General
The following FAQs were retired in July 2008.
- Who can perform wound care negative pressure services, can a nurse? HCPCS codes 97605/97606
- What if the patient receives intermittent therapy Part B services after Part A occurrence code 22, will Part B 22X TOB claims still process
- Are remarks still required on no-pay and benefits exhaust claims in order to be processed?
- When we bill for outpatient hospital clinic visits for our facility we have difficulty finding an evaluation and management (E&M) code that accurately defines the services that we provided.
- Since the existing E&M codes do not fit the services we provide in our clinic and emergency room, does it really matter how we code E&M's?
- What is the home blood glucose monitor?
- Does the order of the ICD-9 codes on the UB-92 impact payment of the claim regarding the LCD Coverage?
Who can perform wound care negative pressure services, can a nurse? HCPCS codes 97605/97606
HCPCS codes 97605 and 97606 fall under CPT code section of physical medicine and rehabilitation. Active wound care management may be performed by therapists and non-therapists when permitted by the scope of practice requirements of each state. When performed by therapist, bill with appropriate modifier, GP, GO, GN in addition a therapy revenue code must be submitted (i.e., 420, 430, 440). When performed by a non-therapist no modifiers are used and a non-therapy revenue code must be submitted. A nurse cannot work off of a therapists plan of care. If a nurse is providing the wound care in the therapy department, the same billing criteria as indicated above is applied. Meaning a non-therapy revenue code is used without a therapy modifier.
Please refer to Local Coverage Determine S-144D Wound Care.
Date Posted: 10/04/2007, Date Reviewed/Revised: 07/03/2008
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CMS release MLN 5220 dated 07/28/2006, which state Medicare systems shall bypass line item service reported on a 22x bill types from the SNF CB therapy edit when the dates of service fall within reported non-covered periods on overlapping SNF 21x bill types.
Date Posted: 10/03/2006, Date Reviewed/Revised: 07/03/2008
Are remarks still required on no-pay and benefits exhaust claims in order to be processed?
Remarks are required on a "no payment bill", but are not required on a benefits exhaust claim.
Date Posted: 10/03/2006, Date Reviewed/Revised: 07/03/2008
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Facilities code clinic and emergency department visits using the same (Physicians') Current Procedural Terminology (CPT) codes as physicians. Because these codes were defined to relect only the activities of physicians, they are inadequate to describe the range and mix of services provided to patients in the clinic and emergency department settings (for example, ongoing nursing care, preparation for diagnostic tests, and patient educaton.) However, providers are instructed to code using the appropriate level of intensity based on their own internal assessment of the charges for these codes.
Date Posted: 10/11/2005, Date Reviewed/Revised: 07/02/2008
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Yes, Each facility is responsible for cross-walking the level of service provided to the most applicable E&M code.
Date Posted: 10/11/2005, Date Reviewed/Revised: 07/02/2008
What is the home blood glucose monitor?
The blood glucose monitor is a meter device that reads color changes produced on specialty treatment re-agent strips by glucose concentrations in the patient' blood. Glucose monitoring measures blood sugar levels for the purpose of managing insulin therapy, medication anad diet. This device is frequently utilized in a SNF.
Date Posted: 05/04/2005, Date Reviewed/Revised: 07/03/2008
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There are certain edits based on primary diagnosis but claim specific inquiries should be referred to CORE/Policy Support staff since they set up the edits.
Date Posted: 04/04/2007, Date Reviewed/Revised: 07/03/2008