and adjustment
E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable
or non-adjustable, custom fabricated, includes fitting and adjustment
Have any of you used these codes successfully? Do the insurance carriers reimburse ENT for the DME related to this service? Any obstacles you are encountering on a regular basis?
The lab is not affiliated with a hospital, but it is under the direction and control of a physician. Is this a case of the POS being wrong, or should the AR department prepare standard documentation and be ready to file lots of appeals?
One of the main questions we have is if the technical component is performed at place of service 22, and the provider reads/interprets the report in their own office, is the professional component place of service 11, or the same as the TC and is 22?
Any help with guidelines would be greatly appreciated. Thanks!
-Cathy