Billing - General Questions
Highmark Medicare Services continues to review and update the ESRD module as appropriate. Certain ICD-9-CM codes are listed as medical justification for services not covered under the composite rate or services that exceed frequency limits for ESRD claims. Justification requirements are based on medical necessity.
- What lab tests are affected?
- Can you provide more information about the ICD-9-CM code updates for aluminum?
- Can you provide more information about the ICD-9 CM code changes for magnesium?
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Lab tests that are affected are Magnesium—HCPC 83735 and Aluminum—HCPC 82108
Date Posted: 06/23/2004, Date Reviewed/Revised: 06/25/2008
Can you provide more information about the ICD-9-CM code updates for aluminum?
The ESRD module is updated when the HCPC and ICD-9 CM codes are updated per CMS. The updated codes justify payment for reasonable and necessary services. Documentation in the medical record must support the diagnoses on the claim, the signs and symptoms of abnormality and necessary treatment based on the lab results. See Medicare Benefit Manual, Pub 100-2, Chapter 11 ESRD, Section 30.2.1.
Date Posted: 06/23/2004, Date Reviewed/Revised: 06/25/2008
Can you provide more information about the ICD-9 CM code changes for magnesium?
The ESRD module is updated when the HCPC and ICD-9 CM codes are updated per CMS. The updated codes justify payment for reasonable and necessary services. Documentation in the medical record must support the diagnoses on the claim, the signs and symptoms of abnormality and necessary treatment based on the lab results. See Medicare Benefit Manual, Pub 100-2, Chapter 11 ESRD, Section 30.2.1.
Date Posted: 06/23/2004, Date Reviewed/Revised: 06/25/2008